Childhood obesity, a significant global public health problem, affects an increasing number of low- and middle- income countries, including in Asia. The obesity epidemic has been fuelled by the rapid nutrition and physical ac- tivity transition with the availability of more energy-dense nutrient-poor foods and lifestyles of many children dominated by physical inactivity. During the growing years the pace and quality of grow this best quantified by a combination of anthropometric and body composition measures. However, where normative data are available, this has typically been collected on Caucasian children. To better define and characterise overweight and obesity in Asian children, and to monitor nutrition and physical activity interventions, there is a need to increase the use of standardized anthropometric and body composition methodologies. The current paper reports on initiatives fa- cilitated by the International Atomic Energy Agency (IAEA) and outlines future research needs for the prevention and management of childhood obesity in Asia.
Postoperative oral intake is an important predictor of early postoperative recovery, and anesthesia is known to in- fluence this intake. We compared the influences of desflurane anesthesia and propofol anesthesia on early post- operative oral intake retrospectively. The subjects included a consecutive series of patients who received general anesthesia with propofol or desflurane between June and December 2013. The total amount of calories and pro- teins taken orally and the incidence of postoperative nausea and vomiting (PONV) on postoperative days (POD) 0, 1, and 2 were collected. A total of 147 patients were analyzed. The desflurane (Des) and the propofol (Pro) groups included 52 and 95 patients, respectively. The incidence of PONV on POD 0, 1, and 2 did not show sig- nificant intergroup differences. Total calorie intake on POD 1 and 2 was not significantly different between the 2 groups (1117±508 vs. 1036±549 kcal/day, p=0.39 and 1504±368 vs. 1437±433 kcal/day, p=0.35, respectively). Total amount of protein via oral intake on POD 1 and 2 were not significantly different between the two groups (45.9±21.1 vs. 43.8±22.8 g/day, p=0.60 and 61.3±15.0 vs. 58.9±18.0 g/day, p=0.42, respectively). These findings suggest that desflurane and propofol affect postoperative oral intake in a similar fashion. These results should be confirmed in a future prospective study.
Background: Multiple micronutrient deficiencies are prevalent in India. Objective: The study aims to establish the efficacy of multi-micronutrient fortified salt in addressing multiple micronutrient deficiencies among children compared to nutrition education and no intervention in Tamilnadu. Methods: The study employed a community based randomized controlled trial designed to study the impact of multiple micronutrient salt (micronutrient group) in comparison with nutrition education (education group) and no intervention (control group) on haemo- globin, serum ferritin, soluble transferrin receptor, body iron stores, serum retinol and urinary iodine outcomes over a period of 8 months. The fortified salt contained iron, iodine, vitamin A, vitamin B12 and folic acid. All the children were dewormed at baseline and at the end of the study just before the biochemical measurements. Re- sults: There was a significant improvement in most biochemical parameters studied in the micronutrient group when compared with the control group whereas this was not seen between the education and control. Over 8 months, in the micronutrient group, hemoglobin increased by 0.52 g/dL, retinol by 8.56 μg/dL, ferritin by 10.8 μg/L, body iron stores by 1.27 mg and the decrease in the prevalence of retinol deficiency was from 51.6% to 28.1%, anaemia from 46.0% to 32.6%, iron deficiency from 66.9% to 51.3% and iron deficiency anaemia from 35.2% to 31.0%, while the prevalence of all these deficiencies increased or the changes were not significant in the other two groups. Conclusions: Multiple micronutrient fortified salt was able to improve iron and vitamin A sta- tus, whereas this was not seen in the nutrition education group.
This study was conducted to determine the relationship between 6-n-propylthiouracil sensitivity and taste charac- teristics in female students at Nara Women’s University. Participants (n=135) were screened for 6-n- propylthiouracil sensitivity using a taste test with 0.56 mM 6-n-propylthiouracil solution, and the sensitivity was confirmed by an assay for the bitter-taste receptor gene, TAS2R38. Based on the screening results, 33 6-n- propylthiouracil tasters and 21 non-tasters were enrolled. The basic characteristics that are thought to influence taste acuity, including body mass index, saliva volume and serum micronutrient concentrations (iron, zinc and copper), were similar between the two groups. In an analysis using a filter-paper disc method, there were no dif- ferences in the acuity for four basic tastes (sweet, salty, sour and bitter) between 6-n-propylthiouracil tasters and non-tasters. In addition, the taste preference for the four basic tastes as measured by a visual analogue scale was also comparable between the two groups. This is the first study to demonstrate that 6-n-propylthiouracil non- tasters have taste sensitivity for the four basic tastes similar to that in 6-n-propylthiouracil tasters, at least in fe- male adolescents, as measured by the gustatory test using a filter-paper disc method.
Variation of plasma free amino acids (PFAAs) is an essential feature of protein metabolic abnormalities in cancer patients. But there still little data about the cancer tissue free amino acid (TFAAs) profiles, including their pat- terns and correlations with PFAAs. To evaluate the variation in PFAAs and cancer TFAAs in patients with lung cancer, including their patterns and correlations, we investigated the concentrations of free amino acids in lung cancer tissues (n=27), paired lung paracarcinomous tissues (n=27) and plasma (n=27) using an automatic amino acid analyzer after pre-treatment. Within the PFAAs, the concentrations of five amino acids (tryptophan, glycine, citrulline, ornithine and proline) were significantly decreased, while that of phenylalanine was markedly in- creased compared with control subjects. Within the TFAAs, the concentrations of three amino acids (taurine, glu- tamic acid and glycine) were increased, while the concentrations of two amino acids (lysine and ornithine) were decreased significantly in lung cancer tissues compared with the paracarcinomous tissues. The amino acid pat- terns in PFAAs and TFAAs had similar trends, but percentage variations were diverse. Additionally, the concen- trations of five amino acids (lysine, phenylalanine, threonine, serine, and alanine) in PFAAs correlated with those in lung cancer TFAAs, but no amino acids in PFAAs were correlated with those in lung paracarcinomous TFAAs. Thus, PFAA profiles may reflect the status of cancer tissues, which may provide more information about the met- abolic statuses and prognoses of patients with lung cancer.
Objectives: To determine the prevalence of malnutrition using anthropometric measures among hospitalized pe- diatric and adult patients admitted at Bach Mai Hospital, Hanoi, Vietnam. Methods: A one-day cross-sectional survey was used in selected wards (Pediatrics, Surgery, Intensive Care Unit, Renal Diseases, Gastroenterology Diseases, Respiratory Diseases, and Endocrinology). Unavailable patients and those discharged within 24 hours were excluded. Anthropometric data included body weight, height (or length), and mid-upper arm circumference. The type, severity, and prevalence rate of malnutrition were defined based on World Health Organization (WHO) criteria. Results: The sample was hospitalized children and adults: 108 and 571 were children aged 6 months to 18.9 years old and adult patients, respectively. The overall rate of pediatric wasting (weight-for-height ≤-2 SD or BMI ≤-2 SD, kg/m2) was 19.0% (n=19/100) and that of stunting (height-for-age ≤-2 SD) was 13.9% (n=14/101). Using either the mid-upper arm circumference <11.5 cm or the weight-for-height and weight-for-length ≤-3 SD, the rate of severe wasting among children aged 6-59 months old was 7.0% (n=3/43). None of the children were obese based on weight-for-length, weight-for-height or BMI. In adults, the prevalence of under-nutrition (BMI<18.5 kg/m2) was 33.3% (n=141/423) while that of obesity (BMI≥30 kg/m2) was 0.9% (n=4/423). Adults admitted to the Respiratory Diseases ward had the highest prevalence of under-nutrition, 40.9% (n=38/93).
Background: In order to monitor malnutrition morbidity and anaemic prevalence of infants and young children in rural disaster areas affected by Wenchuan earthquake. Methods: About three months, one year and two years after earthquake (including 77, 102 and 307 children, respectively), by using the questionnaires, information on nutri- tional and health status of infants and young children aged 6-23 months was collected and evaluated, and anthro- pometry and haemoglobin concentration were measured. Results: Most of families could not prepare complemen- tary foods for their children so that the children only ate the same meals as adults which resulted in very poor sit- uation in the quantity and quality of complementary food for infants and young children. The main nutritional problems in children included the lack of feeding knowledge in parents; only 10% children could have breast feeding within one hour after delivery, and the basic exclusive breastfeeding was lower. More than 90% children never received nutrient supplements. The malnutrition prevalence was significantly increased two years after the earthquake. The decrease of body weight was rapid (underweight prevalence from 0 at three months to 5.9% after two years), and then a lasting effect resulted in decrease of length shown by stunting prevalence from 6.6% at three months to 10.8% after two years and wasting prevalence from 1.3% at three months to 4.0% after two years. From three months to two years after earthquake, anaemic prevalence markedly increased from 36.5% to 67.5% and the increasing percentage of anaemia was more obvious in girls than boys. Conclusion: The child’s nutrition- al status continuously worsened and anaemic prevalence was high in areas affected by the earthquake. It is rec- ommended that in the future nutrition interventions should begin immediately.
This study recorded maternal perceptions of preschool children’s weight in Chinese mothers living in Australia and China. A survey was undertaken of 1951 mothers living in Chengdu and Wuhan, China and 89 Chinese mothers living in Perth, Australia. All participants were mothers with children aged 2-4 years. The children’s weight and height were measured and their weight status were classified using the International Obesity Task Force 2012 revised international child body mass index cut-offs. The prevalence of overweight or obese in chil- dren was 16.7% in China and 8% in Australia. The overall percentages of correct maternal perception of the child’s weight were 35% in underweight children, 69.2% in normal weight children but only 10.8% in over- weight/obese children. Among the overweight/obese children, only 14% in Australia and 10.8% in China were classified as overweight/obese by their mothers. Within the group of underweight children, normal weight moth- ers (p=0.004) and mothers with older age children (p=0.015) were more likely to correctly classify children’s weight status. A higher percentage of overweight/obese mothers (p=0.002) and mothers who over-estimated her own weight status (p<0.001) have correct perception of the weight status of their overweight/obese children, compared to their counterparts. There was a high prevalence of incorrect maternal perception of preschool chil- dren’s weight status in Chinese mothers, especially those with overweight/obese children. To address the obesity epidemic in children, future health promotion programs should put improved efforts to educate parents about obe- sity and its health consequences in order to reduce misperceptions.
Objective: To investigate the effects of a combined intervention of diet and physical activity on body composition, resting energy expenditure (REE) and metabolic factors in obese children and adolescents. Methods: Twenty obese children and adolescents aged 7 to 17 years completed a 4-week summer camp program which focussed on personal behaviour, including energy-restricted diets and supervised physical activity. Anthropometry, bioelectri- cal impedance, ultrasonography (US) for subcutaneous and hepatic fat, and abdominal Magnetic Resonance Im- aging assessments were made and blood pressure (BP) recorded before and after the 4-week intervention. Results: 1) Weight loss was 7.2±2.2 kg, with losses of 5.5±2.2 kg and 1.7±1.2 kg in fat mass (FM) and fat free mass (FFM), respectively, with associated reductions in abdominal and hip fat and in the waist/hip circumference ratio and in BP. 2) There were no significant changes in REE or in its ratio with weight. 3) Reductions in uric acid, to- tal cholesterol, triglycerides, LDL cholesterol, HbA1C, insulin, C-Peptide and insulin resistance (HOMA-IR) and the ratio of fatty liver were observed, but not in the inflammatory marker hsCRP. Conclusions: With behavioural intervention during a summer camp, body fat and its distribution were favourably changed, but with some loss of lean mass. However, there were no detectable reductions in REE. Weight management programs which achieve fat loss with maintenance of REE ought to be more sustainable.
Data for the intake of copper, zinc, and manganese in Japanese populations obtained by detailed diet assessment methods and the most recent version of the food composition database in Japan are scarce. Moreover, data on food sources which contribute to the intake of these nutrients in Asian countries, including Japan, are not availa- ble. Here, we estimated copper, zinc, and manganese intake and elucidated major food sources of these nutrients in a Japanese population. We collected 16-day diet records from 225 adults aged 30 to 69 years living in 4 areas of Japan. Intakes of copper, zinc, and manganese were estimated using the 16-day diet records and the latest ver- sion of the Food Composition Tables in Japan. Mean intakes of copper, zinc, and manganese were 1.2 mg/day, 8.2 mg/day, and 4.9 mg/day for women and 1.4 mg/day, 10.1 mg/day, and 5.1 mg/day for men, respectively. White rice was the largest contributor to the intake of copper, zinc, and manganese, accounting for approximately 20%-30% of the total intake of each.
The epidemic of obesity is now a major public health concern in many parts of the world. Face-to-face tailored lifestyle modification therapy is one of the major approaches used for weight loss. However, the lack of time for multiple visits and the lack of resources for administering therapy hinder its implementation. We administered a web-based weight loss program for obese patients from July 2010 to January 2012 that required only 2 personal interviews over 6 months. The program used a system of auto-extraction of behavioural objectives and auto- recording of daily weight and number of steps taken. The subjects included 3 obese men (mean age, 35.7±2.3 years; mean body mass index (BMI), 30.4±0.8 kg/m2) and 17 obese women (mean age, 39.3±9.5 years; mean BMI, 28.1±1.8 kg/m2) who volunteered to participate in this weight loss program. Weight loss achieved through this program was significant (mean, 2.7%, p=0.047). Abdominal visceral fat area (VFA) decreased significantly (mean, 12.6%, p=0.017), and the serum cholinesterase and alanine aminotransferase levels improved (mean, 33 U/L, p=0.003; mean, 7 IU/L, p=0.033 respectively). Metabolic syndrome criteria number had a tendency to de- crease. Dietary and nutrient intake levels on the food frequency questionnaire improved. Weight loss ratio after 6 months and initial weight loss ratio were strongly significantly correlated. A web-based weight loss program with auto-extraction of behavioural objectives and recording of daily weight and steps can achieve weight loss, as de- termined by VFA reduction, on low manpower.
In 2001 the World Health Assembly adopted the infant feeding strategy which included the recommendation for exclusive breastfeeding until 6 months of age with continued breastfeeding while complementary foods are intro- duced. This recommendation has been endorsed by many national authorities, professional organisations and most countries in the Asia Pacific Region. Reviews by WHO, the US Surgeon General, Agency for Healthcare Research and Quality, US Department of Health and Human Services and others have documented the many ben- efits of breastfeeding. The introduction of solid foods before six months of age is associated with increased rates of infection, reduced breastmilk production, disruption to the microbiome and possibly obesity. If solids are in- troduced at around six months (by 26 weeks) there is no evidence of increases in allergic diseases.
Taiwan was an iodine deficiency area and endemic goiter was common in 1940’s. Mandatory salt iodization started in 1967, and a 1971 survey indicated that goiter rates in children decreased from 21.6% to 4.3%. To un- derstand iodine status before the change of national salt iodization program in 2003, from mandatory to voluntary salt iodization, we retrospectively measured urinary iodine concentrations of samples collected from children in the Nutrition and Health Survey in Taiwan 2001-2002. The median UI level for children aged 6-12 years was 123 μg/L (no differences between males and females). Females aged 10-12 years had the lowest urinary iodine levels. The percentages of this population with urinary iodine levels below 100, 50, and 20 μg/L were 35.2%±1.0%, 4.4%±0.4%, and 0.2%±0.1%, respectively. Older children were more likely to have low urinary iodine levels. People living in different areas of Taiwan had a median urinary iodine levels ranged from 113 μg/L to 164 μg/L (males: 113-153 μg/L; females: 105-174 μg/L), with the highest level in Penghu islands, and the lowest level in the eastern and southern (Southern area 2) areas. According to international criteria, iodine status in 2001-2002 was adequate, comparable to the surveyed goiter rates (4.3%, classified as iodine sufficiency) in 1971, inferring that iodine nutrition remained adequate and stable during this period. The present study is of great importance in documenting the iodine status of Taiwan before the change from mandatory to voluntary salt iodization to serve as a baseline data for future trend analysis in iodine nutrition.
Background: Esophageal squamous cell carcinoma (ESCC) incidence is high in Kazak Autonomous Prefecture, Xinjiang, China. Roasting food has been reported to be related with the risk of various cancers and is very popu- lar in the area, and may be related with the risk of ESCC. The promoter methylation inactivation of p16 gene can increase the risk of ESCC. Thus, we want to know whether long-term roasting food is related with the risk of ESCC by effecting the promoter methylation of p16 gene. Materials and Methods: Ninety ESCC patients and 60 healthy subjects were recruited from Kazak Autonomous Prefecture. MassARRAY was used to detect p16 pro- moter methylation in ESCC tissues, as well as in normal esophageal tissues. The association between the p16 promoter methylation and daily roasting meat intake was examined. Results: Daily roasting meat intake was re- lated with the risk of ESCC (p<0.01) and the mean CpG methylation rates of p16 promoter (p<0.01). In ESCC patients, the mean methylation rates of CpG 11-12 and CpG 33-34-35 were 29.4% and 37.4%, respectively, which was significantly higher than the rates in normal esophageal tissues (16.7% and 12.4%, respectively; p<0.01). The methylation of p16 promoter is also related with daily roasting meat intake (p<0.01) in Kazakh Chi- nese with ESCC. For the CpG methylation of the p16 promoter in the well, moderately and poorly differentiated ESCC, there are significant differences (p<0.05) for the 19 CpG units in the ESCC and controls. Conclusion: Roasting meat intake was associated with the risk of ESCC via effects on the methylation of p16 promoter. These results suggest roasting food intake should be limited in the diet.
Objective: To avoid a second endoscopy for nasojejunal feeding tube placement (NFTP) in patients undergoing endoscopic nasobiliary drainage (ENBD), we studied improved NFTP method and compared it to endoscopic method. Methods: Patients with ENBD were divided into two groups. One group (18 patients) received endo- scopic NFTP and the other group (26 patients) received improved NFTP. Placement time, physical condition of the patients and complications were recorded. Results: In 18 patients who underwent endoscopic NFTP , NFT was successfully placed on the first attempt in 14 patients with a first placement success rate of 77.8%. NFT was wrongly intubated into the trachea in one patient inducing coughing, and after it was removed, the second place ment was successful. The total success rate of endoscopic NFTP was 83.3% with an average placement time of 17.0 minutes. In 26 patients undergoing improved NFTP, all were successfully placed on the first attempt with a success rate of 100%, and an average placement time of 2.55 minutes. In patients with ENBD, the success rate of improved NFTP was significantly higher than endoscopic NFTP (χ2=36.4, p<0.05) with a significantly shorter placement time (t=18.5, p<0.05). Conclusion: For patients with ENBD, improved NFTP method is superior to the endoscopic method as it is more effective, convenient, faster, and cheaper. Additionally it avoids a second endoscopy and has fewer complications, better security and a higher success rate. The improved method is a safer, easier, more effective and practical method of EN and deserves general adoption in clinical work.
L-arginine plays an important role in immune regulation by affecting the immune response and inflammation. This meta-analysis was performed to assess whether L-arginine supplementation could improve the outcomes of immune function, and to evaluate the safety of L-arginine supplementation. Four databases (PubMed, EMBASE, Web of Science, the Cochrane Library) for all randomized controlled trials investigating the effects of supple- mentation with L-arginine published from 1966 to September 2013 were searched. The quality of controlled trials was assessed with the Jadad method. Meta-analyses were performed with fixed- or random-effects models ac- cording to heterogeneity of studies. Data from 11 trials involving 321 patients were enrolled. Meta-analysis showed that the L-arginine supplement group had a significantly greater CD4+ T-cell proliferation response (MD 5.03; 95% CI 1.11, 8.95; p<0.05), and that the incidence of infectious complications was lower (OR 0.40; 95% CI 0.17, 0.95; p<0.05) than control.
The role of the gut microbiota in understanding the onset and development of obesity is gaining importance. Die- tary strategies are the main tool employed to counteract obesity, and nowadays they are focused on a wide range of different aspects of diet and not only on calorie restriction. Additionally, diet is known to be a major factor in- fluencing modification of the gut microbiota. Therefore the influence of both macronutrient and micronutrient content of any dietary strategy to treat obesity on gut bacterial composition should now be taken into considera- tion, in addition to energy restriction. This review aims to collect the available data regarding the influence of dif- ferent dietary components on gut microbiota in relation to obesity and inflammatory states in humans. Although more work is needed, specific dietary factors (carbohydrate, protein and Mediterranean foods) have been shown to have an influence on the gut microbiome composition, meaning that there is an opportunity to prevent and treat obesity based on microbiota outcomes.
Ulam refers to a group of traditional Malaysian plants commonly consumed as a part of a meal, either in the raw form or after a short blanching process. Many types of ulam are thought to possess blood glucose-lowering prop- erties, but relatively little is known on the effectiveness of ulam in modulating blood glucose levels in humans. This review aims to systematically evaluate the effectiveness of ulam in modulating blood glucose levels in hu- mans. A literature review was conducted using multiple databases with no time restriction. Eleven studies were retrieved based on a priori inclusion and exclusion criteria. In these 11 studies, only Momordica charantia, local- ly known as “peria katak”, was extensively studied, followed by Centella asiatica, locally known as “daun pega- ga”, and Alternanthera sessilis, locally known as “kermak putih”. Of the 11 studies, 9 evaluated the effectiveness of M. charantia on blood glucose parameters, and 7 of which showed significant improvement in at least one pa- rameter of blood glucose concentration. The remaining 2 studies reported nonsignificant improvements in blood glucose parameters, despite having high-quality study design according to Jadad scale. None of the studies related to C. asiatica and A. sessilis showed significant improvement in blood glucose-related parameters. Current clini- cal evidence does not support the popular claim that ulam has glucose-lowering effects, not even for M. charantia. Hence, further clinical investigation is needed to verify the glucose modulation effect of M. charantia, C. asiatica, and A. sessilis.
Despite progress in health status and achievements in Millennium Development Indicators, Bangladesh presents a gloomy scenario for nutrition. In 2009, BRAC (formerly known as Bangladesh Rural Advancement Committee) has begun to implement a community-based approach of Alive & Thrive with Family Health International 360, aiming to reduce undernutrition among children under two by promoting exclusive breastfeeding and appropriate complementary feeding practices. To address anemia and other micronutrient deficiencies, home-fortification with micronutrient powders (MNP) has been promoted among under-fives across Bangladesh along with the Global Alliance for Improved Nutrition (GAIN). BRAC’s frontline community health workers play a critical role in promoting micronutrient powders with better feeding practices. Over the years, improvements have been ob- served in the intervention areas: exclusive breastfeeding rose from 49% to 83% of children (0-6 months), 86% of children received complementary feeding at 6-8 months with about two/thirds being fed the recommended num- ber of times; and 70% of children (6-59 months) adhered to MNP use, ie consumption of 1 sachet per day in the past 60 days. However, many challenges are still observed in traditional feeding practices, along with limited skills of community health workers and households’ poor access to quality food, necessitating constant interac- tions between caregivers, mothers-in-law and fathers with the frontline workers. Maintaining the supply chain of micronutrient powders and a visible and convincing change in nutritional status of children are key success fac- tors. The partnerships between BRAC, GAIN and Renata, the producer of MNP in Bangladesh, have given birth to a home-fortification model that can deliver impact at scale.
The aim of this study of Asian Indian migrants in New Zealand was to determine cut-off points for body mass in- dex, waist circumference, waist-to-hip ratio, and waist-to-height ratio that best discriminate for increased risk of type 2 diabetes and cardiovascular disease. One hundred and seventy-five (90F, 85M) Asian Indian volunteers (aged >50 y) were recruited from urban Auckland, New Zealand. Body weight, height and waist and hip circum- ferences were measured using standard techniques. Waist-to-hip ratio, waist-to-height ratio and body mass index were derived. Total and percent body fat by dual energy X-ray absorptiometry, and fasting glucose, insulin and lipids were measured. Three measures of metabolic risk were determined: the homeostasis model assessment of insulin resistance, the McAuley score for insulin sensitivity and metabolic syndrome by International Diabetes Federation criteria. Body mass index, percent body fat and anthropometric measurements of central adiposity generally did not perform well as indicators of metabolic risk in this high risk population of Asian Indian mi- grants. Our data support the use of lower ethnic specific body mass index and waist circumference for Asian Indi- an women and men. The discriminatory power of waist-to-height ratio was similar to that of body mass index. Hence, waist-to-height ratio could be used as a simple screening tool. A recommendation, of a waist-to- height ra- tio of less than 0.5 that would underpin the simple public health message of “your waist circumference should be less than half your height”.
Malnutrition is a major problem in hospitalised older people. Many nutrition screening tools are available for malnutrition identification, however little is known about their prognostic ability. This prospective, observational study investigated the prognostic value of three nutritional screening tools in a Geriatric Evaluation and Man- agement Unit: the Geriatric Nutritional Risk Index (GNRI), the Mini Nutritional Assessment (MNA) and the Mini Nutritional Assessment short form (MNA-SF), incorporating either body mass index or calf circumference. Poor six- month outcome was defined as new admission to higher level residential care or mortality at six months post-discharge. Predictive ability of poor outcome was assessed by logistic regression models, adjusting for age, gender, cognition and co-morbidity. Predictive accuracy was determined by area under Receiver Operator Char- acteristic curves, sensitivity, specificity, predictive values and Youden Index. One hundred and seventy-two con- secutive patients with a mean (SD) age=85.2 (6.4) years were included in the study. Malnutrition was identified in 31% of patients using the MNA and was associated with a higher risk of poor six-month outcome when identi- fied by the MNA (OR, 95% CI=3.29, 1.17-9.23) and the GNRI (OR, 95% CI=2.84, 1.31-6.19), but not by the MNA-SF. All screening tools lacked discriminative power for outcome prediction. The MNA and GNRI were useful clinical predictors of poor six-month outcome, although their accuracy of prediction was low. Nutritional screening remains a priority in the routine assessment of hospitalised older people.
Background & Aims: Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin re- sistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance. Methods: Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during periopera- tive period. Results: Patients in the glucose group (n=11) received 0.15±0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies signifi- cantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.320.7%, than that in the control group, 57.79.3% (p=0.041). Conclusions: Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without caus- ing hyperglycemia.