Soybean isoflavone (SIF) is a type of polyphenol present extensively in legumes. Because of its unique chemical construction and the physiological activity of the phenolic hydroxyl group, SIF exhibits strong antioxidant activi- ty in antioxidant and nonantioxidant enzyme systems. Genistein is the major isoflavone in soy foods, accounting for more than 50% of the isoflavone content. The health effects of soybean dietary isoflavones on humans have gained increased attention. Recent studies have suggested that SIF may alleviate neurodegenerative diseases such as Alzheimer’s disease (AD). Despite the comprehensive research on AD, effective treatments for AD are yet to be established. The early diagnosis and prevention of mild cognitive impairment (MCI) have become crucial for delaying AD development. Several dietary polyphenols have exerted cognitive effects on AD, and the appropriate intake of dietary SIF helps reduce the risk of AD. This study reviews the possible mechanisms of AD pathogene- sis and their relationships with SIF intake; the results provide useful insights for AD prevention in the future.
Background and Objectives: To investigate the prolonged effects of a 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism. Methods and Study Design: A total of 180 participants were randomly divided into an intervention group (n=94), and a control group (n=86). An exercise- plus-diet intervention was conducted on the intervention group for 12 months. The effects were evaluated by questionnaire, physical examinations, and blood tests at baseline, 3 months, 12 months (the end of intervention), and 24 months (one year after the end of intervention). The control group took only the same examinations as the intervention group. Results: At the end of the 12-month intervention, body weight, waist circumference, fasting glucose, HbA1c, triglycerides, and LDL-cholesterol were improved in the intervention group compared to the control group (all p<0.05). One year after the end of the intervention, body weight, waist circumference, fasting glucose, triglycerides, and LDL-cholesterol were still decreased in the intervention group compared to the control group (all p<0.05), especially among non-overweight participants. Among overweight persons, only body weight in the intervention group was lower than the control group. The personal behaviours of physical activity and diet in the intervention group were also improved. Conclusions: The 12-month exercise-plus-diet programs were found to be effective in improving glucose and lipid metabolism, as well as personal behaviour one year after completion of the intervention.
Background and Objectives: The elderly population is increasing rapidly worldwide, and frailty is a common geriatric syndrome. Comprehensive dietary management strategies may have beneficial effects on frailty preven- tion and reversal. This 3-month single-blind, paralleled, randomized controlled trial compared the effects of mi- cronutrients and/or protein supplements, and a personalised diet on frailty status in elderly individuals. Methods and Study Design: Between 2014 and 2015, 40 prefrail or frail subjects aged ≥65 years were recruited at Miaoli General Hospital, Taiwan. Of these, 37 completed the study, and 36 were included in the analysis. Participants were randomly assigned to one of four treatment groups: (1) the control (2) multiple micronutrient supplements, (3) multiple micronutrients plus isolated soy protein supplement, and (4) individualised nutrition education with customised dishware and food supplements (mixed nuts and skimmed milk powder). Dietary intake, protein bi- omarkers, frailty score, and geriatric depression score were assessed. Results: Individualised nutrition education with customised dishware and food supplements significantly increased the participants’ intake of vegetables, dairy, and nuts, in addition to increasing the concentration of urinary urea nitrogen. It yielded a significant reduc- tion in frailty score (p<0.05) and a borderline reduction (p=0.063) in geriatric depression score. No significant beneficial changes were observed for the other two intervention groups. Conclusions: Our study indicated that a dietary approach with easy-to-comprehend dishware and food supplements to optimize the distribution of the consumption of six food groups improved frailty status and, potentially, psychological well-being in elderly peo- ple.
Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is related to inflammation and oxida- tive stress. Probiotics and prebiotics are considered anti-inflammatory and antioxidative factors. In this study, we evaluated the effects of probiotic and/or prebiotic on oxidative stress and inflammatory markers in patients with NAFLD. Methods and Study Design: Seventy-five NAFLD subjects were divided into four groups. The first group received a pro-biotic capsule of Bifidobacterium longum (B.L) and Lactobacillus acidophilus (L.A) (2 × 107 CFU/day), the second group received prebiotic (10g/day inulin), the third group received pro-biotic and prebiotic, and the fourth group received placebo, for three months. Anthropometric, inflammatory and oxida- tive/anti-oxidative indices were measured in all patients before and after the intervention. Results: We showed that consumption of pro- and/or prebiotic compared to placebo is able to significantly decrease body weight, body mass index, waist and hip circumferences, tumour necrosis factor-α and increase serum levels of total antioxidant capacity in patients with NAFLD (p<0.01). There were not any significant differences between probiotic, prebi- otic and co-administration of them on the mentioned parameters. Co-administration of pro- and prebiotic caused significant decrease of high-sensitive C-reactive protein (hs-CRP) compared to the placebo and other groups (p<0.01). Interlekin-6 and malondialdehyde were not significantly different among groups at the end of study. Conclusions: Probiotic or/and prebiotic supplementation can be effective for improvement of some anthropomet- ric, inflammatory and oxidative indices in patients with NAFLD. Co-administration of pro- and prebiotic is more effective than probiotic and prebiotic alone in modifying hs-CRP in patients with NAFLD.
Background and Objectives: This study investigated the updated prevalence of metabolic syndrome among adults in West China and the influence of diet and behaviour on metabolic syndrome. Methods and Study De- sign: A cross-sectional survey was conducted from 2013-2014, and multi-stage stratified clustering sampling was applied in 12 counties of Sichuan province. Data regarding metabolic syndrome and style risk factors were col- lected through interviewer-administered questionnaires, and physical measurements were recorded following a standardized protocol. Logistic regression models were used to explore the association between metabolic syn- drome and its risk factors. Results: A total of 7,131 adults participated. The prevalence of metabolic syndrome was 16.9% and 23.8% according to the International Diabetes Federation criteria and the consensus definition, re- spectively. The International Diabetes Federation criteria failed to identify 28.8% of the participants identified by the consensus definition. The odds ratios (ORs) of suffering from Metabolic syndrome in people eating pork eve- ry week compared with at lower frequencies, people eating more than 100 g of red meat/day, people with more sedentary behaviour per day, and people consuming at least 20 cigarettes/day were 1.76 (1.09-2.84), 1.28 (1.01- 1.62), 1.03 (0.99-1.07), and 1.46 (1.12-1.92), respectively, according to the consensus definition, and 1.51 (1.09- 2.10), 1.4 (1.14-1.72), 1.07 (1.02-1.13), and 1.5 (1.16-1.94), respectively, based on the International Diabetes Federation criteria. Conclusions: The International Diabetes Federation criteria were less sensitive in identifying metabolic syndrome than the consensus definition. More sedentary behaviour, smoking ≥20 cigarettes per day, and a higher frequency of pork intake increased the risk of metabolic syndrome in this study.
Background and Objectives: Little is known about the association between dietary patterns and cardiovascular disease risk factors among Japanese adults based on nationally representative data. This study aimed to explore the association between dietary patterns and hypertension or blood lipid profiles among Japanese people. Meth- ods and Study Design: De-identified Japan National Health and Nutrition Survey (NHNS) 2012 data with a total of 8721 subjects (3524 men and 5197 women) aged 40-74 years were used. Dietary patterns were derived by principal component analysis (PCA). Generalized linear models and multivariate logistic regression analysis were used to assess the relationship between dietary patterns and blood pressure or lipid profiles. Results: We identi- fied four dietary patterns: (a) traditional Japanese, (b) bread-dairy, (c) meat-fat, and (d) noodle patterns. Among these, the traditional Japanese pattern was significantly related to lower blood pressure, lower low-density lipo- protein (LDL)-cholesterol in men and lower high-density lipoprotein (HDL)-cholesterol in women. Bread-dairy pattern was associated with high total cholesterol in women and higher LDL cholesterol in both men and women. Noodle pattern was associated with higher total cholesterol and HDL-cholesterol in men. No significant associa- tion was observed between meat-fat pattern and blood pressure or lipid profiles. Conclusions: Our study showed that the traditional Japanese pattern with high intake of miso, soy-sauce, vegetables, beans, potatoes and mush- room conferred benefits on blood pressure. Our findings have indicated clearly that it is possible to provide useful information on healthy dietary pattern for health promotion from the one-day dietary records of the NHNS.
Background and Objectives: Hemodialysis patients are at risk for bone loss and sarcopenia, characterized by reduced muscle mass and limited mobility/function. Osteoporosis and sarcopenia both increase the risk of hospi- talization and death in affected individuals. Malnutrition also occurs as a complication of hemodialysis and has been identified as a risk factor for osteoporosis and sarcopenia. In this study, we examined the relationship be- tween osteoporosis, muscle volume, walking ability, and malnutrition in hemodialysis patients. Methods and Study Design: Forty-five hemodialysis patients were evaluated. Bone mineral density (BMD) and muscle vol- ume were measured by dual-energy X-ray absorptiometry. Muscle volume and strength were evaluated using lean mass index (LMI), handgrip strength, and walking ability. The time required for a patient to walk 10 meters was measured to evaluate walking ability. The geriatric nutritional risk index (GNRI) was used to assess malnutrition. Results: Multiple linear regression analysis showed that older age, female sex, lower LMI, and higher total type I procollagen N-terminal propeptide were correlated with lower BMD of lumbar spine. Higher age and lower LMI were correlated with lower BMD of the femoral neck. Female sex and lower GNRI were correlated with lower LMI. Longer duration of hemodialysis was correlated with lower walking ability. Conclusions: Our findings suggest that muscle preservation is required to maintain both lumbar spine and femoral neck BMD. Similarly, nu- tritional management is necessary to maintain BMD via preservation of muscle volume. Complementary nutri- tional therapies are needed to improve osteoporosis and sarcopenia in high-risk hemodialysis patients.
Background and Objectives: Obesity is linked to metabolic diseases characterized by insulin resistance, such as diabetes and cardiovascular disease. In this study, we investigated the metabolic disorders of uncomplicated obe- sity to identify early alterations in biological systems. Methods and Study Design: Metabolic differences be- tween overweight/obese (n=36) and normal-weight (n=35) young Chinese men without known metabolic disor- ders were assessed. Metabolic profiling of the serum and urine was performed using ultra-performance liquid- chromatography quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS). Partial least squares discri- minant analysis (PLS-DA) was undertaken to reveal and classify the differences between the two groups. Results: Compared to normal-weight men, obese men had higher levels of the serum metabolites phenylalanine, Phe-Phe, and L-tryptophan, whereas those of p-cresol sulfate and p-cresol were less in obesity. Urinary metabolites phe- nylacetamide, L-glutamine, phenylacetylglutamine, indoxyl sulfate, p-cresol, and p-cresol sulfate were greater in obese men. Conclusions: These findings indicate that disorders involving aromatic amino acids and the tricar- boxylic acid cycle (TCA) have microbiomic involvement in the uncomplicated phase of obesity.
Background and Objectives: Indians are more prone to develop diabetes at a younger age, with normal BMI, and this might partly be due to their higher body fat content. Increase in fat mass in the body might be because of the reduction in fat oxidizing capability. Given the fact that Indians consume high carbohydrate diets, effective fat oxidation is likely to be delayed. Simple preventive weight loss strategies like exercise or change in diet regimen are needed to reduce their body fat. This study investigated the effect of exercise with a high protein dinner on overnight thermogenesis and fat oxidation. Methods and Study Design: Nine healthy normal subjects aged 18 – 30 years participated in randomised cross over study. They underwent 6 sessions of overnight whole body indi- rect calorimetry on separate nights with the following experimental conditions: (i) standard (habitual) meal (ii) standard meal with exercise (iii) 20% protein meal (iv) 20% protein meal with exercise (v) 50% protein meal and (vi) 50% protein meal with exercise. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured overnight, from which energy expenditure, non-protein respiratory quotient (RQ), and fat oxidation were estimated. Results: The estimated marginal means of fat oxidation and energy expenditure were significant- ly different for protocols with exercise compared to those without exercise (p=0.02). There was no acute effect of protein on nocturnal fat or carbohydrate oxidation, with or without exercise. Conclusions: Post-dinner exercise increase nocturnal fat oxidation and energy expenditure in young active Indian men.
Background and Objectives: The failure of infants in developing countries to meet nutrient intake recommenda- tions is well documented. The objective of this study was to assess the nutritional adequacy and identify problem nutrients of the diets of Guatemalan infants with continued breastfeeding. Methods and Study Design: A single previous-day dietary recall was collected from a convenience sample of 94 mothers of infants aged 6-11 mo at- tending a public health clinic in the urban area of Quetzaltenango, Guatemala. Energy and nutrient content of complementary feeding (CF) and breastmilk, modelled by subtracting estimated energy intakes from CF from en- ergy requirements, were calculated and nutrient adequacy of the diet was assessed. Nutrient densities and critical nutrient densities of CF were computed to identify “problem nutrients” and main food sources of these nutrients. Results: Complementary diets were adequate for protein, but likely to be inadequate for pantothenic acid and vit- amins C, A, D, E, and K, as well as calcium, iron and zinc. In the worst-case scenario, i.e. for small girls with limited energy allowances, riboflavin, niacin, vitamin B-6 and magnesium were identified as “problem nutrients” as well. Formula milk, cow milk and Incaparina® were main food sources of “problem nutrients”. Conclusions: The intake of micronutrients during the first six months of the recommend CF period in Guatemala has a number of notable inadequacies, but the gaps are narrower than traditionally reported for this age group in low-income settings.
Background and Objectives: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. Methods and Study Design: A cross-sectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical exami- nation, blood hemoglobin measurements and a 24 hour dietary recall questionnaire Results: The educational lev- el of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient defi- ciencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6-11 and 12-23 month old children. 3.) An increased risk of overweight/obesity. Conclusions: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further im- provements in the diet and nutrition of young children in these environments is likely require more specific edu- cation to parents and other significant carers such as grandparents. The relatively high educational level and so- cio-economic status of the population group is likely to facilitate the uptake of such measures in this population group.
Background and Objectives: Malnutrition is prevalent amongst people with head and neck cancer treated with radiotherapy and can result in reduced tolerance to treatment and increased hospital admissions. Current best- practice guidelines recommend weekly dietetic review during radiotherapy and fortnightly review for six weeks following radiotherapy to minimize weight loss. The primary aim of this study was to compare percent weight loss during radiotherapy before and after the implementation of weekly dietetic review. In the post-guideline im- plementation group we aimed to investigate factors associated with greater weight loss and describe weight changes 4-8 weeks post radiotherapy. Methods and Study Design: Adults with head and neck cancer who re- ceived dietetic input and curative intent radiotherapy were included. Data were collected via retrospective chart audit of records from the Nutrition and Dietetics department. Results: The analysis involved 142 people, 66% (n=94) of whom received dietetic input in the post-guideline implementation period. Mean weight loss was not different between the pre- and post-guideline implementation groups (-5.9±6.34% vs -6.6±5.29%; p=0.477). In the post-guideline implementation group, advanced tumor stage and concurrent chemoradiation were associated with greater percent weight loss (p=0.006 and p<0.001, respectively). Mean weight loss increased by 1.9±4.96%, 4-8 weeks after radiotherapy (p=0.004). Conclusions: Percent weight loss during radiotherapy was not reduced following the implementation of weekly dietetic review. In the 4-8 weeks following radiotherapy, weight loss in- creased significantly over that between baseline and end of radiotherapy. Future research should explore and ad- dress the reasons why critical weight loss occurs despite improved access to dietetic care.
Background and Objectives: To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 – 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey. Methods and Study Design: Individual level, consecutive 3 – day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces represent- ing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size. Results: From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p<0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p<0.05). Sodium-potassium ratios decreased overall and across both sexes (p<0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p<0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p<0.01). Conclusions: This suggests Chinese adolescents are transitioning to a low carbohy- drate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodium- potassium ratios are primarily due to decreased sodium intake and require further reduction efforts.
Background and Objectives: Recent studies have analyzed dietary patterns to assess overall dietary habits, but there have been no studies of dietary patterns among the contemporary Japanese population nationwide. The ob- jective of this study was to identify dietary patterns based on consumption of food items among Japanese adults, and to examine whether these dietary patterns were associated with nutrient intake, demographic characteristics, and lifestyle factors. Methods and Study Design: The study population included 25,754 Japanese adults aged 20 years and older registered in the nationwide National Health and Nutrition Survey database in 2012. Dietary pat- terns were analyzed by factor analysis of 29 food items from the dietary intake survey and household-based semi- weighed dietary records. Results: Five dietary patterns were identified: high-bread and low-rice, high-meat and low-fish, vegetable, wheat-based food, and noodle and alcohol patterns. The lowest quartile of factor scores for high-meat and low-fish, wheat-based food, and noodle and alcohol patterns had higher nutrient intakes, and the highest quartile of factor scores for the vegetable pattern had a higher nutrient intake overall (all p<0.01). Dietary pattern scores were associated with demographic and lifestyle factors such as sex, age, region, smoking status, and alcohol intake. Conclusions: Five major dietary patterns among Japanese adults were identified by factor analysis. Dietary pattern scores were associated with differences in nutrient intakes and demographic and lifestyle factors. These patterns were further used for examining the association between Japanese diets and health out- comes.
Background and Objectives: We conducted this cross-sectional study to identify the association between coffee consumption and risk of metabolic syndrome (MetS) in the Korean population. Methods and Study Design: Subjects aged 30–79 years in the Fifth Korea National Health and Nutrition Examination Survey conducted in 2010 and 2011 were included (n=8,246). The self-reported frequency of coffee consumption was classified as non-drinker, <1, 1, 2, and ≥3 cups/day. Results: The MetS prevalence was 33.6% in men (n=1,149) and 26.1% in women (n=1,388). Among women, the level of coffee consumption was inversely associated with MetS and each component (p for trend 0.002 for abdominal obesity and <0.001 for others). The dose-response inverse association remained significant between coffee consumption and MetS, high triglyceride, and low high-density lipoprotein cholesterol (p for trend 0.001, 0.009, and <0.001, respectively; adjusted for age and body mass index). Compared with women who did not consume coffee, the adjusted odds ratio (OR) for MetS was 0.57 (95% CI, 0.38– 0.86) for women who consumed ≥3 cups per day (p for trend 0.002). Among women, excluding those receiving medical treatments for hypertension, diabetes, and dyslipidemia, a significantly lower OR for MetS (0.53, 95% CI 0.31–0.93) was observed with coffee consumption ≥3 cups, and the dose-response inverse association remained significant (p for trend 0.008). In men, there were no significant associations between coffee consumption and MetS. Conclusion: In conclusion, coffee consumption is associated with a lower risk of MetS among Korean women. There was a dose-response inverse relationship between coffee consumption and the prevalence of MetS in Korean women.
Background and Objectives: Acne vulgaris is a common skin condition among adolescents and young adults. Its relationship with the dietary intake is highly debatable and equivocal. This study aimed to identify the associa- tion between acne vulgaris and dietary intake among Malaysians. Methods and Study Design: A case-control study was conducted involving 57 acne vulgaris patients and 57 age-, gender- and ethnicity-matched controls. All participants were aged 14 and above. The Comprehensive Acne Severity Scale (CASS) was used to categorise patients (grades 2 to 5) and controls (grades 0 to 1). Information such as the demographics, family history, smok- ing habits and dietary intake were collected using a self-administered questionnaire. Results: In the patient arm, the gender ratio of male to female was 1.5:1. 43 patients (75.4%) had a family history of acne vulgaris. No signif- icant association was found for acne in patients with a history of smoking. Milk consumption was significantly higher in patients (63.2%, n=36) versus controls (43.9%, n=25), (OR=2.19, p<0.05). In addition, chocolate con- sumption was also significantly higher in patients (43.9%, n=25) versus controls (24.6%, n=14), (OR=2.4, p<0.05). No significant association was found with the intakes of sweets, potatoes, chips, nuts, yoghurt, ice-cream or carbonated drinks. Conclusions: Dietary intake of milk and chocolate may play a role in acne vulgaris. Pro- spective cohort and intervention studies are recommended to explore whether a causal relationship might obtain.
Background and Objectives: Menstrual irregularities in adolescents are a concern because they are considered a subjective indicator of poor physical and reproductive health. Menstrual regularity is associated with many genet- ic and mental health factors, and lifestyle changes can markedly influence an individual’s level of menstrual regu- larity. Therefore, we investigated associations between lifestyle factors and menstrual irregularities in Korean ad- olescents by analysing data collected from the Korea National Health and Nutrition Examination Survey from 2009 to 2013. Methods and Study Design: A total of 463 female adolescents aged 15–18 years participated in this study; they were divided into two groups based on their menstrual regularity. We assessed the between-group differences in relation to lifestyle-related factors, fast food consumption, and diet quality. Results: The frequen- cies of consumption of soda, coffee, and fried foods were significantly higher in the irregular menstruation group. However, the nutritional quality index was not significantly different between the two groups. Logistic regression analysis revealed that younger age at menarche (odds ratio [OR]=0.69, 95% confidence interval [CI]=0.54–0.88), higher family income (OR=0.37, 95% CI=0.15–0.91), lack of exercise (OR=10.42, 95% CI=2.73–39.8), and high stress levels (OR=4.18, 95% CI=1.02–17.12) were associated with menstrual irregularity, whereas sufficient sleep (OR=0.49, 95% CI=0.39–0.60) and low frequency of eating out accounted for menstrual regularity. Con- clusions: Lifestyle factors and stress levels influence menstrual regularity in Korean adolescents. Appropriate and accessible education on lifestyle management is required.
Background and Objectives: To assess persistence of improvements in nutrition-related attitudes and behav- iours 2-4 years after attending an adult nutrition education program (FOODcents). Methods and Study Design: A link to an online survey was sent to 407 past FOODcents participants. The survey replicated items included in previous FOODcents evaluation surveys. In total, 87 responses were received (response rate 21%). Analyses were conducted on matched responses across 3 time points: pre, post, and follow-up. Results: Improvements since baseline were maintained in confidence to buy healthy foods on a budget and a range of dietary behaviours (e.g., increased consumption of vegetables, legumes, and wholegrain products; greater use of the nutrition information available on food packages; and decreased consumption of soft drinks). There were two primary areas in which improvements were not maintained over time: reported intake of fruit and frequency of consumption of fast food. Conclusions: The results suggest that adult nutrition education can be effective in encouraging individuals to al- ter their food shopping processes and modify their diets. The tendency for some behavioural outcomes to be worse at follow-up than at baseline indicates that marketplace factors such as food promotion and availability may be influencing these specific dietary behaviours. This rare longitudinal study of the effects of adult nutrition education shows that this form of intervention has the potential to produce lasting improvements in attitudes and behaviours. However, such programs cannot be expected to produce large and lasting effects without support from population-level nutrition policies and programs that address macro-environmental factors that influence di- etary behaviours.
Background and Objectives: Vitamin D plays an important role in bone and muscle function, and cell prolifera- tion. The impact of chemotherapy and associated behavioural changes such as fatigue and sun avoidance on vit- amin D (25(OH) D) is unknown. This study aims to evaluate variations in serum vitamin D during chemotherapy and the predictive value of latitude, season and pre-existing vitamin D deficiency. Methods and Study Design: A 12-week prospective cohort study was conducted in chemotherapy-naïve patients in two Australian locations with different sun exposure. Vitamin D deficiency was defined as ≤25 nmol/L and insufficiency 26-50 nmol/L 25(OH) D. Demographics, chemotherapy regimen, nutritional status, sun exposure, geographic location, and sea- son were collected at baseline, 6 and 12 weeks after commencing chemotherapy. Results: Eighty-five patients (μ55.3±13.4 years of age; 49% female) were recruited, 96% Caucasian. Fifty-four patients were treated with cura- tive intent (mostly for breast [n=29] or colorectal [n=12] cancers). At baseline, 10 patients were vitamin D defi- cient and 33 were insufficient. Mean serum 25(OH) D (nmol/L) was higher at latitude -27.5o (Brisbane) than lati- tude -34.9o (Adelaide) (μ61.9±22.1 vs μ42.2±19.2, p<0.001) and varied according to season (spring: μ46.9±20.3, summer: μ50.8±18.2, autumn: μ76.4±25.2, winter: μ36.5±15.7, p<0.001). Serum 25(OH) D decreased with chemotherapy (baseline: μ49.2±22.3, 6-weeks: μ40.9±19.0, 12-weeks: μ45.9±19.7, p=0.05), with a significant and more rapid decline in winter and autumn (p=0.03). Conclusions: Chemotherapy is associated with a decrease in serum vitamin D, particularly during winter and autumn. Investigations into the underlying mechanism and as- sociated potential outcomes with this decrease requires further investigation.
Background and Objectives: A growing body of evidence indicates traditional perioperative care practices of extended fasting and delayed feeding are outdated and detrimental to patient prognosis. This study aimed to ex- plore associations between perioperative fasting, progression to solids and fasting for symptoms; assessing whether excessive pre-operative fasting results in further fasting post-operatively. Methods and Study Design: Two hundred patients who underwent elective surgery from March 2015 to June 2015 in upper gastrointestinal, colorectal and urological departments of a major teaching hospital were included in the study. A retrospective medical record audit was conducted to determine patient demographics, clinical data, perioperative fasting times and diet progression. Results: Preoperative fasting significantly correlated with time taken to progress to solids (rs(198)=0.180, p=0.011), but not with postoperative fasting. Patients who experienced subsequent fasting epi- sodes for symptom management had a significantly longer postoperative fasting time (Med=25.5 hours +/- 19.7) than those who did not (Med=6.2 hours +/- 38.7, p=0.025). Significant differences in fasting times and diet pro- gression were found based on Enhanced Recovery After Surgery (ERAS) status, magnitude of surgery, surgical department, and morning versus afternoon operating lists. Conclusions: Associations between extended periop- erative fasting times, diet progression, and fasting for symptoms exist, such that the adverse effects of suboptimal nutritional status on recovery may be traced back to before the patient even arrives for surgery. Challenges of re- ducing fasting times may be overcome with repeated training of clinicians with best practice guidelines, and im- proving postoperative adherence to ERAS protocols.
Background and Objectives: Pre-operative oral carbohydrate administration (POCA) is an important aspect of enhanced recovery after surgery and has many advantages. The objective of this study was to explore the safety and effect of pre-operative oral carbohydrate administration in infants. Methods and Study Design: This was a prospective, multi-center, randomized study that randomly assigned 1200 infants into four groups. In the control group (group A), the infants were strictly restricted to 6-h preoperative fasting before anesthesia. In the enhanced recovery after surgery (ERAS) groups (groups B, C, and D), the infants were orally administered a 10% carbohy- drate solution (10% glucose water; 5, 10, and 15 mL/kg, respectively) 2 h before anesthesia. Blood glucose, gas- tric residual volumes, crying ratios, and the length of hospital stay were observed. Results: The blood glucose was significantly higher in groups B, C, and D than group A at the time of anesthesia. The gastric residual vol- ume revealed virtually no residue in groups A, B, and C, but 15 infants in group D had a gastric residual volume. The crying ratio was significantly higher in group A. The length of hospital stay was not significantly different between the groups. Conclusions: POCA is well-tolerated in infants at a dose of 10 mL/kg.
Background and Objectives: There exist many studies in Western countries dealing with pediatric nutritional assessment on admission, but those in Asian countries are comparatively limited. This study aimed at clarifying the prevalence of undernutrition in 3 Japanese pediatric hospitals, especially focusing on their different character- istics. Methods and Study Design: Study participants included 313 patients aged 1–17 years admitted to a ter- tiary hospital (175 patients), an acute-care hospital (99 patients), or a rehabilitation hospital (39 patients). On ad- mission, body height, weight, and serum albumin were measured. BMI was calculated by dividing the weight (kg) by the square of height (m). Patients exhibited undernutrition on account of BMI z-score <−2, weight-for-height (W/H) <90%, height-for-age (H/A) <95%, or albumin <3.5 g/dL. Results: The overall prevalence of undernutri- tion was 53.0%. Among 4 nutritional measures, the prevalence was highest in H/A (33.9%), followed by W/H (26.8%), BMI z-score (17.6%) and albumin (12.8%). A rehabilitation hospital exhibited significantly higher prevalence than that in a tertiary- or acute-care hospital. By the classification of International Statistical Classifi- cation of Diseases and Related Health Problems-10, neurological diseases and congenital anomalies showed higher prevalence among the disease categories which had the number of enrolled patients more than twenty. Conclusions: This study indicates that hospital characteristics and inpatient disease categories are important in the admission evaluation of the likelihood of undernutrition. These observations require consideration by hospital physicians in paediatric nutritional diagnosis and management.
Background and Objectives: This study aims to assess the prevalence and associated risk factors of malnutrition in adults in acute care settings. Methods and Study Design: A cross-sectional study among 883 participants from 6 representative general public hospitals was conducted during April and May 2016. Participants were con- sidered malnourished if they were classified using Subjective Global Assessment (SGA) as malnourished (B or C) or with BMI < 18.5kg/m2. Demographic and socio-economic status characteristics were measured using inter- viewer-administered questionnaires. Sampling weights for the number of participants in each hospital were calcu- lated to account for the difference in the stratified cluster sampling design. Logistic regression was used to exam- ine the association of malnutrition with potential risk factors. Results: The prevalence of underweight (BMI <18.5 kg/m2) and hospital malnutrition (B/C on SGA or BMI <18.5 kg/m2) in acute care setting was 14.0% and 34.1%. The prevalence was higher in participants over 80 years old (49.7%), attending a Level 1 hospital (37.1%), with an oncology (46.5%) or pulmonary (43.6%) diagnosis. The risk of being malnourished was statistically sig- nificantly higher among participants who were living in poverty (OR: 1.6), were living in marginal poverty (OR: 1.3), did not work in the last six months (OR: 1.7), had a length of stay over 10 days (OR: 1.6) and were admitted via emergency (OR: 1.5). Conclusions: Hospital malnutrition is a significant health problem in Ho Chi Minh City. Socio-economic status and pre-admission underweight were significant risk factors besides other clinical risk factors. Improvement of nutrition and dietetics services is crucial to optimize patient outcomes.
Background and Objectives: This study was designed to evaluate the impact of the prognostic nutritional index (PNI) on treatment-related toxicities and tolerance in patients with advanced head and neck cancers who were undergoing concurrent chemoradiotherapy (CCRT). Methods and Study Design: We retrospectively analyzed and compared the clinical characteristic, toxicities and survival of 143 patients with stage III, IVA, and IVB head and neck cancer who were treated with CCRT according to their PNI between 2007 and 2010. Results: Low PNI was correlated with T classification and advanced tumor stage. Patients with low PNI were less likely to tolerate CCRT, required tube feeding support more frequently and had higher percentages of grade 3/4 hematological tox- icities, sepsis and toxic death. Conclusions: Pretreatment PNI predicts treatment-tolerance and toxicity in pa- tients with advanced head and neck cancer undergoing CCRT.
Background and Objectives: Low HDL concentrations are considered an important risk factor for cardiovascu- lar disease. Interventions promoting a low-fat, plant-based eating pattern appear to reduce CVD risk while para- doxically also reducing HDL concentrations. Recent studies show HDL to comprise a range of subfractions, but the role these play in ameliorating the risk of CVD is unclear. The purpose of this study was to characterise changes in HDL subfractions in participants where HDL decreased following the CHIP intervention which pro- motes a low-fat, plant-based diet, with physical activity. Methods and Study Design: Individuals (n=22; mean age=55.4±16.3 years; 45.5% men, 54.5% women) participating in a CHIP intervention were assessed at baseline and 30 days for changes in BMI, blood pressure, lipid profile, (including large-, intermediate- and small-HDL subfractions) and fasting glucose. Results: HDL significantly decreased (10.6%, p<0.001) together with BMI (2.5%, p=0.028), systolic blood pressure (7.1%, p=-0.005), total cholesterol (9.5%, p=0.002), LDL (11.2%, p=0.007) and fasting glucose (8.2%, p=0.028). Triglycerides (TG) did not significantly change. Physical activity (22.7%, p=0.016) and consumption of whole plant-foods (13.9%, p=0.003) significantly increased, while non- plant (energy and animal) foods decreased (43.1%, p=0.009). Large-, intermediate- and small-HDL decreased (- 10.0%, p=0.003; -8.3%, p=0.013 and 22%, p=0.005, respectively). Conclusions: This paper discusses specific changes in HDL subfractions when overall-HDL decreases as a response to low fat, whole-food, plant-based eat- ing and exercise. Additional research is required to elucidate the reasons through which behavioural therapies re- model the HDL particle and how this impacts the functional properties of HDL and CVD risk.