The clinical nutrition case study is a neglected area of activity and publication. This may be in part be- cause it is not regarded as a serious contributor to evidence-based nutrition (EBN). Yet it can play a valu- able part in hypothesis formulation and in the cross-checking of evidence. Most of all, it is usually a point at which the operationalisation of nutrition evidence is granted best current practice status.
The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical monitoring guidelines, two groups of patients, those given PN before (n = 106) NST intervention and those given PN after (n=106) NST intervention, were retrospectively compared. Intervention by the NST significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01); potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05) and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly re- duced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved ad- herence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospi- tal stay, patient mortality, and duration of PN were similar in both groups. This study failed to demon- strate that the establishment of a NST gave better outcomes in terms of the common measures of effec- tiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality rates and length of hospital stay.
Background: It has been reported that adequate calcium intake decreases body fat and appropriate intakes of magnesium suppress the development of the metabolic syndrome. Furthermore, lactulose increases the absorption of calcium and magnesium. An optimal combination of calcium, magnesium and lactulose may therefore reduce body fat mass. Methods: An open-label randomized controlled trial was conducted to investigate the body fat- reducing effects of a test food containing 300 mg calcium, 150 mg magnesium, and 4.0 g lactulose. Body compo- sition parameters and blood hormone and urine mineral concentrations were measured at baseline and at 6 and 12 months thereafter. Whole-body fat mass was measured with dual-energy x-ray absorptiometry. Results: Sev- enty-six middle-aged Japanese women (47.5±4.7 years) were randomized to the intake group (n=48) or the non- intake control group (n=28). At 12 months the difference in body fat mass change between the two groups (intake group – control group) was -0.8 kg (95% CI: -1.5 - 0.0 kg, p=0.046), although there were no differences in an- thropometric data between the two groups. Body fat percentage at 12 months tended to be lower in the intake group, but the difference was not significant (p=0.09). Conclusions: These findings may suggest that calcium in combination with magnesium and lactulose can reduce body fat mass in middle-aged Japanese women. However, the contribution of magnesium and lactulose are unclear in this study. Further studies are needed to clarify these contributions.
The consumption of dates with coffee is common among Arabs and may affect postprandial hyperglycemia ex- cursion. The study aimed to determine the effect of coffee on the glycemic index of a common variety of dates (Khalas) tested in healthy and type 2 diabetes mellitus individuals. Study subjects were thirteen healthy volun- teers (mean age: 40.2±6.7 years) and ten diabetic participants with a mean HbA1c of 6.6±(0.7%) and a mean age of 40.8±5.7 years. Each subject participated in five days of tests with 50 g of glucose and 50 g equivalent of available carbohydrates from the dates (with/without coffee). Capillary glucose was measured in the healthy sub- jects at 0, 15, 30, 45, 60, 90 and 120 min, and for the diabetics at 0, 30, 60, 90, 120, 150 and 180 min. Glycemic indices were determined as ratios of the incremental areas under the response curves for the interventions. Statis- tical analyses were performed using the independent samples and paired t-tests. Mean±SE glycemic indices of the Khalas dates for the healthy individuals were 55.1±7.7 and 52.7±6.2 without and with coffee consumption, re- spectively. Similar values were observed for those with diabetes (53.0±6.0 and 41.5±5.4). Differences between glycemic indices of Khalas with or without coffee were not significant (p=0.124). There were no significant dif- ferences in glycemic index between the diabetic and healthy subjects (p=0.834 and p=0.202 without and with cof- fee respectively). In conclusion, at least in the short term, coffee does not adversely affect capillary glucose levels following Khalas dates consumption in healthy and diabetic volunteers.
Young overweight women are at risk of iron and zinc deficiency. This study assessed iron, zinc and inflammatory status during a 12-month weight loss trial in young women (18-25 y; BMI ≥27.5 kg/m2) randomised to a higher- protein (HP: 32% protein; 12.2 mg/day iron; 11.7 mg/day zinc) or lower-protein (LP: 20%; 9.9 mg/day; 7.6 mg/day respectively) diet with contrasting haem iron and zinc content. In completers (HP: n=21; LP: n=15), HP participants showed higher median ferritin (52.0 vs 39.0 μg/L; p=0.021) and lower median soluble transferrin re- ceptor-ferritin index (sTfR-F; 0.89 vs 1.05; p=0.024) although concentrations remained within normal range for both diets. Median C-reactive protein (CRP; HP: 3.54; LP: 4.63 mg/L) and hepcidin (HP: 5.70; LP: 8.25 ng/mL) were not elevated at baseline, and no longitudinal between-diet differences were observed for zinc and CRP. Compared to those with <5% weight loss, HP participants losing ≥10% weight showed lower median sTfR-F (0.76 vs 1.03; p=0.019) at six months. Impact of ≥10% weight loss on iron was more apparent in LP participants who exhibited greater mean serum iron (20.0 vs 13.5 μmol/L; p=0.002), transferrin saturation (29.8% vs 19.4%; p=0.001) and lower sTfR (1.24 vs 1.92 mg/L; p=0.034) at 12 months. Results show normal iron and zinc status can be maintained during 12 months of energy restriction. In the absence of elevated baseline inflammation and hepcidin, a more favourable iron profile in those with ≥10% weight loss may reflect stronger compliance or the potential influence of iron regulatory mechanisms unrelated to inflammatory hepcidin reduction.
Back ground and aims: It is well known that insufficient nutrient intake leads to poor bone status. To find a simple evaluation method for prevention of nutrition intake disorder, a cross-sectional study with 275 healthy Japanese female students aged 19-25 was conducted. Methods: Anthropometric parameters, bone mineral density (BMD) at lumbar and total hip, bone metabolic markers and physical activity were meas- ured in study participants and the frequency of skipping meals (breakfast, lunch, supper), and absolute values for nutrient intakes were assessed using a Diet History Questionnaire. Results: The frequency of skipping breakfast significantly correlate to total energy intake (ρ= -0.276, p<0.001). BMI, total intake of energy, intake of protein, intake of phosphate, and energy expenditure positively correlated significant- ly to BMD at lumbar and total hip (p<0.05) using simple linear regression. BMI (regression coefficient (b))=0.088, p<0.001), bone alkaline phosphatase (b= -0.050, p=0.012), total energy expenditure (b=0.019, p<0.001), and frequency of skipping breakfast (b= -0.018, p=0.048) were independent risk factors for lower total hip BMD by multiple regression analysis. The total hip BMD in participants who skipped breakfast three or more times was significantly lower than in those who did not skip breakfast (p=0.007). Conclusions: In conclusion, managing the frequency of skipping breakfast and reducing it to <3 times per week may be beneficial for the maintenance of bone health in younger women.
This study investigated the prevalence and determinants of hyperuricemia in Chinese type 2 diabetes mellitus (T2DM) patients with central obesity. A multicentric hospital-based cross-sectional study was carried out in Guangdong Province between August 2011 and March 2012. At each hospital, Chinese T2DM patients with cen- tral obesity who were aged over 20 years, whose serum uric acid levels were measured, and who had lived in Guangdong Province for ≥1 year, were recruited. Hyperuricemia was defined as serum uric acid >420 μmol/L in men and >360 μmol/L in women. Binary logistic regression was used to assess associated risk factors for hyperu- ricemia. A total of 2,917 T2DM patients with central obesity took part. The overall prevalence of hyperuricemia was 32.6% (36.1% for women, 28.4% for men). Binary logistic regression analyses demonstrated that women (OR: 1.576; 95% confidence interval (CI): 1.231, 2.018), high BMI (OR: 1.228; 95% CI: 1.094, 1.379), waist cir- cumference (OR: 1.135; 95% CI: 1.009, 1.276), hypertension (OR: 1.603; 95% CI: 1.263, 2.035), high total cho- lesterol (OR: 1.133; 95% CI: 1.002, 1.281), triglycerides (OR: 1.134; 95% CI: 1.069, 1.203), low HDL- cholesterol (OR: 0.820; 95% CI: 0.677, 0.995) and low estimated glomerular filtration rate (OR: 0.840; 95% CI: 0.815, 0.866) were risk factors associated with hyperuricemia. Hyperuricemia is prevalent in Chinese T2DM pa- tients with central obesity and is significantly positively associated with women, cardiovascular risk factors such as obesity, hypertension and dyslipidemia, and low eGFR.
Indigenous peoples are at greater risk of obesity-related health problems for various reasons. These have been explored in the adulthood (19 yrs) section of the nationally-representative Nutrition and Health Survey in Taiwan (NAHSIT) for 2005-2008 in Indigenous mountain-dwelling (IndT) (n=226) and general (mainly Han Chinese) (GenT) (n=1486) Taiwanese. Physical activity, BMI, fat distribution (waist circum- ference (WC) and triceps skinfold (TSF)) and mid arm muscle circumference (MAMC) have been com- pared. Leisure-time physical activities (LTPA) were assigned metabolic equivalents (METs). Comparisons were made by ethnicity-locality. Indigenous men and women were 3.81 and 5.47 times more obese (WHO criteria BMI 30 kg/m2) than the GenT, respectively. Some 55% of the IndT and 34% of the GenT report- ed no LTPA. All LTPA types were less evident in the IndT. Multivaiable adjusted ORs (95% CIs) against inactivity as referent were, for sarcopenic MAMC, in Indigenes with MVI-LTPA 0.13 (0.03-0.67) and in the GenT 0.61 (0.37-1.01); in the GenT with LTPA for BMI ≥30 kg/m2 and obese TSF, they were 0.53 (0.31-0.91) and 0.77 (0.60-0.98), respectively. Without dietary quality adjustment, the sarcopenia risk in GenT with LTPA was significant (OR=0.60, 95% CI: 0.37-0.97). Having adjusted for dietary quality, the significance disappeared. Less sarcopenia was found with ambulation in the GenT (OR=2.07, 95% CI: 1.26-3.43). More over-fatness in an IndT than GenT is associated with less LTPA. LTPA reduces sarcope- nic risk irrespective of ethnicity, is partly dependent on diet, and reduces obesity indices in the GenT.
Background: Although Vietnam is a region with a plant-based diet that has a high zinc deficiency, epidemiologi- cal data showing how this affects pregnant women are limited. This study explores the prevalence of zinc defi- ciency and possible correlates in pregnant Vietnamese women in Ho Chi Minh City. Methods: This was a cross- sectional study conducted at a general hospital in Ho Chi Minh City, Vietnam. All pregnant women who came to their first antenatal care visit from November 2011 to June 2012 were recruited. Those taking a vitamin and/or mineral supplement were excluded. Serum zinc concentrations, determined by a standard colorimetric method, of 10.7 mol/L-17.5 mol/L (70.0 g/dL-114 g/dL) were classified as normal and under 10.7 mol/L (70.0 g/dL) as zinc deficient. Results: In total, 254 pregnant women were invited and 107 (42%) participated. The mean age of participants was 29 years, and mean gestational age was 10 weeks. Median zinc concentration in serum was 13.6 mol/L, and the prevalence of zinc deficiency was 29% (95% CI=21%-39%). The daily intake of a milk product supplement was the only significant correlate of zinc deficiency of the items investigated (adjusted OR=0.40, 95% CI=0.16-0.99, p=0.049). Discussion: This is the first study reporting that more than 25% of pregnant Viet- namese women in Ho Chi Minh City are zinc deficient. Further academic and clinical input is needed to confirm the scale of this neglected issue and to investigate the potential of milk product supplementation in this popula- tion.
Diabetes and diabetes-induced complications is a rising health concern in Northern Cyprus. Of the adult popula- tion in Northern Cyprus, 12.2% has diabetes and 90% of all individuals suffering from cardiovascular disease are people with diabetes. The aim of this study was to evaluate nutritional habits of people with diabetes in Northern Cyprus in order to make the necessary recommendations to improve their eating habits to prevent diabetes- induced complications. We used the Healthy Eating Index (HEI) to evaluate dietary quality of people with diabe- tes in Northern Cyprus based on their 24-hour food intake. A total of 200 participants with diabetes were select- ed randomly from the out-patient clinic of Dr. Burhan Nalbantoğlu central hospital in Nicosia. Individuals were asked to complete a questionnaire to determine their 24-hour food intake and frequency of intake of various food substances. The mean HEI score for the subjects with diabetes was 58.8. The HEI component scores for saturat- ed fat, vegetables, dairy products and meat consumption were less than 5, whereas average scores for fat, choles- terol, fruits, grains, and sodium consumption were more than 5. The meat component of the HEI had the lowest mean score (3.3). There was statistical significance between male and female subjects regarding the HEI scores for meat and nutrient variety intake. In conclusion, the results of the present study suggest that subjects with dia- betes in Northern Cyprus should improve their diet by decreasing their intake of saturated fat and by increasing their intake of vegetables, meat and milk.
The association of body mass index (BMI) with blood pressure may be stronger in Asian than non-Asian popula- tions, however, longitudinal studies with direct comparisons between ethnicities are lacking. We compared the re- lationship of BMI with incident hypertension over approximately 9.5 years of follow-up in young (24-39 years) and middle-aged (45-64 years) Chinese Asians (n=5354), American Blacks (n=6076) and American Whites (n=13451). We estimated risk differences using logistic regression models and calculated adjusted incidences and incidence differences. To facilitate comparisons across ethnicities, standardized estimates were calculated using mean covariate values for age, sex, smoking, education and field center, and included the quadratic terms for BMI and age. Weighted least-squares regression models with were constructed to summarize ethnic-specific incidence differences across BMI. Wald statistics and p-values were calculated based on chi-square distributions. The asso- ciation of BMI with the incidence difference for hypertension was steeper in Chinese (p<0.05) than in American populations during young and middle-adulthood. For example, at a BMI of 25 vs 21 kg/m2 the adjusted incidence differences per 1000 persons (95% CI) in young adults with a BMI of 25 vs those with a BMI of 21 was 83 (36- 130) for Chinese, 50 (26-74) for Blacks and 30 (12-48) for Whites; among middle-aged adults it was 137 (77-198) for Chinese, 49 (9-88) for Blacks and 54 (38-69) for Whites. Whether hypertension carries the same level of risk of stroke or cardiovascular disease across national or ethnic groups remains uncertain.
In Asia, the concept of dietary reference values is shifting from recommended dietary allowances (RDAs) to dietary reference intakes (DRIs). To assist Asian countries that are planning to develop or revise their own DRIs, this study summarizes the scientific literature used in the development of the latest DRIs for the Japanese (DRIs-J 2010): it aims to clarify critical issues on- and discuss future prospects for DRIs in Asia. The criteria and studies used to determine reference values in DRIs-J 2010 in adults were extracted from the DRIs-J 2010 report, systematically classified, and summarized for each nutrient in tables accord- ing to the type of DRIs. The classification categories were as follows: criteria, subject ethnicity, year of publication, type of study and study design, number of subjects, and study content. In all, 184 studies were extracted and some issues in DRIs-J 2010 were clarified: 1) some nutrients were lacking in studies based on native populations; 2) only a few and relatively old studies determined tolerable upper intake levels for some nutrients; 3) with the same DRIs, there were inconsistencies among the nutrients in the study criteria. These were considered common issues when determining DRIs in other Asian countries. When establishing DRIs, these issues should be considered, in addition to population health status and country-specific needs.
OBJECTIVES: To establish whether elderly people with impaired cognition are at greater risk for the de- velopment of type 2 diabetes. DESIGN: Prospective population-based cohort study. SETTING: The El- derly Nutrition and Health Survey in Taiwan (NAHSIT Elderly). PARTICIPANTS: One thousand and four hundred ninety-three diabetes-free people ≥65 years were followed for incident diabetes in relation to cognitive status for up to 8 years. MEASUREMENTS: The association between cognitive impairment and diabetes incidence was analyzed with Cox proportional hazards models with exclusion of people who had diabetes within one year of cognitive function assessments. RESULTS: Cognitively-impaired women, but not men, had increased diabetes incidence density (DID). Age, gender, ethnicity and personal behav- ior adjusted hazard ratios (HR) and 95% confidence intervals (CI) for type 2 diabetes with normal cogni- tion as referent were 2.43 (95% CI: 1.27-4.63) for women and 1.55 (95% CI: 0.48-5.07) for men. These gender differences and the HR significances remained with adjustments for age, ethnicity, financial status, dietary quality as a dietary diversity score, physical functioning, physical activity, fasting glucose, indices of body composition, body mass index, waist circumference, mid-arm muscle circumference, perceived and mental health status. There were extensive significant interactions with the covariates in women. CONCLUSION: Cognitive impairment in later life is associated with greater risk of type 2 diabetes in women and considerable potential risk enhancement.
Introduction: It has been demonstrated that single nucleotide polymorphism (SNP) (R325Q, 974G>A) in the gamma-glutamyl carboxylase (GGCX) gene is associated with the bone mineral density (BMD). In the present study, we investigated the effect of GGCX polymorphism (974G>A) on the correlations among the vitamin K in- take, level of serum vitamin K, and ratio of undercarboxylated osteocalcin (ucOC) to intact osteocalcin (OC) in healthy young Japanese subjects. Methods: Healthy young adult subjects (n=189) were genotyped for the poly- morphism, and we measured the levels of serum vitamin K, intact OC, ucOC, and dietary nutrient intakes. Re- sults: Dietary vitamin K intake from vegetables was significantly correlated with the level of serum phylloqui- none (PK), and vitamin K intake from fermented beans, natto, was also significantly correlated with the level of serum menaquinone-7 (MK-7). Moreover, the total dietary vitamin K intake showed a significant negative corre- lation with the ratio of ucOC to intact OC. Interestingly, on grouping by the GGCX genotype, there was a signifi- cant interaction between the ratio of ucOC to intact OC with vitamin K intake in homozygotes (GG-type) and heterozygotes (GA-type) (p<0.001). These results suggest that an adequate nutritional strategy is necessary for people with high-risk genotypes (GG- or GA-type). Conclusions: We demonstrated the effects of SNP (974G>A) in the GGCX gene on the correlation between dietary vitamin K intake and gamma-carboxylation of serum OC. Our data may be useful for planning strategies to prevent osteoporosis.
In the last few decades, there has been a significant increase in survival rate of preterm infants, especially very low birth weight infants. The nutrition problems have become particularly relevant in neonates, and nutrition support is usually required for preterm infants and most sick term infants. The actual amount of nutrition must be calculated (not estimated) in neonates. The goals of nutrition support are to maintain development and growth while avoiding nutrition related complications. Nutrition requirements (enteral nutrition and parenteral nutrition) should be adjusted according to different weights and gestational age. Parenteral nutrition (PN), which allows the infant’s requirements for growth and development to be met, is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous. En- teral nutrition (EN) should be gradually introduced and should replace PN as quickly as possible in order to minimize any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. Opti- mal nutrition care of the preterm infant offers the opportunity to improve outcomes for children. This guideline aims to provide proposed advisable ranges for nutrient intakes in neonates. These recommenda- tions are based on a considered review of available scientific reports on the subject, and on expert consen- sus for which the available scientific data are considered inadequate.
Increased dietary sodium intake is a modifiable risk factor for cardiovascular disease. The monitoring of popula- tion sodium intake is a key part of any salt reduction intervention. However, the extent and methods used for as- sessment of sodium intake in Southeast Asia is currently unclear. This paper provides a narrative synthesis of the best available evidence regarding levels of sodium intake in six Southeast Asian countries: Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam, and describes salt reduction measures being undertaken in these countries. Electronic databases were screened to identify relevant articles for inclusion up to 29 February 2012. Reference lists of included studies and conference proceedings were also examined. Local experts and research- ers in nutrition and public health were consulted. Quality of studies was assessed using a modified version of the Downs and Black Checklist. Twenty-five studies fulfilled the inclusion criteria and were included in this review. Full texts of 19 studies including government reports were retrieved, with most studies being of good quality. In- sufficient evidence exists regarding salt intakes in Southeast Asia. Dietary data suggest that sodium intake in most SEA countries exceeded the WHO recommendation of 2 g/day. Studies are needed that estimate sodium in- take using the gold standard 24-hour urinary sodium excretion. The greatest proportion of dietary sodium came from added salt and sauces. Data on children were limited. The six countries had salt reduction initiatives that differed in specificity and extent, with greater emphasis on consumer education.
Background: Shiftworking has long been unrecognised as an occupational health hazard up until now. Methods: Electronic databases were searched using OVID host as the main search engine for Medline, PUBMED and CINHAL during the years 1990-December 2010. Combinations of the keywords yielded 35 full papers and ab- stracts, of which 16 articles were relevant. One paper was not in English, leaving 15 included in this review after final reconsideration. Studies were categorised into two main titles: studies assessing the association between shift working and obesity and/or BMI (n=8) and studies assessing the association between shift working and nu- tritional/dietary patterns (n=7). Type of study was also considered as a part of the search strategy. Results: In total, one interventional, nine cross-sectional and five cohort studies were retrieved. Seven cross-sectional studies and one cohort study showed a higher BMI/obesity prevalence in shiftworks. Interventional, one cross-sectional and three cohort studies showed higher frequency of meal intake or poor nutrition quality/habits in the shift workers compared with the day-shift workers. Another cross-sectional study showed no difference between workers. Con- clusion: In terms of obesity or high BMI, majority of cross-sectional studies indicate that shiftwork increases weight gain and the prevalence of obesity. On the other hand, half of cohort studies show higher frequency of meal intake and/or poor nutrition quality in the shift workers. Generally, it is indicated that shift working nega- tively impacts on health and nutritional status of workforces.
Malnutrition in hospitals often goes unrecognized. At present, no nutrition screening tool provides satisfactory re- sults in identifying nutritional risk. Most tools depend on weight and height as criteria for diagnosing malnutrition. Weight is not recorded in many patients and some tools are time-consuming. An inclusive nutrition screening form (Nutrition Alert Form, NAF) was developed and validated. NAF was modified from the original version of Subjective Global Assessment (SGA) by adding in two standard laboratory tests. The severity of the symptom and laboratory changes were scored. NAF was validated in 210 hospitalized Thai patients at Ramathibodi hospital by an experienced clinical nutritionist (physician) at Ramathibodi hospital. Cross validation was carried out be- tween the dietitian and nurse in another 90 patients. Most of the time nurses could complete the nutrition screen- ing in a patient within 5 minutes. One out of four patients could not be weighed on admission. The scores of 5 and 11 were selected as the cut-off scores of different malnutrition levels due to their high sensitivity, specificity and accuracy and scores of 6 to 10 were defined as moderate malnutrition. The diagnostic agreement between the dietitian and nurse for “normal to mild malnutrition”, “moderate malnutrition”, and “severe malnutrition” were 85%, 70% and 72%, respectively. NAF for screening of malnutrition in hospitalized Thai patients is easy to use, concise, does not require nutrition expertise and can be used whether or not body weight is taken.
Body composition of 292 males aged between 18 and 65 years was measured using the deuterium oxide dilution technique. Participants were divided into development (n=146) and cross-validation (n=146) groups. Stature, body weight, skinfold thickness at eight sites, girth at five sites, and bone breadth at four sites were measured and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) calculated. Equations were developed using multiple regression analyses with skinfolds, breadth and girth measures, BMI, and other indices as independent variables and percentage body fat (%BF) determined from deuterium dilution technique as the reference. All equations were then tested in the cross-validation group. Results from the reference method were also compared with existing prediction equations by Durnin and Womersley (1974), Davidson et al (2011), and Gurrici et al (1998). The proposed prediction equations were valid in our cross-validation samples with r=0.77- 0.86, bias 0.2-0.5%, and pure error 2.8-3.6%. The strongest was generated from skinfolds with r=0.83, SEE 3.7%, and AIC 377.2. The Durnin and Womersley (1974) and Davidson et al (2011) equations significantly (p<0.001) underestimated %BF by 1.0 and 6.9% respectively, whereas the Gurrici et al (1998) equation significantly (p<0.001) overestimated %BF by 3.3% in our cross-validation samples compared to the reference. Results sug- gest that the proposed prediction equations are useful in the estimation of %BF in Indonesian men.
Objective: The aim of study was to confirm the protective effects of parenteral glutamine supplementation on liv- er injury in premature infants and determine how quickly effects became evident. Methods: We performed a dou- ble-blind, randomized, controlled clinical study to assess the effect of parenteral nutrition (PN) supplemented with glutamine in premature infants. Thirty infants from two children’s centers, were randomly assigned to either a control group (Standard PN; n=15) or a glutamine-supplemented group (GlnPN; n=15). The primary endpoint was hepatic function. The secondary endpoints were total duration of PN, weight and head circumference gain, length of hospitalization, and days on a ventilator. Results: The serum level of alkaline phosphatase (AKP) after parenteral nutrition for 14 days was significantly higher (p<0.05) in the control group. But in the glutamine- supplemented group, the serum concentration of aspartate aminotransferase (AST) and gamma glutamyltransfer- ase (GGT) significantly decreased after PN for 7 days and 14 days (p<0.05), and the level of alkaline phosphatase (AKP) showed no increase. The levels of AKP and GGT were significantly different with time by group interac- tion. Levels of AKP was higher in control group than glutamine-supplemented group, and GGT level was lower in glutamine-supplemented group compared with controls. There were no significant differences between the groups in terms of total duration of PN, weight gain (g/d), increase in head circumference (cm/w), length of hos- pitalization, and duration of mechanical ventilation. Conclusion: The longer the duration of parenteral nutrition, the more severe hepatic dysfunction became. Parenteral glutamine supplementation suggested a hepatoprotective effect.
Objective: To evaluate the benefits of reducing insulin resistance by early enteral nutrition (EEN) in gastric can- cer patients after surgery. Methods: Gastric cancer patients were managed to randomly accept traditional total parenteral nutrition (group A) or EEN (group B) after surgical treatment. The patients in group B were fed by tubes with 250-500 mL 5% sodium chloride and glucose injection at 24 h post-surgery, and were fed enteral nu- tritional emulsion with constant infusion by pump slowly increasing from 20 mL/h to 100 mL/h from 48 h, and then transiting to total enteral nutrition. Insulin sensitivity of patients was detected by Quicki method before op- eration and at 24 h, 48 h, 72 h, 120 h and 168 h post-surgery. Results: A total of 77 patients were enrolled, with 42 patients in group A, and 35 patients in group B. Baseline characteristics, biochemical indexes and operational characteristics were well balanced between two groups. The time-insulin sensitivity curves of the two groups in- dicated that IR was present early (day 1 to day 7) in gastric cancer patients and was significantly different be- tween patients who had undergone surgical treatment and those who had not. Insulin sensitivity (SI) of patients in group B were higher than patients in group A with adjusting BMI, age and SI preoperative at 72 h, 120 h and 168 h post-surgery. Conclusions: The management of EEN can alleviate insulin resistance in gastric cancer patients with surgical treatment.
Background: Burned patients have increased level of mortality, possibly due to late introduction of enteral feed- ing. The aim of this study was to compare the benefits and safety of very early enteral nutrition introduction com- pared to the normal diet among burns patients in an intensive care unit. Participants and Methods: Participants consisted of 101 patients, aged 20-76 years (mean age 48 years), 49 men and 52 women, with burns that covered more than 20% of the body. The intervention group consisted of 52 subjects fed via introduced nasojejunal probe that started within four hours after admission to the hospital. The control group consisted of fifty patients fed in standard manner per os (three standard hospital meals) immediately after the first wound dressing. Results: The average decline BMI in control group was 2.27±0.56 kg/m2, while the average reduction in BMI in the interven- tion group was 1.77±0.38 kg/m2 (p<0.001). The largest drop of albumin concentration in the control group was 28.5%, whereas in the intervention group was 23.8%. (p<0.001). The greatest decrease of transferrin concentra- tion in the control group was 31.1%, while the average reduction in the intervention group was 18.3%. (p<0.001). C-reactive protein values were statistically higher in control group (p<0.001). Intervention group had lower rate of complications and infection rates. Conclusion: Enteral nutrition in burned patients should begin within few hours of burn onset. Such approach leads to better outcomes, reduces complications, and improves nutritional profile.