In order to sustain life during the occurrence of a natural disaster, it is vital to ensure that people’s intake of water and food is adequate (prioritizing first energy, then protein and water-soluble vitamins). Infants, pregnant women, patients, and the elderly are particularly vulnerable to insufficiencies in food intake, even if they are provided with the same quantity of food as others, and providing them with dietary and nutritional support becomes a high priority as their insufficient intake of energy and protein becomes long term. It is necessary to have a system in place for identifying those who are vulnerable and in need of support and providing them with the items (food) and nutritional care that they require. Eating is equivalent to living, and if the vulnerable themselves recognize the importance of food and nutrition, this will help improve the nutritional situation of the entire population. It is recommended that measures be taken in non-emergency periods such as stockpiling food for special dietary uses.
Background and Objectives: Cognitive impairment develops with pre-diabetes and dementia is a complication of diabetes. Natural products like turmeric and cinnamon may ameliorate the underlying pathogenesis. Methods: People ≥60 years (n=48) with newly-recognised untreated pre-diabetes were randomised to a double-blind meta- bolic study of placebo, turmeric (1 g), cinnamon (2 g) or both (1 g & 2 g respectively), ingested at a white bread (119 g) breakfast. Observations were made over 6 hours for pre- and post-working memory (WM), glycaemic and insulin responses and biomarkers of Alzheimer’s disease (AD)(0, 2, 4 and 6 hours): amyloid precursor protein (APP), γ-secretase subunits presenilin-1 (PS1), presenilin-2 (PS2), and glycogen synthase kinase (GSK-3β). Dif- ferences between natural product users and non-users were determined by Students t and chi square tests; and be- tween pre-test and post-test WM by Wilcoxon signed rank tests. Interaction between turmeric and cinnamon was tested by 2-way ANOVA. Multivariable linear regression (MLR) took account of BMI, glycaemia, insulin and AD biomarkers in the WM responses to turmeric and cinnamon. Results: No interaction between turmeric and cinnamon was detected. WM increased from 2.6 to 2.9 out of 3.0(p=0.05) with turmeric, but was unchanged with cinnamon. WM improvement was inversely associated with insulin resistance (r=-0.418, p<0.01), but not with AD biomarkers. With MLR, the WM responses to turmeric were best predicted with an R2 of 34.5%; and with significant turmeric, BMI and insulin/glucose AUC beta-coefficients. Conclusions: Co-ingestion of turmeric with white bread increases working memory independent of body fatness, glycaemia, insulin, or AD biomarkers.
Background and aim: Glycated hemoglobin (HbA1c) assessment is basic to diabetes management. Little is done to describe the whole spectrum of the trajectory, its related temporal patterns of metabolic indices, and comor- bidities. Methods and Results: This was a longitudinal study. In the Diabetes Management through Integrated Delivery System project in Taiwan, enrollees had diabetes, but no major comorbidities. They were randomized into intensive or conventional education (health, diet and exercise) groups. HbA1c was classified by a group- based trajectory model on the basis of repeated six-monthly measurements. We analyzed data from 1091 subjects who had at least two measurements on HbA1c. HbA1c exhibited three distinct ranges of low (42-53 mmol/mol), intermediate (64-75 mmol/mol) and high (97 mmol/mol), all of which persisted for 4.5 years regardless of receiv- ing intensive education or not. Temporal changes and a time-group interaction were found for triglycerides, total cholesterol, HDL-C and LDL-C. The high trajectory was associated with the major co-morbidities of retinopathy, nephropathy, neuropathy, stroke, hypoglycemia, and ketoacidosis. Patients in the intensive education group (62.4%), which were equally distributed in the three trajectories, had significantly lower HbA1cs (-0.14%= -1.5 mmol/mol, p=0.026). The intermediate trajectory patients with intensive education had HbA1cs higher than the low trajectory patients with conventional education (=0.189, p=0.033). Though not significant, a similar pattern was found for DM education in the high group (=0.223, p=0.154). Conclusions: Novel strategies beyond cur- rent education and pharmacotherapeutic regimens are needed to lower HbA1c at least 11 mmol/mol for the high HbA1c group to minimize comorbidities.
Objective: To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition (TPN group) after total gastrectomy for gastric cancer. Method: The nutrition index, liver function, patient- generated subjective global assessment (PG-SGA) score, the post-operation complications, the hospital stay and hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of Surgery from May 2011 to May 2013 were analyzed retrospectively. Results: A total of 72 patients including 37 cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN group was significantly lower than the EEN group at 21 days (p<0.05). There were significant differences in both the groups (p<0.05) in nutrition indicators. The incidence of complications in the EEN group and TPN group were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the EEN and in the TPN group were up to 12.2±2.5 d vs 14.9±2.9 d (p<0.05) and the hospitalization expenses were 36472±4833 CNY vs 40140±3927 CNY (p<0.05), respectively. Conclusion: Compared with TPN, EEN was safe and well tolerated and can shorten the hospital stay as well as reduce costs incurred with total gastrectomy for gastric cancer.
We aimed to prospectively assess dairy intake among adolescents, and determine the predictors of adequate dairy consumption during adolescence. 634 Sydney schoolchildren (351 girls and 283 boys) who had dietary data at both age 12 and 17 were included for analyses. Dairy consumption was assessed from validated semi-quantitative food frequency questionnaires. At age 12, mean total dairy intake was 1.62 serves/day which decreased to 1.40 by age 17 (p<0.0001). Mean serves/day of milk decreased from 1.11 to 0.92 during adolescence. Moreover, 90% of the decrease in serves/day of total dairy was due to reduced milk consumption. At age 12, 8.5% of children con- sumed ≥3.5 serves/day of total dairy and this decreased to 6.2%, 5 years later at age 17 (p=0.001). A lower pro- portion of girls compared with boys consumed ≥3 serves/day of total dairy at both ages 12 (p=0.005) and 17 (p=0.01). Participants with tertiary qualified parents at baseline were 85% more likely to have intakes of the dairy food group above the median during the 5 years, OR 1.85 (95% CI 1.18-2.91). Frequent flavored milk consump- tion (≥2 serves/week) at baseline was associated with ~5-fold greater likelihood of maintaining intakes of dairy foods above the median during adolescence. Dairy food consumption decreased significantly during adolescence, driven primarily by a decrease in milk consumption. Most adolescents did not meet national recommended guide- lines for the dairy food group intake. These findings highlight the need for further research into intervention strat- egies aimed at sustaining dairy consumption.
Background: Clinical practice guidelines recommend objective nutritional assessments in managing chronic kid- ney disease (CKD) patients but were developed while referencing to a North-American population. Specific rec- ommendations for assessing muscle mass were suggested (mid-arm circumference, MAC; corrected mid-arm muscle area, cAMA; mid-arm muscle circumference, MAMC). This study aimed to assess correlation and associ- ation of these assessments with dietary protein intake in a multi-ethnic Asian population of healthy and CKD pa- tients. Methods: We analyzed 24-hour urine collections of selected participants to estimate total protein intake (TPI; g/day). Ideal body weight (IDW; kg) was calculated and muscle assessments conducted. Analyses involved correlation and linear regression, taking significance at p<0.05. Results: There were 232 stable CKD patients and 103 healthy participants comprising of 51.0% male, 38.5% Chinese, 29.6% Malay, 23.6% Indian, and 8.4% oth- ers. The mean TPI was 58.9±18.4 g/day in healthy participants and 53.6±19.4 g/day in CKD patients. When nor- malized to ideal body weight, TPI-IDW (g/kg/day) was similar in healthy and CKD participants. Overall, TPI was associated with MAC (r=0.372, p<0.001), cAMA (r=0.337, p<0.001), and MAMC (r=0.351, p<0.001). TPI-IDW was also associated with MAC (r=0.304, p<0.001), cAMA (r=0.202, p<0.001), and MAMC (r=0.200, p<0.001) but not for TPI normalized to actual body weight. When examined separately, TPI was associated with MAC, cAMA, and MAMC in both CKD and healthy participants, but was associated with TPI-IDW only in CKD pa- tients. Conclusion: Total protein intake was associated with muscle assessments in all participants. TPI normal- ized to IDW should only be used in CKD patients.
Background: Iodine content in table salt was adjusted from 30-50 mg/kg to 21-39 mg/kg from March of 2012 in Henan Province, China. The vulnerable population may be at risk of iodine deficiency. Objectives: To determine whether the iodine intake was sufficient in vulnerable populations and to investigate what factors may be associ- ated with iodine status in these vulnerable populations in Henan Province, China. Methods: A cross-sectional survey was conducted in 17 cities in Henan Province, China, from April 2012 to December 2012 to assess the io- dine status in vulnerable populations, including women of reproductive-age (n=2648), pregnant women (n=39684), lactating women (n=6859), infants <2 years of age (n=16481), and children aged 8-10 years (n=3198). Questionnaires (n=4865) related to demographic and dietary factors were collected from the investigated women to identify factors that were related to iodine intake and iodine status. Results: The median urinary iodine con- centrations (mUICs) were 205 μg/L, 198 μg/L, 167 μg/L, 205 μg/L and 200 μg/L, respectively, in reproductive- age, pregnant and lactating women, infants <2 years of age and children aged 8-10 years. Higher income, and consuming more poultry and fish in the diet had positive impact on UIC levels. Low salt intake, consuming more rice and vegetables in the diet were negative factors for UIC. Conclusions: Iodine status of the vulnerable popu- lations was generally adequate in Henan Province, China, according to WHO criteria. But the mUICs were slight- ly above the adequate level in reproductive-age women and children aged 8-10 years. It’s important to monitor the iodine status in vulnerable populations after the adjustment on iodine content in table salt.
The WHO recommends exclusive breastfeeding during the first 6 mo of life; however, deviations from this rec- ommendation are widespread. The objective of the current study was to evaluate exclusive and predominant breastfeeding rates, as defined by the WHO, in a cross-sectional sample of Guatemalan children using retrospec- tive records on the temporal pattern of introducing foods and beverages before 6 mo. Mothers of 150 infants, aged 6 to 23 mo, attending a public health clinic were interviewed about early life feeding practices with a struc- tured questionnaire. In addition, the plausibility of the reported offering of liquids and foods, other than breast milk, since birth was checked against reported current feeding practices. We observed that estimated exclusive breastfeeding was rare with 14% of infants receiving exclusive breastfeeding for 5 mo, and only 9% for the rec- ommended 6 mo. The proportion of infants with predominant breastfeeding, which allows certain liquids such as water, juices and ritual fluids, was 33% through 5 mo and 23% through 6 mo. One-quarter of mothers (n=38) re- ported implausible answers concerning age-of-introduction of liquids and foods. Nevertheless, retrospective re- ports at up to 2 y give credible outcomes for estimations of feeding pattern at 6 mo of age. Our findings match the findings of other studies conducted in Guatemala. Overall adherence to the WHO guidelines for feeding in the first semester of infancy was much less than ideal and in need of strengthening.
Objective: Childhood obesity is tracked to adulthood at a high rate. However, longitudinal studies of obesity in early childhood remain limited. This study aimed at tracking young obese children back to birth in comparison with normal-weight children, and investigating the relationship with parental obesity. Methods: A total of 2,678 (1,353 boys) young children attending kindergarten or nursery school in Nara Prefecture, Japan, were enrolled. The present heights and weights of children and parents were obtained by a questionnaire, and children’s heights and weights at birth, 1.5, and 3.5 years were obtained from mother-child health notebooks. Using body mass in- dex (BMI), child and parental obesity were defined as ≥90th percentile based on the reference values for Japanese children and ≥25 (kg/m2), respectively. Results: The overall prevalence of obesity at birth was 10.2%, and de- creased to 5.6% at 5 years. In the retrospective tracking, obese children at 5 years exhibited significantly higher weight z-scores and BMI percentiles consistently from birth than in normal-weight children. The increased veloc- ity of weight gain as judged by their z-score during three periods; birth-1.5, 1.5-3.5, and 3.5-5 years were signifi- cantly associated with an increased risk for the obesity at 5 years of age. Only maternal obesity was found to be associated with daughters’ obesity in the analysis of association of parents-children obesity. Conclusions: It is important to manage body weight from early infancy for reducing the occurrence of obesity at 5 years. Where there is maternal obesity, greater attention may be required, especially for daughters.
Purpose: This study explored the relationship between adolescents’ emotional intelligence and the tendency to develop an eating disorder. Methods: Senior high school students in Taiwan were recruited for the study. A 3- part anonymous questionnaire measured demographic information, body weight satisfaction, and expectation of body weight. Students also completed the Adolescent Emotional Intelligence Scale and the Eating Disorders Atti- tude-26 Test (EAT-26). Height and weight were also measured. Results: The mean of EAT-26 score was 8.66±7.36, and 8.6% students were at high risk to develop eating disorders. Gender, body weight, body dissatis- faction and the expected body shape were significantly related to disturbed eating attitudes and behaviours. Scores of EAT-26 were positively correlated with emotional perception, emotional expression, and emotional ap- plication. Conclusions: Disturbed eating behaviours exist among adolescents in Taiwan, and these behaviours may be related to emotional intelligence. However further studies with larger samples are needed.
The association between water and nutrient intake in pregnant women, and wheeze in their 18 month old infants, was investigated in a prospective study. Volunteers (n=369) recruited from northern New Zealand were visited in months 4 and 7 of pregnancy. At each visit anthropometric measurements were taken, diet assessed by 24-hour recall and 3-day food records and questionnaires determining personal details administered. Eighteen months af- ter birth, infants were measured, and questions on infant feeding and wheeze asked. Overall, mothers reported 32% of their infants had wheezed in the last 12 months. After adjusting for significant covariates and energy in- take, higher maternal intakes of dietary water (p=0.009) and manganese (p=0.024) were associated with de- creased wheeze, and glucose (p=0.003) with increased wheeze. Prevalence of infant wheeze decreased 18.5% from the lower to the upper quartile of water intake, and 17.4% from the lower to the upper quartile of manganese intake. Wheeze was more common in Polynesian than European infants (41.8% vs 28.9%). Polynesian mothers consumed significantly less dietary water (median 451 g less) and manganese (median 1374 g less) than Euro- pean mothers per day. Glucose was only significant because of strong association with infant wheeze at extreme- ly high maternal intakes of >40 g/day in ~10% of the subjects. There was no association between maternal dietary supplement intake and wheeze. Mothers estimated at high risk of infant wheeze consumed less tap water, whole grains, tea, fruit; and more fruit juice, soft drink, processed meat and fish products, and refined grain products. This is the first study to report an intergenerational association between maternal water, and glucose intake with infant wheeze.
Asian regions have been suffering from growing double burden of nutritional health problems, such as undernu- trition and chronic diseases. National nutrition survey plays an essential role in helping to improve both national and global health and reduce health disparities. The aim of this review was to compile and present the infor- mation on current national nutrition surveys conducted in Asian countries and suggest relevant issues in imple- mentation of national nutrition surveys. Fifteen countries in Asia have conducted national nutrition surveys to collect data on nutrition and health status of the population. The information on national nutrition survey of each country was obtained from government documents, international organizations, survey website of governmental agencies, and publications, including journal articles, books, reports, and brochures. The national nutrition survey of each country has different variables and procedures. Variables of the surveys include sociodemographic and lifestyle variables; foods and beverages intake, dietary habits, and food security of individual or household; and health indicators, such as anthropometric and biochemical variables. The surveys have focused on collecting data about nutritional health status in children aged under five years and women of reproductive ages, nutrition intake adequacy and prevalence of obesity and chronic diseases for all individuals. To measure nutrition and health sta- tus of Asian populations accurately, improvement of current dietary assessment methods with various diet evalua- tion tools is necessary. The information organized in this review is important for researchers, policy makers, pub- lic health program developers, educators, and consumers in improving national and global health.
Populations with special physiological state, such as pregnant, nursing and women of child-bearing age, have been identified as nutritionally vulnerable during natural disaster. The objective of this survey was to evaluate the prevalence of anaemia and micronutrient status of women of reproductive age in April 2009 one year after the Whenchuan Earthquake. The survey recruited 58 pregnant, 66 lactating and 242 women of child-bearing age from 19 to 45 years. The concentrations of haemoglobin in whole blood and ferritin and micronutrients in serum were assayed. Among the three groups (pregnant, nursing and child-bearing women), respectively, the prevalence of anaemia was 29.1%, 25.5% and 28.8%; that of iron deficiency was 45.4%, 49.0% and 52.9%; and that of zinc de- ficiency was 45.4%, 23.0% and 33.5%. The sum of vitamin D deficiency and insufficiency was more than 90% in each group, and the total vitamin B12 deficiency and marginal deficiency prevalence percentages were 47.3%, 17.7% and 35.7%, respectively. The prevalence of vitamin A deficiency and marginal deficiency was 1.8% and 9.1% in pregnant women, 6.1% and 15.2% in nursing women and 8.6% and 21.3% in women of child-bearing age, respectively. Our findings indicated that the micronutrient status of women of reproductive age was poor in the disaster areas. Therefore, improving the micronutrient status of these women should be an urgent priority in these areas.
This paper addresses the need for diet assessment methods that capture the rapidly changing beverage consump- tion patterns in China. The objective of this study was to develop a 3-day smartphone-assisted 24-hour recall to improve the quantification of beverage intake amongst young Chinese adults (n=110) and validate, in a small subset (n=34), the extent to which the written record and smartphone-assisted recalls adequately estimated total fluid intake, using 24-hour urine samples. The smartphone-assisted method showed improved validity compared with the written record-assisted method, when comparing reported total fluid intake to total urine volume. How- ever, participants reported consuming fewer beverages on the smartphone-assisted method compared with the written record-assisted method, primarily due to decreased consumption of traditional zero-energy beverages (i.e. water, tea) in the smartphone-assisted method. It is unclear why participants reported fewer beverages in the smartphone-assisted method than the written record -assisted method. One possibility is that participants found the smartphone method too cumbersome, and responded by decreasing beverage intake. These results suggest that smartphone-assisted 24-hour recalls perform comparably but do not appear to substantially improve beverage quantification compared with the current written record-based approach. In addition, we piloted a beverage screener to identify consumers of episodically consumed SSBs. As expected, a substantially higher proportion of consumers reported consuming SSBs on the beverage screener compared with either recall type, suggesting that a beverage screener may be useful in characterizing consumption of episodically consumed beverages in China’s dynamic food and beverage landscape.
We examined coffee consumption patterns over the past decade among Korean adults. This study was based on seven different cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2001 and 2011 (17,367 men and 23,591 women aged 19-103 y, mean 48.1 y). Information on frequency and type of coffee consumption was derived from frequency questionnaires or 24-hour recalls. For the study period, the prevalence of daily coffee consumption increased by 20.3% (from 54.6 to 65.7%; p<0.001). For those who consumed 2 or more cups of coffee daily, it dramatically increased by 48.8% (from 29.1 to 43.3%; p<0.001). The instant coffee mix was consumed the most frequently by Korean adults, and it was on the increas- ing trend among people who were middle aged or older (≥40 y), while it was on the slowdown in young men or on the declining trend in young women. Brewed coffee consumption had an increasing trend by all age groups in recent years. Especially, there was a rapid increase in brewed coffee consumption among young women (strong- ly) and young men. The instant coffee mix that contains non-dairy creamer and/or sugar still takes up a signifi- cant portion of coffee consumption in Korea, which may result in weight gain and insulin resistance, and poten- tial benefits of coffee may be offset. Given high prevalence of coffee consumption in Korea, nutrition education should be conducted to help people (especially the elderly) to make healthy coffee drinking habits.
Food affordability and quality can influence food choice. This research explores the impact of geographic factors on food pricing and quality in Western Australia (WA). A Healthy Food Access Basket (HFAB) was cost and a visual and descriptive quality assessment of 13 commonly consumed fresh produce items was conducted in-store on a representative sample of 144 food grocery stores. The WA retail environment in 2010 had 447 grocery stores servicing 2.9 million people: 38% of stores the two major chains (Coles® Supermarkets Australia and Wool- worths® Limited) in population dense areas, 50% were smaller independently owned stores (Independent Gro- cers Association®) in regional areas as well, and 12% Indigenous community stores in very remote areas. The HFAB cost 24% (p<0.0001) more in very remote areas than the major city with fruit (32%, p<0.0001), vegetables (26.1%, p<0.0005) and dairy (40%, p<0.0001) higher. Higher price did not correlate with higher quality with only 80% of very remote stores meeting all criteria for fresh produce compared with 93% in Perth. About 30% of very remote stores did not meet quality criteria for bananas, green beans, lettuce, and tomatoes. With increasing geo- graphic isolation, most foods cost more and the quality of fresh produce was lower. Food affordability and quality may deter healthier food choice in geographically isolated communities. Improving affordability and quality of nutritious foods in remote communities may positively impact food choices, improve food security and prevent diet-sensitive chronic disease. Policy makers should consider influencing agriculture, trade, commerce, transport, freight, and modifying local food economies.
Financial restraints and poverty lead to poor diets and poor health outcomes. Limited research shows that socio- economic status is related to home availability of certain foods. However, studies in this area have used different socio-economic indicators, which may not equally influence eating-related behaviors. Using multiple indicators of socio-economic status may provide a more accurate picture of these relationships. The aim of this study was to investigate whether several socio-economic indicators are independently associated with home availability of se- lected foods known to influence chronic disease risk in 50 year olds from Canterbury, New Zealand, participating in the CHALICE study. Participants were selected randomly from health research extracts from Canterbury. Data from 216 participants (110 females, 106 males) were included. The presence (but not quantity) of foods/beverages in the home was measured by a validated home food inventory. Linear regression analyses were performed for the following home food inventory scores: fruit, vegetables, lower fat dairy, obesogenic foods and sweetened beverages with household income, standard of living and education using multivariate models. Higher household income and standard of living were individually associated with a 2% to 3% higher fruit and vegeta- bles (3 to 5 types/forms) and total food scores (6 to 9 types/forms) (p<0.03). Higher education level was associat- ed with a 2.5% increase in fruit and vegetables score (4 types/forms) and an 8% decrease in sweetened beverages score (0.4 beverages) (p<0.02). These results suggest that using only one measure of socio-economic status can- not accurately capture the effects of social inequalities in food availability. Those experiencing the most social disadvantage had a lesser availability of fruit and vegetables which may be detrimental to good health.
Background: Cambodia is among the 28 worst countries globally with the highest rates of childhood malnutri- tion. The aim of the assessment was to apply published evidence associating malnutrition and a variety of func- tional consequences to project economic implications of this high rate of childhood malnutrition. Such infor- mation is vital to advocate for appropriate programs and action plan to reduce malnutrition (from severe stunting to micronutrient deficiencies). Methods: This exercise used a “consequence model” to apply these “coefficients of loss” established in the global scientific literature to Cambodia health, demographic and economic data to de- velop a national estimation of the economic losses link to malnutrition. Results: The impact of the indicators of malnutrition analysed represent a burden to the national economy of Cambodia estimated at more than $400 mil- lion annually -2.5% of GDP. Micronutrient deficiencies suggest deficits in the quality of the diet - representing a national burden of more than $200 million annually while breastfeeding behaviours account for 6% of the burden. 57% of the losses emerge from indicators measured in children, while 43% of losses are from indicators inde- pendent of childhood measurements - indicators of maternal behaviour along with maternal and adult nutrition. Conclusions: Given the low cost of interventions and the high baseline losses, investment in nutrition programs in Cambodia is likely to offer high returns and attractive benefit cost ratios. Since nearly half the losses are de- termined prior to the birth of the child, this has implications for targeting and timing of programs.
Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This pa- per reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to Australia and clinical studies investigating dietary mechanisms which may explain the “morbidity mortality para- dox”. The FHILL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818 people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared to be “getting away” with these CVD risk factors because of their continued adherence in old age to a Mediterra- nean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its metabolites.
Background: This work represents the first part of a progressive review of AuSPEN’s 1999 Guidelines for Pro- vision of Micronutrient Supplementation in Adult Patients receiving Parenteral Nutrition, in recognition of the developments in the literature on this topic since that time. Methods: A systematic literature review was under- taken and recommendations were made based on the available evidence and with consideration to specific ele- ments of the Australian and New Zealand practice environment. The strength of evidence underpinning each rec- ommendation was assessed. External reviewers provided feedback on the guidelines using the AGREE II tool. Results: Reduced doses of manganese, copper, chromium and molybdenum, and an increased dose of selenium are recommended when compared with the 1999 guidelines. Currently the composition of available multi-trace element formulations is recognised as an obstacle to aligning these guidelines with practice. A paucity of availa- ble literature and limitations with currently available methods of monitoring trace element status are acknowl- edged. The currently unknown clinical impact of changes to trace element contamination of parenteral solutions with contemporary practices highlights need for research and clinical vigilance in this area of nutrition support practice. Conclusions: Trace elements are essential and should be provided daily to patients receiving parenteral nutrition. Monitoring is generally only required in longer term parenteral nutrition, however should be determined on an individual basis. Industry is encouraged to modify existing multi-trace element solutions available in Aus- tralia and New Zealand to reflect changes in the literature outlined in these guidelines. Areas requiring research are highlighted.
Minimally invasive esophagectomy has recently become popular after the laparoscopic technique was developed. However, the postoperative energy expenditure in patients undergoing this procedure has not been evaluated. Therefore, we hypothesized that postoperative resting energy expenditure (REE) following minimally invasive esophagectomy is lower than that estimated using the Harris-Benedict equation. Fifteen patients who underwent esophagectomy by thoracoscopy in the prone position were analyzed. After esophagectomy, an indirect calorime- ter measured the energy expenditure during ventilation in the ICU. These values and the estimated basal energy expenditure values were compared using the paired t test. The mean age was 66±10 years and mean duration of ventilator use in the ICU was 697±70 mins. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at the time of ICU admission were 13±4 and 2±1, respec- tively. The average temperature, heart rate, and respiratory rate during ventilation were 36.2±0.6°C, 67±9 beats/min, and 12±2/min, respectively. The average REE during ventilation was 985±167 kcal/day (18.1±3.4 kcal/kg/day). The estimated REE was 1191±159 kcal/day. The average REE measured using the indirect calorim- eter during ventilation was significantly lower than the estimated REE (83±10% of the estimated REE, p<0.001). In conclusion, the REE measured by an indirect calorimeter after minimally invasive esophagectomy at early postoperative stage under sedation was significantly lower than the REE estimated using the Harris-Benedict equation.
It is important to identify patients who are at risk of malnutrition upon hospital admission as malnutrition results in poor outcomes such as longer length of hospital stay, readmission, hospitalisation cost and mortality. The aim of this study was to determine the prognostic validity of 3-Minute Nutrition Screening (3-MinNS) in predicting hospital outcomes in patients admitted to an acute tertiary hospital through a list of diagnosis-related groups (DRG). In this study, 818 adult patients were screened for risk of malnutrition using 3-MinNS within 24 hours of admission. Mortality data was collected from the National Registry with other hospitalisation outcomes retrieved from electronic hospital records. The results were adjusted for age, gender and ethnicity, and matched for DRG. Patients identified to be at risk of malnutrition (37%) using 3-MinNS had significant positive association with longer length of hospital stay (6.6±7.1 days vs 4.5±5.5 days, p<0.001), higher hospitalisation cost (S$4540±7190 vs S$3630±4961, p<0.001) and increased mortality rate at 1 year (27.8% vs 3.9%), 2 years (33.8% vs 7.2%) and 3 years (39.1% vs 10.5%); p<0.001 for all. The 3-MinNS is able to predict clinical outcomes and can be used to screen newly admitted patients for nutrition risk so that appropriate nutrition assessment and early nutritional in- tervention can be initiated.
Many studies have demonstrated the efficacy of folic acid (FA) supplementation in prevention of neural tube de- fects (NTDs), although the extent of NTDs varies among individuals of different races and ethnic origin. China is a multi-ethnic country with no standard practice for FA-fortified food. Milk is consumed by women, but little is known about the effects of milk on folate concentration in maternal blood and neonatal umbilical cord blood in Han and Mongolian women after stopping taking the supplement for a month and five month, respectively. The objective of this study was to determine whether only daily consumption of liquid milk can increase the blood fo- late concentration in pregnant women and whether there are differences in blood folate concentrations between Han and Mongolian women after cessation of FA supplementation. Of the 4052 women enrolled in the parallel group design study. Three thousand five hundred and twenty-six women had confirmed pregnancies and were randomized to receive liquid milk or not until delivery. Women who consumed the liquid milk had significantly increased serum folate concentrations at 16 and 32 weeks of gestation as well as cord blood at birth compared to control groups in both ethnic groups. Infants born to women drinking milk also had better the term birth weight and height, which may be related to the increased concentration of folate. In conclusion, daily consumption of milk can increase the serum folate concentration in pregnant Han and Mongolian women in China (differences in the efficacy of FA and milk supplementation) and may enhance birth outcomes.
Background: Probiotics are microbial supplements that have shown efficacy in a wide range of applications. To assess the safety and effects of enteral probiotics in critically ill neonates. Methods: A double-blind, randomized controlled trial was conducted in 100 full-term infants with critical illness according to scores of neonatal acute physiology. Fifty neonatal intensive care patients were randomly assigned to receive probiotics three times daily after birth for 8 days, and fifty patients were not given probiotics, but who received a placebo. The incidence of sepsis, multiple organ dysfunction syndrome (MODS), nosocomial pneumonia, and necrotizing enterocolitis were recorded. The prognosis of probiotic treatment was determined based on the rate of recovery and hospital days. Serum IgA, IgG, and IgM concentrations were measured on days 4 and 8. Results: Infants in the probiotics group showed a significantly reduced rate of nosocomial pneumonia (18% versus 36%) and multiple organ dysfunction syndrome (6% versus 16%) compared with the placebo group (p<0.05). Significant results were demonstrated in favour of the probiotics for days of hospital stay (13±3.5 d versus 15.8±5.3 d) (p<0.05). However, there were no significant differences in the occurrence of sepsis, necrotizing enterocolitis, and recovery rate. Patients given pro- biotics had significantly greater levels of IgA than those in the placebo group (p<0.05). No serious adverse effects in the study population were noted. Conclusions: Supplements of probiotics to critically ill neonates could en- hance immune activity, decrease occurrence of nosocomial pneumonia and MODS, and reduce days in hospital.