Background and Objectives: Behavioural strategies can promote adherence to intensive lifestyle treatments for obesity. This study aimed to explore effective behavioural strategies for weight maintenance in Chinese patients with overweight or obesity. Methods and Study Design: Retrospective analysis of weight maintenance data was conducted. Patients with overweight or obesity, who had received a 3-month weight loss and behavioural intervention, were asked to complete questionnaires to monitor compliance with behavioural strategies after the weight loss. They continued to follow a daily calorie restriction for 12 months to maintain their weight. The primary outcome was to evaluate the association between a total weight loss (TWL) of more than 5% and compliance with behavioural strategies during the 6-month weight maintenance phase. Results: A total of 131 patients completed the questionnaire. The top three easy-to-perform behaviours were eating vegetables and protein first and carbohydrates later, self-weighing each day and having regular eating times. Of 131 patients, 61(46.5%) and 42 (32.1%) were followed up for 6 months and 12 months respectively. Reducing high-fat food intake (p = 0.002) and eating an average frequency of 5 times a day (p = 0.034) were associated with a TWL of more than 5% during 6 months weight maintenance. Reducing high-fat food intake was associated with a TWL of more than 5% during 12 months weight maintenance (p = 0.029). Conclusions: Chinese patients with overweight or obesity who experienced a TWL of more than 5% were more likely to reduce high-fat food intake during long-term weight maintenance.
Background and Objectives: Sleeve gastrectomy (SG) is a commonly utilized surgical procedure for managing weight and patients must adopt healthy lifestyle practices and dietary modifications to sustain weight loss and prevent relapse. This study aims to evaluate the dietary habits, levels of physical activity, and weight outcomes among Saudi women post-gastric sleeve surgery. Methods and Study Design: This study involved 352 female participants aged 20 to 50, who had undergone gastric sleeve surgery. The Bariatric Patients Association, Bariatric World and Patients Forum were also used and contacted via phone. Surveys were used to ascertain their physical activity levels and dietary behaviors; a food frequency questionnaire (FFQ) was also utilized and each participant’s BMI was calculated. Results: The study involved 352 women, of whom the highest proportion was in the 40-50 age group. Prior to the surgery, nearly all of the participants (98.9%) were diagnosed as having obesity or morbid obesity, which significantly decreased following the surgery. According to the participants, the primary reason for undergoing the surgery was failed dietary regimens (26.4%). A considerable portion of participants continued consuming dietary supplements post-surgery (35.59%) and frequently consumed juices and sweets. Most of the participants did not meet the WHO recommendations for regular physical activity. Correlation analysis revealed a significant relationship between BMI and the consumption of healthy foods post-surgery. Conclusions: The study identified concerning lifestyle habits among the participants, underscoring the importance of maintaining a healthy diet and engaging in regular physical activity to optimize the long-term benefits of weight loss surgery and enhance overall well-being.
Background and Objectives: Menopausal women with chronic heart failure (CHF) exhibit unique physiological characteristics and prognostic features. The aim of this study is to analyze the significant predictive factors for the prognosis of chronic heart failure in menopausal women and the impact of different nutritional interventions on prognosis. Methods and Study Design: A total of 270 menopausal women with CHF were enrolled in the study and divided into two groups based on the nutritional intervention received. Analyze the significant predictive factors of all-cause mortality, readmission rate, deterioration of cardiac function, deterioration of nutritional status, and deterioration of quality of life, as well as the impact of nutritional intervention on these prognoses. Build a risk score model based on significant factors in the prognostic model. Evaluate the predictive ability of the model through the ROC curve. Results: Multivariate logistic regression analysis showed that NYHA grading BNP, eGFR, The level of estradiol (E2) and nutritional intervention are significant influencing factors in multiple prognostic indicators, among which the enhanced nutritional support and micronutrient supplementation program in nutritional intervention have a significant protective effect on poor prognosis. The constructed nutritional risk model has good discriminative ability and robustness in predicting prognosis. Conclusions: This study identified menopausal characteristics, NYHA classification, BNP, eGFR, and estradiol levels as important prognostic predictors in menopausal women with CHF. Enhanced nutritional support and micronutrient supplementation significantly improved patient prognosis. The risk model based on nutritional intervention provides scientific basis for the management strategy of chronic heart failure in menopausal women.
Background and Objectives: This study aimed to investigate nutritional status of hospitalized Chinese patients according to the Global Leadership Initiative on Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and to identify the effects of nutritional characteristics and nutritional support on clinical good outcome. Methods and Study Design: Inpatients participated in Chinese nutritionDay 2010-2020 surveys were included. Malnutrition was defined according to the ESPEN and GLIM criteria after being risk evaluated by Malnutrition Universal Screening Tool (MUST). Cumulative incidence curves were plotted for 30-day good outcomes in patients according to the ESPEN and GLIM criteria. Cox regression models were used to determine the factors associated with good outcomes in the univariate and multivariable analyses. Results: The prevalence of malnutrition defined by the GLIM criteria (22.8%) was higher than that defined by the ESPEN criteria (16.2%). Patients with malnutrition defined by the ESPEN and GLIM criteria had a significantly prolonged median length of hospital stay (LOS) after nutritionDay compared with non-malnutrition patients (8 days vs. 6 days, p < 0.001). Inpatients defined as nutritionally at-risk by the MUST or malnutrition defined by the ESPEN criteria and the GLIM criteria, and patients with pre-operative conditions, decreased mobility, prolonged LOS over three weeks before nutritionDay, as well as those receiving nutritional support had a reduced chance of good outcome. Conclusions: Nutritional risk or malnutrition and nutritional support were significantly associated with decreased good 30-day outcomes, highlighting the necessity for standardized nutrition training in the healthcare setting.
Background and Objectives: Previous studies have demonstrated that insulin resistance (IR) is associated with atrial fibrillation (AF). As a reliable indicator of IR, the triglyceride glucose (TyG) index has been extensively studied in relation to AF. We aimed to investigate the relationship between the TyG index and AF through a systematic review and meta-analysis. Methods and Study Design: We systematically searched studies published up to August 2024 in online databases including PubMed, Embase, Web of Science, Wanfang, and the China National Knowledge Internet database. Seventeen studies involving 57,213 patients were included in the analysis. A random-effects model and exposure-effect analysis were used to calculate the pooled effect estimate and compute the linear trend. Results: A significantly higher TyG index was observed in AF patients (standardized mean difference [SMD]: 0.78; 95% CI: 0.43- 1.13; p<0.001). The TyG index was associated with the risk of AF in both continuous analysis (odds ratio [OR]: 1.80; 95% CI: 1.50-2.17; p<0.001) and category analysis (odds ratio [OR]: 1.98; 95% CI: 1.35-2.91]; p<0.001). Exposure-effect analysis confirmed a linear positive relationship between the TyG index and the risk of AF (plinearity = 0.006). Conclusions: The TyG index is associated with an increased risk of AF, including pure AF, post-operative AF and AF recurrence after ablation. Further studies are needed to confirm the causal relationship between the TyG index and AF.
Background and Objectives: The incidence of hypertension is higher in individuals with the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype. Riboflavin serves as a coenzyme of MTHFR, but its role in hypertension prevalence is poorly understood. This study aimed to explore the relationship between riboflavin levels and hypertension and the impact of genotype on this relationship. Methods and Study Design: The case-control study used data from the Tianjin Elderly Nutrition and Cognition study, with 200 hypertensive patients and 200 matched non-hypertensive controls. It collected questionnaires, clinical data, and measured blood riboflavin levels using the dried blood spot technique. Conditional logistic regression analyzed variables related to hypertension prevalence, with effects assessed by odds ratios (ORs) and 95% confidence intervals (CIs). Results: The hypertensive group had significantly lower riboflavin concentration than the non-hypertensive group (p<0.001). The regression analysis indicated that regardless of adjustment for sociodemographic characteristics, riboflavin concentration was negatively associated with the prevalence of hypertension. In the multivariable model, the OR was 0.607 [95%CI, 0.507-0.727], p<0.001. Additionally, we found an interaction between MTHFR genotype and riboflavin status. Compared with the combined TT genotype and below-median riboflavin levels as the reference category, the CC genotype and above-median riboflavin levels decreased the prevalence of hypertension (OR, 0.189 [95%CI, 0.071-0.501], p=0.001). Conclusions: In conclusion, riboflavin status impacts the development of hypertension. There is also interaction between the MTHFR genotype and riboflavin. Specifically, low riboflavin status increases the prevalence of hypertension when combined with the MTHFR 677TT genotype.
Background and Objectives: Life’s Essential 8 (LE8) is a comprehensive indicator that evaluates cardiovascular health (CVH). There have been limited studies on the relationship between LE8 and hyperuricemia (HUA). This study explored the association and dose-response relationship between LE8 and HUA among elderly people in China. Methods and Study Design: The subjects were the elderly aged 60 and over who participated in the China Health and Nutrition Survey (CHNS) in 2018. The definition of American Heart Association (AHA) was used to measure the score of LE8. Multivariate Logistic regression and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between LE8 and HUA. Results: A total of 4229 subjects were included, and the prevalence of HUA was 13.2%. The LE8 score was 68.5 points, and physical activity (85.8) and blood pressure (37.6) were the highest and lowest scores, respectively. People with low, medium and high CVH accounted for 5.7%, 77.3% and 17.0%, respectively. Multivariate Logistic regression showed that high CVH in LE8 score reduced the risk of HUA (OR = 0.62, 95%CI = 0.39-0.99) significantly, and the risk decreased by 15% (OR = 0.85, 95%CI = 0.78-0.93) for every 10-point increase in LE8 score. RCS showed a linear dose-response relationship between LE8 and HUA, and the beneficial protective threshold was 68.6 points. The negative association between LE8 score and HUA was more significant in 60-69 years. Conclusions: This study suggested that the elderly in 15 provinces of China were at a moderate level of CVH, and a higher LE8 score was beneficial for reducing the risk of HUA.
Background and Objectives: To investigate the correlation between weight-adjusted-waist index (WWI), a novel obesity index, and serum ferritin (SF) level in patients with type 2 diabetes mellitus (T2DM), and the association between WWI and the prevalence of hyperferritinemia. Methods and Study Design: A total of 943 patients with T2DM were divided into three groups based on WWI tertile levels. Disparities in SF levels and the prevalence of hyperferritinemia were compared among these groups. The correlations among WWI, SF levels, and hyperferritinemia were analyzed in patients with T2DM. Results: : As WWI tertile levels increased, SF levels tended to increase (p for trend <0.01). A statistically significant positive correlation was observed between the WWI and SF levels (R = 0.263, p < 0.001). After adjusting for confounders by multiple linear regression, a significant positive correlation was maintained between the WWI and SF levels [β = 0.194, 95% CI (49.914, 112.120)], p < 0.01]. Binary logistic regression analysis revealed a positive association between the WWI and the likelihood of hyperferritinemia, with a notably stronger correlation observed in females compared to males [OR = 3.248, 95% CI (2.027, 5.204), p < 0.01 vs. OR = 2.091, 95% CI (1.432, 3.054), p < 0.01]. Conclusions: Along with increasing WWI, SF levels gradually increased in patients with T2DM. The WWI exhibited a positive correlation with SF levels and hyperferritinemia, more significantly in female patients.
Background and Objectives: Repeating food frequency questionnaires (FFQs) within the same population was reported to improve the validity of correlation coefficient (CC). However, the enhancement of validity in ranking agreement remains underreported. Herein, we assessed the validity of energy and nutrient intake estimates using single and multiple FFQs and their ability to rank individuals. Methods and Study Design: 213 men and women aged ≥20 years were recruited from the residents participating in the Tohoku Medical Megabank Project (TMM) cohort studies; three FFQs were conducted in November each year from 2019 to 2021, with 12-day weighted food records (WFRs) as the reference method. Spearman’s rank CCs were calculated between single or multiple FFQs estimates and those obtained through the 12-day WFR. Additionally, the ranking agreement was compared based on cross-classification. Results: CCs between intake estimated using a single FFQ and 12-day WFR were moderate for several nutrients, with median CCs of 0.52 for men and 0.48 for women. CCs for multiple FFQs were slightly higher than that of single FFQ, with median CCs of 0.59 for men and 0.56 for women. Regardless of the number of FFQs, the proportion of subjects classified into the opposite extreme category was ≤5% for most nutrients. Conclusions: A single FFQ used for adults in the TMM cohort studies showed moderate validity. Estimates from multiple FFQs improved the accuracy slightly; nevertheless, this indicates that relying on a single FFQ is unlikely to result in a serious misclassification compared to using intake data from multiple FFQs over a relatively short period.
Background and Objectives: Acquired acrodermatitis enteropathica (AE), a rare dermatological condition, often stems from nutritional zinc deficiency linked to prolonged total parenteral nutrition (TPN). This study aims to explore the pathogenesis, clinical characteristics, and treatment approaches for AE, emphasizing the importance of early recognition and intervention. Methods and Study Design: A 51-year-old female patient with acquired AE presented with widespread erythema, pustules, and itching. A comprehensive diagnostic approach, including various tests and skin biopsy pathology, confirmed the diagnosis. Treatment involved zinc gluconate supplementation, topical applications, and symptomatic TPN support. Results: Significant improvement was noted one week post-treatment, with reduced erythema, pustules, and skin lesions, alongside improved hair loss. Erosive and ulcerative surfaces healed substantially, indicating positive treatment outcomes. Conclusions: The successful management of adult-onset AE in this case underscores the significance of recognizing clinical features and implementing effective treatment strategies. These findings provide valuable insights for diagnosing and managing AE.
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a disease characterized by malnutrition, a catabolic process, and chronic inflammation; thus, vitamin deficiency may occur frequently. We aimed to evaluate the levels of micronutrients in stable COPD patients. Methods and Study Design: There were 168 COPD patients from six pulmonology departments, with 36 healthy controls. The patients also performed pulmonary function tests and filled out the St. George's Respiratory Questionnaire (SGRQ). Serum vitamin B-12 and folate levels were measured using the chemiluminescence immunoassay (CLIA) method. Plasma 25-OH D3 levels were measured by high-performance liquid chromatography (HPLC). Results: Our results revealed vitamin D deficiency in 68.9% (mild: 59.6%, intermediate: 25.7%, severe: 14.7%), vitamin B-12 deficiency in 21.7%, and folic acid deficiency in 50% of COPD patients. There was a significant difference between the COPD and healthy control groups regarding vitamin D deficiency (68.9% vs. 16.6%; p <0.001). Mean plasma 25-OH-D level was significantly lower in COPD patients (p <0.01). There was a positive correlation of plasma 25-OH-D level with the SGRQ impact score (r = 0.174, p = 0.028) and a negative correlation with age and number of exacerbations (respectively; r = -0.248, p = 0.002, and r = -0.160, p = 0.044). Conclusions: Vitamin D, B-12, and folate deficiencies frequently occur in COPD patients. Low plasma levels of 25-OH-D may be associated with advanced age and a higher number of exacerbations in patients with COPD. COPD patients with low vitamin D and folate may experience a decrease in quality of life.
Background and Objectives: Children with developmental disabilities commonly experience feeding problems; however, tools to assess the nature and extent of these difficulties are not available in Arabic. This study aims to validate the Arabic version of the Screening Tool for Feeding Problems (STEP) and evaluate its factorial structure in children with developmental disabilities. Methods and Study Design: This cross-sectional study involved 167 children with developmental disabilities, recruited from nine disability centers and schools in Madinah, Saudi Arabia. Data were collected from caregivers using a paper version of the Arabic version of STEP, which was sent home with the child along with a consent form for signature. The English-to-Arabic translation of the tool was conducted by a bilingual professional using the forward-backward translation method. Results: Confirmatory factor analysis was performed to evaluate the factorial structure of the Arabic version of STEP using two models. Model 1 included all 23 items; Model 2 excluded six items with low factor loadings, resulting in a 17-item version. Model 2 demonstrated improved goodness of fit indices, supporting a modified five-factor structure. Reliability analysis showed acceptable internal reliability for the total scale in both models, with Cronbach’s alpha of 0.80 and McDonald’s omega of 0.79 for Model 1, and alpha of 0.83 and omega of 0.82 for Model 2. Internal consistency for individual factors ranged from 0.31 to 0.70. Conclusions: The Arabic version of STEP demonstrates satisfactory psychometric properties and appears to be a valid and reliable tool for screening feeding difficulties in children with developmental disabilities in the Saudi Arabian context.
Background and Objectives: Healthy diets are crucial in disease prevention and balanced diets can slow telomere shortening. Currently, it is still unclear which dietary factors are causally related to telomere length. Methods and Study Design: The inverse variance weighted, Mendelian Randomization-Egger, weighted median, simple mode, and weighted mode methods were used. Additionally, heterogeneity, pleiotropy, MR-PRESSO and leave-one-out tests were conducted to ensure accuracy. Outcomes included granulocyte, lymphocyte, naive T-cell, memory T-cell, B-cell, and natural killer-cell telomere lengths. Exposures included alcohol intake frequency, alcoholic drinks per week, average weekly beer plus cider intake, average weekly red wine intake, intake of beef, bread, cereal, coffee, cooked vegetable, dried fruit, fresh fruit, lamb/mutton, non-oily fish, oily fish, pork, processed meat, salad/raw vegetable, tea and water. Results: The positive causal relationships were found between dried fruit intake and granulocyte telomere length (OR: 4.31; 95% CI: 1.29 to 14.4; p = 0.02), lymphocyte telomere length (OR: 4.22; 95% CI: 1.21 to 14.7; p = 0.02), naive T-cell telomere length (OR: 5.49; 95% CI: 1.58 to 19.0; p = 0.01). Oily fish intake was positively associated with memory T-cell telomere length (OR: 2.55; 95% CI: 1.16 to 5.58; p = 0.02). No significant causal relationships were found between other exposures and outcomes. Conclusions: This study found positive causal associations between telomere length and the intake of dried fruit and oily fish. No significant causal relationships were observed with other dietary factors. These findings provide insights into how specific dietary components may help maintain telomere length.
Background and Objectives: Consuming refined white rice, a staple food in most Asian countries, reportedly causes postprandial hyperglycemia and facilitates the development of diabetes. However, cereal grains with low glycemic indices may reduce the postprandial glycemic response. We developed a highland barley-multigrain rice by combining traditional Chinese grains including, highland barley, brown rice, oats, corn grit, and buckwheat. This study aimed to evaluate the glycemic impact, sensory attributes, and appetite response of our highland barley-multigrain rice compared to white rice. Methods and Study Design: In this randomized crossover trial, ten healthy participants consumed highland barley-multigrain rice, white rice, and glucose, each containing 50 g of available carbohydrate under continuous glucose monitoring to compare postprandial glycemic responses over 180 min. The sensory and appetite ratings for the test foods were also evaluated. Results: The glucose response of highland barley-multigrain rice, based on the incremental area under the curve and peak glucose change levels, showed statistically lower values than white rice. The glycemic index at 120 min (42.9±4.4 vs.79.5±8.0, p <0.001) and 180 min (45.3±4.7 vs. 86.1±8.7, p <0.01) after the consumption of highland barley-multigrain rice was all significantly lower than those of regular white rice. Despite its relatively poor taste and overall preference rating, the highland barley-multigrain rice achieved a higher satiety score at 120 min after intake than white rice. Conclusions: As a low-glycemic index food, highland barley-multigrain rice could decrease postprandial glucose response and reduce hunger in healthy adults, indicating a potential role in improving glycemic control for patients with diabetes.
Background and Objectives: The aim of this study was to investigate the effect of dietary iron and zinc intake on the risk of preterm labor before and during different trimesters, and to assess whether there is an interaction between iron and zinc intake and the risk of preterm labor. Methods and Study Design: The study was a nested case-control study of 880 cases and 8017 controls in Lanzhou City, northwest China. Unconditional logistic regression was used to determine the association between dietary iron/zinc intake and the risk of preterm labor and its clinical subtypes. Multivariable-adjusted restricted cubic spline (RCS) modeling was used to explore the non-linear relationship between dietary iron/zinc intake levels and the risk of preterm birth. Lower iron/zinc intake before and during pregnancy was associated with a higher risk of preterm labor and some of its subtypes, and there was a non-linear trend between iron/zinc intake and risk of preterm labor (pnon-linear<0.05). A synergistic effect of low iron and zinc intake on the risk of preterm labor was also observed. Results: We observed a significant increase in the risk of preterm labor in women with low dietary zinc intake before and during pregnancy, with a dose-response relationship. Similarly, there was a significant negative association between lower dietary iron intake during pregnancy and preterm labor. In addition, there was a multiplicative interaction between low dietary iron and zinc intake and preterm delivery before pregnancy and during three different periods of pregnancy. Conclusions: Higher dietary intake of iron and zinc before and during pregnancy may reduce the risk of preterm labor. Low intakes of iron and zinc during pregnancy appear to have a synergistic effect on the risk of preterm labor.
Background and Objectives: Type 2 diabetes mellitus (T2DM) has emerged as a significant global public health concern. Multiple studies have shown that traditional nutraceuticals are potential to treat T2DM and its complications. This review will explore traditional nutraceuticals with antidiabetic properties with a focus on traditional Asian nutraceuticals and their antioxidant effects on gene expression associated to T2DM. Methods and Study Design: Literature searching was conducted in Pubmed, Scopus, and Science Direct using the keywords “nutraceutical”, “antidiabetic”, "insulin resistance", "Diabetes Mellitus", "herbal medicine", “mechanism”, “pathway”, "traditional food", "functional food", “antioxidant”, “clinical”, “preclinical”, "animal studies", and “Asian” combined with Boolean operators “OR”. Results: Nutraceuticals sourced from traditional Indonesian herbal beverages, including Galohgor, Bir Pletok, and Wedang Uwuh, have shown potential efficacy in reducing hyperglycemia, oxidative stress, and obesity in type 2 diabetes mellitus (T2DM). Furthermore, multiple Asian plants and their bioactive compounds, such as curcumin, kaempferol, cinnamon, saponin, quercetin, myricetin, anthocyanin, terpenoid, alkaloid, and gallic acid, have been shown to beneficially influence glucose homeostasis, insulin sensitivity, and problems associated with diabetes. Moreover, bioactive compounds of these traditional nutraceuticals have been proven in modulating gene expression associated with β-cell function, insulin signaling pathway, and antioxidant activity, which may offer a new therapeutic target. Conclusions: This review highlights the increasing scientific evidence on the role of traditional nutraceuticals for the prevention and management of diabetes mellitus, presenting promising alternatives to standard pharmacological therapy. Nonetheless, double-blind randomized clinical trials are required to validate these antidiabetic effects.
Background and Objectives: Stunting is a global health challenge, especially in developing countries like Indonesia, where its prevalence reached 21.6% in 2022. This condition stems from malnutrition, recurrent infections, and inadequate care during the first 1,000 days of life. Maternal nutrition is critical for fetal growth, as deficiencies can lead to low birth weight and short birth length, increasing the risk of stunting. This study evaluates the potential of fortified tempeh as a nutritional intervention to improve birth outcomes. Methods and Study Design: A quasi-experimental study with a quantitative approach was conducted to compare the effects of regular and fortified tempeh on BW and BL among pregnant women in Kuningan Regency. Participants were divided into two groups: one receiving fortified tempeh and the other regular tempeh. BW and BL were measured at birth and statistically analyzed for differences. Results: The results showed no statistically significant differences in BW and BL between the two groups. However, the fortified tempeh group exhibited a positive trend, with an average BW of 2.92 kg and an average BL of 49.12 cm, compared to the regular tempeh group. Conclusions: Fortified tempeh demonstrates potential as a cost-effective, locally sourced intervention to support fetal growth and reduce stunting risks. Its integration into public health programs could enhance maternal nutrition and improve birth outcomes in Indonesia.
Background and Objectives: Vitamin D deficiency has been linked to urticaria, but causality remains uncertain. We used Mendelian randomization (MR) to investigate potential causal effects of vitamin D and its metabolites on urticaria risk. Methods and Study Design: Summary statistics from genome-wide association studies of total 25-hydroxyvitamin D [25(OH)D] (n=120,618), 25-hydroxyvitamin D3 [25(OH)D3] (n=40,562), and C3-epimer-25-hydroxyvitamin D3 [C3-epi-25(OH)D3] (n=40,562) in Europeans were used, along with data on urticaria and its subtypes from FinnGen consortium (R10 release). For validation, we performed additional MR analyses using a larger dataset that meta-analyzed data from the UK Biobank and GWAS results from the SUNLIGHT consortium (n=496,946) as exposure variables. We performed comprehensive sensitivity analyses, including heterogeneity tests, pleiotropy assessments, and leave-one-out analyses to evaluate result robustness. Statistical power calculations were conducted to validate the reliability of our findings. Results: MR analysis revealed a causal protective effect of higher total 25(OH)D levels on urticaria risk (odds ratio [OR] = 0.807, 95% confidence interval [CI]:0.688-0.945, p = 0.008, statistical power = 81.10%). Similar causal effects were observed for 25(OH)D3 levels (OR = 0.851, 95% CI: 0.739-0.978, p = 0.023, statistical power = 67.40%).These findings were validated in the replication cohort using serume 25(OH)D measurements (OR = 0.692, 95%CI: 0.560-0.854, p = 0.001, statistical power = 96.10%). Sensitivity analyses showed no significant heterogeneity or pleiotropy. Reverse MR analysis found no genetic risk of urticaria affecting vitamin D levels, suggesting a potentially unidirectional causal relationship. Conclusions: This study provides the first genetic evidence that higher vitamin D levels may reduce urticaria risk, offering new theoretical basis for urticaria prevention and treatment strategies.
Background and Objectives: The presence and accumulation of inflammation may exacerbate the development of dyslipidemia. Therefore, this study aimed to explore the relationship between blood inflammatory markers and the dietary inflammatory index (DII) in American adults as well as their association with dyslipidemia. Methods and Study Design: This cross-sectional study included participants with complete data on lipid levels, dietary intake, and blood inflammatory markers. The associations between dyslipidemia and two sets of exposures—blood inflammatory markers and the DII—were analysed using weighted univariate and multivariate logistic regression models. Results: Among the 9,441 participants (2009–2018), 6,689 (70.9%) had dyslipidemia. Logistic regression analysis revealed that higher DII quartiles were significantly associated with an increased risk of dyslipidemia, with the fourth quartile exhibiting an odds ratio of 1.33 (95% CI: 1.10–1.62; p < 0.001). Furthermore, DII combined with various blood inflammatory markers was consistently associated with an increased dyslipidemia risk (all OR > 1.0, all p < 0.05). A non-linear relationship was observed between the systemic immune-inflammation index (SII) and dyslipidemia risk, which became significant when the SII exceeded 434.65. Conclusions: DII and blood inflammation markers showed a positive association with dyslipidemia. Nonetheless, these findings still offer valuable insights to public health policymakers for developing evidence-based strategies to prevent dyslipidemia and potentially reduce inflammation-associated dyslipidemia risk.
Background and Objectives: Dietary nutrition plays an essential role in the progression of chronic obstructive pulmonary disease (COPD). This study aimed to use Chinese Healthy Eating Index (CHEI) to evaluate dietary quality in COPD patients and investigate the relationship between dietary quality and COPD disease severity. Methods and Study Design: A total of 525 COPD inpatients were collected from December 1st, 2022, to December 1st, 2023. The dietary intake was collected through food frequency questionnaires (FFQ), and diet quality was assessed by the CHEI. Modified Medical Research Council Dyspnea Scale (mMRC), the COPD assessment test (CAT), and Global Initiative for Obstructive Lung Disease (GOLD) stage were used to assess disease severity. Multivariable logistic regression was used to analyze the association between the total CHEI score, and its component scores and COPD disease severity. Results: The CHEI score with COPD patients is 56.75±8.89. The CAT score of the low CHEI group was significantly higher than that of the high CHEI group (p<0.05). Ordinal logistic regression analysis indicated that the group with higher CHEI total scores was significantly associated with the low grade of mMRC (OR: 0.982, 95%CI: 0.964, 1.000, p<0.05). And the higher intake of tubers, whole grains and mixed beans, and fish and seafood were all associated with lower mMRC grades (p<0.05). Conclusions: COPD patients have poor dietary quality. High CHEI scores were associated with the low mMRC grades. Patients with COPD should be encouraged to maintain a good quality diet to reduce the risk of disease exacerbation.
Background and Objectives: Tuberculosis (TB) is associated with a number of non-communicable diseases including hypertension. The aim of this study is to determine the prevalence of hypertension in TB patients and investigate associated risk factors. Methods and Study Design: A hospital based cross-sectional study was conducted in Qingdao, China. Patients diagnosed of TB in Qingdao Chest Hospital between July 2011 and December 2019 were recruited. Basic information of each participant was obtained from face-to-face questionnaire, including relevant demographic characteristics, medical history, diet intake, alcohol consumption and smoking. Blood pressure was measured at admission by standard method. Logistic regression analysis was used to determine the association of possible risk factors of prevalent hypertension. Results: Totally, 2159 TB patients were included in the final analysis. Among them, 485 (22.5%) were hypertensive. Multivariate logistic regression showed that hemoglobin (HGB) ≥143 (OR 95% CI 2.29, 1.50 ~ 3.50) , age >35 (OR 95% CI 3.21, 2.16 ~ 4.76), overweight or obesity (OR 95% CI 2.14, 1.54 ~ 2.95) , heavy drinking (OR 95% CI 1.81, 1.32 ~ 2.49) and concurrent DM (OR 95% CI 1.50,1.10 ~ 2.03) were associated with increased risk of hypertension in TB patients. Conclusions: Nearly 25% of TB patients have high blood pressure. High HGB, being overweight or obese, alcohol abuse, and DM are associated with higher odds of hypertension in TB. Our study provides important evidence for understanding the prevalence of hypertension in TB, underlying the double burden of TB and hypertension.
Background and Objectives: Hashimoto's thyroiditis (HT) is an autoimmune disease, characterized by abnormal elevation in thyroid peroxidase antibody and/or thyroglobulin antibody. In recent decades, HT disease has become more and more widespread. Patients always report multiple symptoms, even though their thyroid hormone levels are kept in normal ranges. However, no treatment exists to effectively reduce the levels of thyroid antibodies. Our study aims to determine whether calorie-restricted diet is helpful in improving health of HT patients. Methods and Study Design: This is a 3-month randomized controlled trial. HT patients will be randomized into a calorie-restricted (CR) group or a calorie-unrestricted control group. All the participants will be instructed to consume a diet that includes a combination of 45-55% calories from carbohydrates, 20-30% from fats, and 15-25% from proteins, according to current Chinese Dietary Guidelines. Participants in CR group need to limit their calories intake equal to their basal energy expenditure, which means that their daily caloric intake will be limited by about 20-30%. Results: The study population is planned to be 66 HT patients aged 18 to 65 years. The primary outcome is change of thyroid antibody levels from baseline. Secondary outcomes include the changes of non-hypothyroid symptoms scores, thyroid function indexes, morphology of thyroid, T lymphocyte subpopulations, inflammatory biomarkers and lipids from baseline to 12 weeks. Conclusions: This trial will have implications for nutrition treatment policy in regard to thyroid antibodies control, immune dysfunction and related non-hypothyroid symptoms improvement among HT patients.
Background and Objectives: Mechanism studies have indicated that magnesium (Mg) and calcium (Ca) had important biological functions in glucose regulation, but epidemiological data on their associations with glycosylated hemoglobin (HbA1c) are sparse. We aimed to explore the associations of Mg and Ca with abnormal HbA1c, and examined the mediating effects of inflammation in coronary artery disease (CAD) Chinese adults. Methods and Study Design: A hospital–based cross–sectional study of 11934 patients with CAD was conducted. Serum Mg and Ca concentrations were measured. Results: In multivariable analyses, Mg and Mg/Ca ratio were inversely associated with abnormal HbA1c (Q4 vs Q1: ORMg: 0.61, 95% CIMg: 0.53, 0.71; ORMg/Ca ratio: 0.67, 95% CIMg/Ca ratio: 0.54, 0.84). However, null association of Ca with abnormal HbA1c was shown (Q4 vs Q1: OR: 1.15, 95% CI: 0.92, 1.44). Serum Mg and Mg/Ca ratio were inversely associated with abnormal fasting blood glucose (FBG). In contrast, serum Ca was positively associated with abnormal FBG. Path analysis indicated that there were no mediating effects of hypersensitivity C reactive protein (hsCRP) on Mg and Mg/Ca-abnormal HbA1c associations. Conclusions: Our study suggested that serum Mg and Mg/Ca ratio were inversely associated with abnormal HbA1c in Chinese adults with CAD. The Mg-abnormal HbA1c relationship might not be mediated by hsCRP.
Background and Objectives: This study aimed to assess the predictive power of the Geriatric Nutritional Risk Index (GNRI) and the triglyceride-glucose (TyG) index for poor prognosis in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients post-percutaneous coronary intervention (PCI). Methods and Study Design: A cohort of 393 NSTE-ACS patients who underwent PCI at the People’s Hospital of Nanjing Jiangbei from 2016 to 2022 was analyzed. Major adverse cardiovascular events (MACEs), including death, non-fatal myocardial infarction, and target vessel revascularization, served as the primary outcome. Relationships between GNRI, TyG index, and MACEs were explored using univariate and multivariate logistic regression, with results presented as odds ratios (OR) and 95% confidence intervals (CI). The predictive value was further evaluated using the area under the curve (AUC) from the receiver operating characteristic (ROC) curve. Results: MACEs occurred in 34 patients. A TyG index ≥1.359 was associated with a significantly increased risk of MACEs (OR=5.07, 95%CI: 1.64-15.71), while a GNRI ≥107.514 indicated a decreased risk (OR=0.17, 95%CI: 0.04-0.68). These associations were consistent across various subgroups, including age, gender, and specific pre-existing conditions. The combined predictive value of TyG index and GNRI was higher than each alone (AUC=0.711, 95%CI: 0.642-0.779). Conclusions: In post-PCI patients with NSTE-ACS, the TyG index and GNRI are significant predictors of MACEs, with the TyG index indicating higher risk and GNRI lower risk. Their combined use may enhance the predictive accuracy for MACEs in this patient population.
Background and Objectives: Consuming a diet that ensures adequate nutrient intake is essential to address all forms of malnutrition. In Japan, a meal combining staple food, main dish, and side dish is considered a balanced diet. This study was conducted to investigate the frequency of meals combining staple food, main dish, and side dish associated with nutrient adequacy. Methods and Study Design: This cross-sectional study included 6,264 adults. All data were obtained from the 2015 Health and Nutrition Survey in Shiga prefecture. Staple food, main dish, and side dish were each defined as a dish with primary ingredients of ≥50 g. Regarding the frequency, participants were divided into ≥2 and <2 times/d groups. The nutrient adequacy evaluated using the Dietary Reference Intakes for Japanese 2020 (DRIs–J) score is based on the reference values provided in the DRIs–J. The t-test was used to evaluate nutrient adequacy between the 2 groups. Results: Of the total participants, only 1,423 (22.7%) were classified into the ≥2 times/d group, and they had significantly higher DRIs–J scores than participants in the <2 times/d group (p < 0.001). The adequacy percentage of all nutrients except saturated fatty acid, particularly dietary fiber and most micronutrients, was >1.5-fold higher in the ≥2 times/d group than in the <2 times/d group (p < 0.001). Conclusions: This study provides important information that meals combining staple food, main dish, and side dish at least twice a day is effective in maintaining a diet with high nutrient adequacy.
Background and Objectives: To explore the nutritional challenges and its influencing factors of adults aged 40-69 living in Chinese cities. Methods and Study Design: This cross-sectional study involved 300 subjects from 29 cities in China. Questionnaires were used to collect demographic information, presence of chronic disease, and the use of nutritional supplements and fortified foods. 24-hour food intake was recorded using the Eat-Right Assistant, a validated digital service. Results: Fiber (56.7%), calcium (66.3%) and selenium (67.0%) were the nutrients with the highest insufficient intake. The foods with the highest inadequate consumption were dairy products (91%), fruits (84.3%), tubers (76.3%), soybeans and nuts (70%), and whole grains (65%). Even though 95.7% of the study population showed medium-high level of dietary diversity, dietary imbalance was present among 99% of the subjects. Higher socioeconomic status, passive health awareness, or the use of nutritional supplements or fortified foods, showed positive influence on nutrient intake and dietary quality. Conclusions: This research provided insights into the dietary intake status and its influencing factors of 300 urban residents aged 40-69. The adult population still face a challenge of inadequate nutrient intake and imbalanced diet. In addition, this study supported the feasibility of using a digital service in research. Further studies with a larger sample size are needed to confirm current findings. This will help to clarify the unmet nutritional needs of adults in China and thus help to achieve healthy aging.
Cow’s milk protein allergy is an adverse immune reaction to proteins found in cow’s milk, primarily casein and whey, affecting artificially fed, breastfed and mixed-fed infants. The immunological mechanisms involved lead to diverse clinical presentations, most commonly impacting the digestive and respiratory systems, as well as the skin. Diagnosis relies primarily on clinical evaluation due to the absence of specific diagnostic tests, making accurate identification crucial to prevent misdiagnosis or underdiagnosis. Treatment requires strict avoidance of cow’s milk proteins in both children’s and breastfeeding mothers’ diets, with close monitoring of nutritional status during long-term management. Recent advancements in treatment, including the use of probiotics, provide new options for improving clinical outcomes. This narrative review aims to provide clinicians with evidence to standardise diagnosis and treatment, improve food allergy management by non-allergy specialists and develop accurate feeding recommendations.
Background and Objectives: This study aimed to analyze the relationship between thyroid volume (TVOL) and physical development of children, and explore the suitable TVOL correction methods. Methods and Study Design: 1500 children aged 8-10 years from Gansu Province northwest China were selected. The height (H), weight (W), urine iodine of children was measured and their thyroid was examined by ultrasound. Body mass index (BMI), body surface area (BSA) and TVOL were calculated (BSA was calculated by three formulas), and the relationship between TVOL and age, sex, physical development was analyzed. The applicability of TVOL correction methods including BMI corrected volume (BMIV), BSA corrected volume (BSAV), weight and height corrected volume indicator (WHVI) and height corrected volume indicator (HVI) were compared. Results: Median urinary iodine concentrations of children aged 8, 9, 10 years were 166.6 μg/L, 167.2 μg/L and 178.8 μg/L respectively. The rate of iodine deficiency was 20.3%, the rate of thyroid goiter was 3.2%. The physical development indexes (height, weight, BMI and BSA) and TVOL increased with age. The physical development indexes (height, weight, BMI and BSA) of boys were higher than girls (p <0.05). Only BSAV1 had no correlation with all physical development indexes (p >0.05). The TVOL P97 (97th percentile) of children aged 8, 9, 10 years were 4.4 ml, 4.9 ml, 6.5 ml, the values were 4.6 mL, 4.7 mL, 5.9 mL after BSAV1 corrected. The difference between TVOL and BSAV1 ranges from -0.37% to 0.36%. Conclusions: The thyroid volume is not only affected by age, but it is also affected by physical development. Thyroid goiter should be assessed based on age and physical development. The formula BSAV1=TVOL/ (W0.425×H0.725×71.84×10-4) was a suitable TVOL correction method.
Background and Objectives: Exploring the effects of circulating micronutrients on Graves' disease (GD) through observational research or randomized controlled trials has drawn more attention. In order to investigate the putative causal inference, we provide an illustrative estimate of two-sample Mendelian randomization (MR) study. Methods and Study Design: Inverse-variance weighted (IVW) method was employed as the primary approach to determine the causal relationships between micronutrients level and GD. Several complementary sensitivity analyses were also undertaken to evaluate the impact of potential violations of MR assumptions. In addition, we utilized cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) to analyze the differences in the prevalence of GD among participants with different levels of trace nutrient concentrations. Results: In terms of vitamins, IVW MR analysis revealed a suggestive relationship between each standard deviation decrease in vitamin D level and increased risk of GD (OR=1.28, 95% CI: 1.04-1.59, p = 0.0212). A nominally significant association was also noted for genetically predicted vitamin B-6 concentration and higher risk of GD (OR=1.56, 95% CI: 1.08-2.25, p = 0.0171). Genetically predicted concentrations of other vitamins level and 6 minerals levels were not in association with GD susceptibility. The causal estimates from other complementary MR approaches were consistent with these findings. Additionally, we found that participants from NHANES with vitamin D and VB-6 deficiency had a higher prevalence of GD. Conclusions: Our study provides an obvious unidirectional causality of circulating vitamin B-6 and vitamin D with GD. Dietary supplementation with micronutrients may be a complement to classical therapies for preventing and treating GD.
Background and Objectives: Patients with gastrointestinal (GI) malignancies are at high risk for malnutrition because of reduced food intake, poor digestion, and altered absorption. Methods and Study Design: In a retrospective review of medical records for patients admitted to urban hospitals in an Asian nation for GI tumor surgery (gastric, colon, or anorectal cancers), we found that malnutrition was common yet often overlooked. Our review identified records for 349 adult GI-tumor surgery patients. The Nutrition Risk Screening-2002 (NRS-2002) was the most frequently used screening instrument. In further review, we compared outcomes for malnourished GI tumor surgery patients given daily oral nutritional supplements (ONS) to outcomes for patients who were not given ONS. Results: Review of results revealed that only 20% of patients in our sample underwent nutritional screening or assessment on admission. Of those who did, nearly 60% were malnourished. Although due to small sample sizes, no statistically significant differences were observed, malnourished patients who received ONS had fewer complications and shorter lengths of stay by 1-day. Such findings reveal many missed opportunities to improve patient outcomes and to avert excess healthcare costs for treatment of complications, slowed recovery, longer hospital stays, and readmissions. Conclusions: Based on our findings, nutritional training for professionals is necessary to address the serious problems of under-recognition and inadequate treatment of malnutrition in hospitalized patients.
Background and Objectives: Obese and diabetic individuals tend to have insulin resistance, but are less likely to develop osteoporosis. The association of triglyceride-glucose (TyG) related indices with osteoporosis remains controversial, and longitudinal evidence exploring the male osteoporosis (MOP) is limited. This study aims to examine TyG, TyG-body mass index (TyG-BMI) and the metabolic score for insulin resistance (METS-IR) with osteoporosis risk among older men. Methods and Study Design: A cohort study based on 1622 middle-aged and older men in 2015 was conducted, and followed up until 2022. Participants with osteoporosis and admittedly secondary risk factors were excluded. TyG, TyG-BMI, METS-IR and corresponding quantiles were calculated. Cox proportional hazard regression models were used to assess the hazard ratios (HRs) and 95% confidence interval (CI). Receiver operating characteristic (ROC) curve was applied to estimate their performance in osteoporosis screening. Results: 72 of 1622 participants were newly developed OP during the 9317 person-years. The adjusted HRs of TyG, TyG-BMI, and METS-IR for MOP were 0.573 (95%CI 0.336-0.976), 0.991(95%CI 0.984-0.999) and 0.929 (95%CI 0.892-0.968), respectively, and presented at linear dose-response relationships. Subgroup analysis showed that the estimated benefit for MOP incidence was consistent among participants aged more than 70 years and related to BMI and eating mount of milk, fresh fruit and vegetables. No difference was found in the area under ROC curve for screening osteoporosis, ranging from 0.585 to 0.617. Conclusions: TyG and relevant indices were associated with the incidence of osteoporosis in the senile men, and the relationship was thought to correlate with BMI and nutritional behaviors.
Background and Objectives: Protein-energy wasting (PEW) is common among maintenance hemodialysis (MHD) patients and is strongly associated with mortality and adverse outcomes. This study aimed to assess the effects of low-protein energy supplements on the nutritional status of MHD patients with PEW. Methods and Study Design: We conducted a prospective randomized controlled trial in 68 MHD patients suffering from PEW. Patients randomized to the intervention group received dietary counseling along with daily low-protein supplements containing 212 kcal of energy and 2.4 g of protein every day for 3 months. The control group received dietary counseling only. Dietary data, nutritional assessments, anthropometric measurements, bioelectrical impedance analysis and blood analysis were collected at baseline and after three months from both groups. Results: Fifty-nine MHD patients completed the study. Patients in the intervention group showed an increase in energy intakes (p < 0.001). A significant decrease in the Malnutrition Inflammation Score (MIS) (p < 0.001) and Nutrition Risk Screening 2002 (p < 0.001) were found in the intervention group compared with the control group. Moreover, significant improvements in mid-upper arm circumference (p < 0.001), mid-arm muscle circumference (p < 0.001), albumin (p = 0.003), and prealbumin (p = 0.033) were observed in the intervention group compared with the control group. Conclusions: The combination of oral low-protein supplements and dietary counseling for three months was more effective than dietary counseling alone in terms of improving the nutritional status of MHD patients with PEW.
Background and Objectives: Globally, there is an increasing trend in the number of individuals utilizing home enteral nutrition (HEN). In China, HEN is currently at a nascent stage. We aim to investigate the current situation of home enteral tube feeding (HETF) caregivers to provide more convenient services and assistance to them in China. Methods and Study Design: We conducted a questionnaire survey among family caregivers of enteral tube feeding patients preparing for hospital discharge to assess their awareness, needs, and preferences for resources. Results: 108 family caregivers were recruited in the study. 65 caregivers were considered proficient in tube feeding knowledge, while 43 were not, resulting in a non-proficiency rate of 39.8%. Education levels (p <0.001), employment status (p = 0.029), and the patients’ age-adjusted Charlson Comorbidity Index (aCCI) (p = 0.032) were the critical factors affecting the caregivers’ tube feeding knowledge. The risk of non-proficiency in tube feeding knowledge was increased for those with lower education levels compared with those with higher education levels (OR=5.08, 95% CI: 1.77-14.52). The family’s monthly income and expenditure (p = 0.030) was the sole factor impacting the type of tube feeding service needs. Conclusions: Providing tube feeding knowledge to HETF patients and their caregivers before discharge is essential. Personalized training, especially for caregivers with lower education levels, can improve their understanding. Additionally, implementing online nutrition follow-ups and Nutrition-Nursing Joint Clinics can help address healthcare resource disparities and offer more accessible services to HETF patients in China.
Background and Objectives: Critically ill patients require individualized nutrition support, with assessment tools like Nutrition Risk Screening 2002 and Nutrition Risk in the Critically Ill scores. Challenges in continuous nutrition care prompt the need for innovative solutions. This study develops an artificial intelligence assisted nutrition risk evaluation model using explainable machine learning to support intensive care unit dietitians. Methods and Study Design: Ethical approval was obtained for a retrospective analysis of 2,122 patients. Nutrition risk assessment involved six dietitians, with 1,994 patients assessed comprehensively. Artificial intelligence models and shapley additive explanations analysis were used to predict and understand nutrition risk. Results: High nutrition risk (35.16%) correlated with elder age, lower body weight, BMI, albumin, and higher disease severity. The AUROC scores achieved by XGBoost (0.921), CatBoost (0.926), and LightGBM (0.923) were superior to those of Logistic Regression. Key features influencing nutrition risk included Acute Physiology and Chronic Health Evaluation II score, albumin, age, BMI, and hemoglobin. Conclusions: The study introduces an artificial intelligence assisted nutrition risk evaluation model, offering a promising avenue for continuous and timely nutrition support in critically ill patients. External validation and exploration of feature relationships are needed.