Objective: To evaluate the cutoff value of HbA1c for predicting diabetes and prediabetes in a Chinese high risk population aged over 45. Methods: A total of 619 people aged over 45 without diabetes were randomly recruited to complete the Finnish Diabetes Risk Score (FINDRISC) questionnaire. 208 high-risk individuals (defined by Diabetes Risk Score ≥9) had OGTT and HbA1c determined at the same time. Results: In a Chinese population aged over 45, the best cutoff values of HbA1c for detecting diabetes and prediabetes were 5.8% and 5.4% respec- tively. The area under the receiver operating characteristic (AUROC) curve of HbA1c for detecting diabetes was 0.85 (95% CI: 0.80-0.90) and prediabetes was 0.62 (95% CI: 0.54-0.70). The combined use of HbA1c and fasting blood glucose (FPG) had a larger AUROC than HbA1c alone (0.88, 95%CI: 0.83-0.92 in detecting diabetes vs 0.75, 95% CI: 0.67-0.82 in prediabetes), and had a higher sensitivity in predicting diabetes and higher specificity and positive predictive value (PPV) in predicting prediabetes. However, the AUROC between HbA1c alone and combined use in predicting diabetes was not significantly different (p=0.173). Conclusions: FINDRISC is a fea- sible tool to screen people who are at high risk of diabetes. The cutoff values of HbA1c to diagnose diabetes and prediabetes in a Chinese high risk population aged over 45 were 5.8% and 5.4%, respectively. The sensitivity and specificity of HbA1c for detecting diabetes and prediabetes were relatively low, so that the combined use of HbA1c and FPG may be more effective in prediction.
We examined the influences of patients’ background characteristics on the frequency of performing five diabetes self-care behaviours that 185 Taiwanese outpatients reported. All patients had type 2 diabetes diagnosed for more than a year and attended an outpatient clinic at a large university hospital where they had received at least one di- etitian-led individual nutrition education session and one nurse-led diabetes education session during the course of their care. Seventy nine percent of the patients regularly (defined as responses often or always on the question- naire) took their medications and over half followed recommended meal plans and exercised, but fewer per- formed foot care (38%) or checked their blood glucose levels (20%) regularly. The associations between patients’ demographics and disease-related characteristics and their performance of self-care behaviours were assessed with logistic regression. Although checking blood glucose levels and performing diabetes foot care were unrelat- ed to any clinical outcome examined, patients who took their diabetes medications had lower hemoglobin A1c lev- els and fewer chronic complications than those who did not. Furthermore, patients who followed a diabetes meal plan also had lower hemoglobin A1c levels, and those who exercised regularly had healthier body mass indices (BMI) than those who did not.
Muscle strength declines with age. However, factors that contribute to such declines are not well documented and have not been extensively studied in elderly populations of Asian origin. Correlations of grip strength with a broad range of factors associated with declines in muscle strength were examined in 202 community-living elder- ly Japanese women. After adjustment for age, grip strength was positively correlated with body weight, height, serum albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C) and serum iron and inversely with serum copper, and log high-sensitivity C-reactive protein (hsCRP). Multiple linear regression analysis with grip strength as a dependent variable showed that 47.0% of variability of grip strength could be accounted for by height, age and haemoglobin in order of increasing R2. In conclusion, low haemoglobin may contribute to low muscle strength independently of age, anthropometric, nutritional, and inflammatory markers in the elderly, and may represent an important confounder of the association between grip strength and functional decline in com- munity-living Japanese elderly women.
Objective: To summarize anaemia prevalence data for children, women, and men using data from the second, third and fourth waves of the Indonesia Family Life Surveys (IFLS), which were conducted in 1997/8, 2000, and 2007/8, respectively. Methods: Anaemia prevalence was determined for children 0 to 5 years, 5 to 12 years, 12 to 15 years, non-pregnant women at least 15 years, pregnant women at least 15 years, and men at least 15 years, based on haemoglobin adjusted for altitude and smoking status. Results: Compared with 1997/8 estimates, anae- mia prevalence estimates were lower in 2007/8 for all groups, with the greatest relative decline occurring in chil- dren 5 to 12 years (25.4%). Trend analysis found anaemia significantly declined over the survey years for all groups (χ2 p=0.005 for pregnant women, χ2 p<0.001 for all other groups). Conclusions: IFLS anaemia estimates for different population groups decreased between 1997/8 and 2007/8 and were consistent with estimates from Southeast Asia, and with other studies conducted in Indonesia. While the prevalence of anaemia consistently de- creased in all groups, anaemia remains a moderate public health problem for children 0 to 5 years, children 5 to 12 years, and non-pregnant and pregnant women.
With an effort to investigate possible relationship between flavonoids and health, an accurate estimation of flavo- noid intake is valuable. We estimated dietary flavonoid intake and identified the major food sources. Subjects were healthy adults aged ≥19 y (n=11,474) who completed the 24-h dietary recall of the Korean National Health and Nutritional Examination Survey (2010-2012). The US Department of Agriculture and newly estimated or published values for typical Korean foods were combined into a Korean-targeted flavonoid database. The mean intake of total flavonoid was 107±1.47 mg/d, with a higher intake in women than in men after energy-adjustment. Quercetin, cyanidin, genistein, daidzein, epigallocatechin 3-gallate, epicatechin, hesperetin, and luteolin were identified as major flavonoid compounds. Across the age range studied, flavonols and flavones showed a reversed U-shape curve; flavan-3-ol and flavanones showed a decreasing pattern; and anthocyanidins and isoflavones showed an increasing pattern. Forty-five food items were identified as contributing >2% of at least one flavonoid compound’s intake. Kimchi was the major food source of total flavonoids, followed by green tea, persimmons, and soybeans. Single food items accounting for more than 50% of the intake of a specific flavonoid included per- simmons (cyanidin), green tea (epigallocatechin, epicatechin-3-gallate, and epigallocatechin 3-gallate), black tea (thearubigin), tangerines (hesperetin and naringenin), and onions (isorhamnetin). This study provides information on Korean flavonoid intake to enable international comparisons, along with insight into how the sources and in- take of various flavonoids vary according to age and gender. This work should facilitate future investigations of the association between flavonoid intake and health.
Objectives: To assess the potential dietary supply of vitamin D to Australian adults by application of new data for Australian primary foods of animal origin. Methods: New published analytical data on the vitamin D contents of Australian primary foods from animal products were obtained and assessed for reliability. Using food con- sumption data from Australian population dietary surveys for 1995 and 2011-2013, estimates were made of the likely average daily intakes of vitamin D equivalents from these sources by Australian adults. Results: Meats, chicken, fish, eggs and dairy produce may alone have contributed about 4.2 μg vitamin D equivalents per day to average Australian diets of adults >18 years in 1995 and 4.3 μg in 2011-2013. Conclusions: Dietary vitamin D intake in Australia is likely to be higher than previously estimated because new data from improved analytical methods reveal the contributions to vitamin D supply from foods of animal origin. Absence of reliable vitamin D data for milk and milk products, and the gaps in vitamin D data for many commonly consumed seafood, poultry, eggs and processed animal products greatly limit estimation of dietary vitamin D intakes by Australians.
Background: Lower ethnic-specific body mass index (BMI) cutpoints have been proposed for Asians and adapted in some countries. However, to our knowledge, no study has directly compared Asians to other ethnic groups to test differences in associations between BMI and all-cause mortality using common methods. Objec- tives: We estimated the association between BMI and all-cause mortality in Chinese Asians and Caucasian Amer- icans to determine if lower Asian-specific BMI cutpoints are warranted. Methods: Extant data of the People’s Republic of China Study (1983-1997) including 5546 Chinese and the Atherosclerosis Risk in Communities Study (1987-2002) including 9932 Caucasians aged 45-64 years at baseline were used. All analyses were per- formed using Cox proportional regression models. Results: Standardized mortality rates were 6.88 (95% confi- dence interval (CI): 5.75-8.24) and 5.50 (95% CI: 4.74-6.39) per 1000 person-years for Chinese and Caucasians, respectively. Standardized mortality probabilities by age 70 were similar across all BMI categories among Chi- nese. Furthermore, the probabilities were similar to those among Caucasians with BMI of 27.5-<32.5 kg/m2. The BMI associated with lowest mortality risk was almost identical between Chinese (25.1 kg/m2) and Caucasians (25.2 kg/m2). The analysis of categorical BMI did not reveal an increased mortality risk at any BMI category among Chinese. In contrast, compared to those with a BMI of 23.0-<25.0 kg/m2, risk was elevated by 35% among Caucasians with a BMI of 30.0-<32.5 kg/m2. Conclusions: These findings do not support different BMI cutpoints for Chinese than Caucasians on the basis of mortality rates.
Objective: To investigate the predictive value of high body mass index (H-BMI) on the survival of patients with esophageal cancer (EC) after curative esophagectomy. Methods: Studies were systematically identified to inves- tigate the relationship between overweight and obese (H-BMI) and clinical outcomes in EC patients treated with curative esophagectomy. Measured clinical outcomes were disease-free survival (DFS) and overall survival (OS). The pooled hazard ratio (HR) with 95% confidence interval (CI) was estimated. Subgroup analyses were per- formed according to tumour type and body mass index (BMI). Results: Fourteen studies with 4823 cases were included in the final pooled quantitative analysis. In EC patients overall, H-BMI was associated with improved DFS (HR, 0.83; 95% CI: 0.75-0.90) and OS (HR, 0.79; 95 % CI: 0.73-0.85), as compared with normal BMI. The results were consistent with those who were overweight. Among patients with esophageal adenocarcinoma (EAC), a better prognosis, as reflected by OS, was observed with H-BMI (HR, 0.81; 95% CI: 0.73-0.89). The same re- sults were also observed in EAC patients who were obese and overweight. In contrast, among patients with esophageal squamous cell carcinoma (ESCC), H-BMI was associated with a worse prognosis, as reflected by DFS (HR, 2.26; 95% CI: 1.29-3.24). Conclusions: H-BMI has distinctly different impacts on the postoperative survival of EAC and ESCC patients. H-BMI is a potential predictor for better prognosis in EC patients overall, and particularly in EAC patients, treated with curative esophagectomy. However, in ESCC patients, H-BMI is a potential predictor for a worse prognosis of postoperative survival.
Objective: Undercarboxylated osteocalcin (ucOC) produced from the bone was recently found to play a regulato- ry role in the insulin and adiponectin secretion. We performed a cross-sectional study to investigate the relation- ship between ucOC and diabetes mellitus (DM). Methods: We included 1,870 subjects aged over 50 from partic- ipants of a health examination. According to the current medication and past history, 605 subjects had hyperten- sion (HT), 316 had dyslipidemia (DL), and 182 had type 2 DM. Fasting blood samples were collected to measure concentrations of ucOC and the bone turnover marker, tartrate-resistant acid phosphatase 5b (TRACP5b) by ELI- SA. Results: The serum ucOC level was significantly lower in DM(+) than DM(-) in both men and women. In a logistic regression analysis, a low level of ucOC was significantly associated with the presence of DM in both men and women after adjusting for age, BMI, serum creatinine, triglyceride, and TRACP5b. Multiple regression analysis showed a negative association of ucOC with HbA1c and fasting plasma glucose, and a positive associa- tion with the insulin level. In contrast, no association was found between TRACP5b and the indices above, sug- gesting that the effect of ucOC on the insulin secretion and the glycemic status was independent of bone turnover. Conclusions: The present cross-sectional study showed a significant association between ucOC and glucose me- tabolism after correction with bone turnover in a community-dwelling population both in men and women, indi- cating that ucOC may play an important role in the pathogenesis of DM through the pathways independent of bone metabolism.
The purpose of this analysis was to combine evidence from parallel and cross-over randomized controlled trials to assess the impact of iodine fortified foods on urinary iodine concentration (UIC) in children. A structured search for studies on iodine intervention studies on MEDLINE, Pro Quest, and the Cochrane Library from Jan, 1990 to Dec, 2012 was carried out. Carry-over effect was estimated by general linear model. We explored two methods to pool continuous outcomes in a meta-analysis by combining parallel and cross-over trial designs. The standard mean difference was calculated for net change in UIC. Fixed or random-effects models were used to summaries fortified food response data. Meta-regression and covariate meta-analysis were performed to explore the influ- ence of confounders on the net pooled effect on UIC. The overall pooled estimate, which combined parallel with cross-over trials in the absence of carry-over effect of UIC from 9 studies, showed a significant increase in the fortified group compared with the control group (n=3448; standard mean difference=2.02 μg/L; 95% CI: 1.30, 2.73; I2=99%, τ2=1.81, p<0.01). Meta-regression analysis indicated that dose of the feeding was positively related to the effect size (regression coefficient=0.014; 95% CI: 0.003, 0.026; p<0.019). The net pooled effect size after removing the confounders was 1.59 (95% CI: 0.953, 2.23) μg/L. There was an association between intakes of io- dine fortified foods and UIC in children. These results suggest that we can combine parallel with cross-over trials for meta-analysis for nutrients such as iodine when absorption is high.
Measurement of rapid-turnover proteins has an established place in nutrition assessment and is partly dependent on the zinc metallo-enzymes involved. We investigated the reference values of rapid turnover proteins and zinc in Japanese children. This cross-sectional study was conducted at a single center. We collected data from chil- dren aged 0 to 12 years with inguinal hernia, umbilical hernia, or hydrocele of the spermatic cord, who had body mass index z scores of -2 to 2. The standard references (mean±2 SD) of transthyretin were 11.5-21.5 mg/dL in infants (≤1.5 years), 13.6-21.5 mg/dL in preschool children (1.6-6 years), and 12.3-23.4 mg/dL in preadolescent children (6.1-12 years). The standard references of retinol binding protein were 1.27-2.55 mg/dL, 1.28-2.54 mg/dL, and 1.27-2.44 mg/dL in each age group, respectively. Rapid turnover proteins did not differ significantly in each group. The transthyretin level was weakly correlated with aging (r=0.284, p=0.003) and estimated lean body mass (r=0.274, p=0.004). Retinol-binding protein was not correlated with aging and anthropometric pa- rameters. We established reference values for rapid turnover proteins with known zinc status in Japanese chil- dren. These values were not, or only weakly, correlated with anthropometric parameters for assessing protein en- ergy malnutrition.
Malnutrition is an independent risk factor for complications, mortality, wound healing, length of hospital stay, and costs. Associations between nutritional support and surgical patients remain controversial. Databases, includ- ing Pubmed, EMBASE, Web of Science, CNKI, VIP, and the Cochrane Library, were searched to find random- ized controlled trials (RCTs) that assessed the effect of nutritional support on clinical outcomes in perioperative malnourished patients. The methodological quality of each included trial was assessed. A meta-analysis was con- ducted with Rev Man 5.2. Fifteen RCTs, involving 3831 patients, were included in this meta-analysis. Compared with control group, results showed that nutritional support was more effective in decreasing the incidence of in- fectious [relative risk (RR): 0.58; 95% CI: 0.50, 0.68; p<0.01] and non-infectious complications (RR: 0.74; 95% CI: 0.63, 0.88; p<0.01), and shortening the length of hospital stay [weighted mean difference (WMD): -2.64; 95% CI: -5.13, -0.16; p<0.05]. Moreover, the incidence of infectious complications in the immune nutrition group was significantly lower than that in the standard nutrition group (RR: 0.75; 95% CI: 0.58, 0.97; p<0.05). However, changes in hospital costs (WMD: 894; 95% CI: -1140, 2928; p>0.05) and postoperative mortality (RR: 0.77; 95% CI: 0.41, 1.44; p>0.05) between the nutritional support group and control group were not significantly different. In conclusion, perioperative nutritional support was superior in improving clinical outcomes in malnourished pa- tients, which could significantly reduce the incidence of complications and effectively shorten the length of hos- pital stay.
Objectives: This study aimed to evaluate the relationship between parental body weight and their children’s overweight and obesity in school students in Gao Hang Town, Shanghai. Methods: A cross-sectional study was performed in five primary schools in Gao Hang Town, Shanghai. Overall, 2,025 sets of parents and their children (7-13 years, 981 boys/1044 girls) were enrolled. Body mass index (BMI) and waist circumference for each child were measured. Age, gender, birth weight, and breastfeeding history was recorded for each child and the BMI of their parents was obtained by a self-completion questionnaire. Overweight (including obesity) was defined as a BMI of ≥24.0 kg/m2 in parents and a BMI ≥P85 in children according to age- and gender-specific percentiles. Re- sults: The total prevalence of overweight was higher in boys than in girls (35.5% vs 19.5%), while it was the same in fathers compared with mothers (50.6% vs 18.9%). The prevalence of overweight in boys showed a trend with increasing age, but remained stable versus age in girls. Parents were further divided into four subgroups as follows: I) both father and mother had a normal BMI; II) father overweight, mother normal weight; III) father normal weight, mother overweight; IV) both father and mother are overweight. The odds ratio of overweight was 2.26 for group II, 2.71 for group III, and 4.36 for group IV, respectively, compared with group I. Gender, paternal BMI, and maternal BMI were chosen as risk factors for children overweight. Conclusions: Parental BMI affects their offspring overweight and obesity in Chinese school students.
The aim of this study was to determine the level of exposure to polychlorinated biphenyls (PCBs) and selected heavy metals among fishermen via dietary intake of fish and other seafood from the eastern coast along the Straits of Malacca. This study determined the neurobehavioural performances (based on neurobehavioural core test bat- tery scores) of the fishermen and evaluated the correlations between scores of neurobehavioural core test battery and exposure factors. Ninety fishermen participated in the study. The total fish intakes of the fishermen were measured using a set of food frequency questionnaires. The PCBs contents in the seafood samples ranged be- tween 0.2 and 0.6 pg/g fresh sample. The concentrations of mercury (Hg), arsenic (As), cadmium (Cd), and lead (Pb) in the seafood samples were 1.1-5.4, 0.3-4.4, 0.6-36.1, and 0.02-0.3 μg/g fresh sample, respectively. The PCBs, Hg, As, Cd, and Pb exposures of the fishermen was estimated to be 2.8, 0.02, 4.5, 0.09, and 0.5 pg/kg body weight/day, respectively. PCB and heavy metal exposures through dietary intake of fish and seafood were within the tolerable daily limits. The results of neurobehavioural core test battery revealed that the neurobehavioural per- formances of the fishermen were not affected due to PCB and heavy metal intoxication. No correlations were found between the exposure and neurobehavioural performance among the fishermen. These data are useful for policy makers to assure the safety and quality of seafood in relation to sea pollution. Although the levels of expo- sure were low, periodic assessment of the quality of fish and fish products is required due to the polluted seawater.
Objective: Diabetes mellitus requires lifelong treatment, most of which is accomplished in family and communi- ty settings. The present study was designed to identify the effectiveness of nutrition intervention provided by pub- lic dietitian on glycemic control in a community setting in China. Methods: Two communities were selected and randomly assigned to a routine care group (59 subjects) and a public dietitian-led intervention group (58 subjects) who received diabetic nutrition management for one year. The main measures included fasting plasma glucose, HbA1c, weight, body mass index (BMI), lipid profile, and blood pressure. Results: In the intervention group, there was significant improvement in fasting plasma glucose, HbA1c, cholesterol, and triglyceride levels relative to the control subjects (p<0.05). Over the 12-month period, there was a decrease in energy intake, including re- ductions in absolute amounts (grams) of protein and fat in the intervention group. The energy percent values of carbohydrate, protein, and fat were 50.7%, 17.0%, and 32.3%, respectively, at baseline and 53.0%, 17.1%, and 29.9% (within the recommended range) after the intervention. There were significant improvements in total ener- gy, absolute amounts of fat and protein, and the energy percent values of carbohydrates and fat. In the control group, however, these values were similar before and after the intervention, and the energy percent values of fat were still above the recommended range. Conclusions: In a community setting, a diabetes nutrition intervention led by a public dietitian significantly improved the glycemic control of type 2 diabetic patients.
To improve the nutritional status of children and adolescents, it is critical to identify the barriers to the implemen- tation of nutrition education in schools. We carried out a cross-sectional study by analyzing data from 121 sub- jects (45 nutrition teachers and 76 school dietitians). Among the personal, environmental and systematic barriers, the top four barriers to the implementation of nutrition education were heavy workload (4.28 points), lack of a systematic curriculum (4.12 points), lack of perception of nutrition education by school administrators and teach- ers (4.07 points), and lack of continuing education for nutrition teachers and school dietitians (4.05 points). Addi- tionally, poor working conditions, such as low pay, were identified as significant barriers to nutrition education for school dietitians compared with nutrition teachers (4.33 vs 3.47 points, p<0.001). This research provides use- ful information for nutrition policy makers to promote nutrition education in schools in South Korea.
Background: India is experiencing a nutrition transition with the consumption of processed foods rapidly in- creasing. Nutrition labels are essential if consumers are to understand the healthiness of these products. The Food Safety and Standards Authority of India have recently introduced regulation defining national nutrition labelling requirements and Codex Alimentarius recommends a global standard. Objectives: To quantify the adherence of the declared nutrients on Indian packaged foods with national and global requirements. Methods: The presence or absence of data for seven required nutrients was recorded for all food products available for sale. Branches of three major retail chains and three smaller stores in Hyderabad, India between October and November, 2010 were surveyed. Results: Data were collected for 4166 packaged products that fell into 14 different food groups. 52% of products displayed nutrient information on energy, protein, carbohydrate, sugar and total fat, meeting the mini- mum requirements of the Food Safety and Standards Authority of India. Only 27% met the minimum criteria de- fined by Codex which also requires the reporting of saturated fat and sodium. There was significant variation in compliance for leading brands, country of manufacture and food group (p<0.01 for all). Conclusions: The ma- jority of Indian packaged foods do not meet national and international nutrient labelling guidelines. With the In- dian population likely to consume much more packaged food over coming years full and effective food labelling will be essential. The failure of Indian legislation to require labelling of sodium and saturated fat may warrant re- view.
The objective of this study was to test how the genetic polymorphisms located within the lipoprotein lipase (LPL) locus would modulate the relationship between a diet high in carbohydrate and insulin resistance related traits in metabolic syndrome adults. A one year nutritional intervention study focusing on education to increase dietary in- take of whole grain, vegetable and fruit, and to reduce the intake of sodium, simple sugar and dietary fat (espe- cially cooking oil and pork lard) was conducted. Two districts in Shanghai, China were randomly selected to be the intervention and control group, and patients (n=235) with metabolic syndrome within these two districts were selected based on a multistage sampling method. Fasting glucose was reduced in rs328 CC homozygotes (p=0.028) but not G carriers (p=0.686) within the intervention group. Also an ancillary study with greater statisti- cal power by combining the baseline measurements across both the intervention and control groups was conduct- ed to test the cross-sectional statistical interactions between carbohydrate/fat and lipoprotein lipase genotypes for homeostasis model assessment of insulin resistance/insulin/fasting glucose. Increased carbohydrate intakes were positively associated with homeostasis model assessment of insulin resistance and insulin in rs328 G carriers but not CC homozygotes (p for interaction was 0.025). These results indicate that diet high in carbohydrate may not be suitable for metabolic syndrome rs328 G carriers, calling for the development of personalized dietary interven- tion for metabolic syndrome subjects.
Objective: Questions exist regarding the causal relationship between malnutrition and stroke outcomes. This study aimed to determine whether nutritional status changes or malnutrition during hospitalisation could predict 3-month outcomes in acute stroke patients. Methods: During a 10-month period, patients who suffered their first stroke within 7 days after stroke onset were included in this prospective multi-centre study. The demographic pa- rameters, stroke risk and severity factors, malnutrition risk factors and dysphagia were recorded. Nutritional sta- tus was assessed by 3 anthropometric and 3 biochemical indices. Changes in nutritional status were defined by comparing the admission values with the 2-week values. A Modified Rankin Scale score of 3-6 was defined as a poor outcome at the 3-month follow-up. Univariate and multiple logistic regression analyses were used to inves- tigate the power of nutritional status changes in predicting poor patient outcomes. Results: Data from 760 pa- tients were analysed. Poor outcomes were observed in 264 (34.7%) patients. Malnutrition prevalence was 3.8% at admission and 7.5% after 2-weeks in hospital, which could not predict 3-month outcome. Emerging malnutrition was observed in 36 patients (4.7%) during the 2-week hospitalisation period and independently predicted poor 3- month outcomes after adjusting for confounding factors (odds ratio 1.37, 95% confidence interval, 1.03-1.83). Conclusions: Emerging malnutrition during hospitalisation independently predicted poor 3-month outcomes in acute stroke patients in this study.
Objectives: Medium chain triglycerides (MCTs) are of nutritional interest for their unique properties on ingestion, absorption and metabolism. However, dietary and enteral MCTs usage in hospitalized patients in China requires evaluation. Methods: A retrospective analysis was conducted on 46 hospitalized patients who were administered MCTs therapy between January, 2012 and December, 2013 in Peking Union Medical College Hospital. The clini- cal parameters of subjects were evaluated 2 weeks after intervention. All indications and outcomes of MCTs ther- apy underwent evidence-based evaluation. A survey was conducted on a random sample of 77 doctors to clarify the awareness and knowledge of MCTs therapy among clinicians. Results: Among 46 cases undergoing MCTs therapy, there were 21 with gastrointestinal dysfunction (with improvement in 15 cases), 15 with lymphatic anomalies (with improvement in 7 cases), 5 with dyslipidemia (with improvement in 3 cases), 4 with exocrine pancreatic insufficiency (with improvement in 2 cases) and 1 with epilepsy (without improvement). All indica- tions were evidence -based. Although MCTs were being utilized in an increasing number of patients, the survey revealed poor knowledge of their physicochemical properties, medical indications and the therapeutic basis of their use among clinicians. Conclusions: MCTs therapy is of benefit in the management of gastrointestinal mal- absorption, pancreatic exocrine insufficiency, intestinal lymphangiectasia and dyslipidemia. However, randomized controlled trials with adequate sample size and longer follow-up are required to evaluate further their efficacy, and more educational programs are needed to ensure clinical competence for MCT therapy.
Objectives: Peritoneal dialysis patients are at risk of glucose absorption from peritoneal dialysate, not only be- cause of energy imbalance but also the toxic effects of high glucose. The current widely applied formulae may be not suitable for estimation of glucose absorption in continuous ambulatory peritoneal dialysis (CAPD) patients. This study examined the actual glucose absorption in a cohort of CAPD patients and compared the results with estimates from four current formulae. Methods: We conducted a survey of glucose absorption of a cohort of 72 CAPD patients and compared actual dialysate glucose absorbed and estimates using K/DOQI formula, Grodstein formula, Bodnar formula, or a percentage estimate of 60%. Results: The total dialysate glucose infused each day varied from 54.4 to 191 g/day with average of 102±27.9 g. The average of glucose absorbed was 65.7 g (ranging from 19.5 to 131 g) by actual measurements. The mean absorption rate was 64.4% (ranging from 30.6% to 92.4%). The glucose absorbed from dialysate accounted for 13.8% (ranging from 5.0% to 30.1%) of total energy intake. The average errors of absolute values between actual measurements and estimates were greater than 10 g or 20 g glucose (p<0.001). The average errors in percentages were greater than 20% or 40%, dependently on es- timating methods. Conclusions: The applications of current estimating methods may have limitations. The actual measurement provides dietitians and doctors with more exact information of absorbed glucose and energy com- pared to the current estimating methods.
Objectives: Vitamin B-12 and n-3 polyunsaturated fatty acids (PUFA) decrease blood homocysteine (Hcy) con- centrations. However, the combined effect of these nutrients on Hcy and ferritin, and C-reactive protein is limited and inconclusive. The objective was to examine the synergistic effect of vitamin B-12 in combination of n-3 PUFA on plasma Hcy, ferritin, and other biochemical markers. Methods: In a randomized controlled trial, thirty eligible subjects were randomly divided into three groups, and assigned to receive 1000 μg of vitamin B-12, 2 g fish oil, or 1000 μg vitamin B-12 and 2 g fish oil, respectively, for 8 weeks. Plasma phospholipids (PL) fatty ac- ids and biochemical markers were determined. This study was registered under ClinicalTrials.gov Identifier: NCT01762072. Results: Plasma PL 20:5n-3, 22:6n-3 and n-3 PUFA was increased after 4 and 8 week supple- mentation of fish oil, and vitamin B-12+fish oil. Plasma concentrations of triacylglycerol, uric acid, C-reactive protein, and ferritin were significantly decreased after 4 and 8 week supplementation of fish oil, and vitamin B- 12+fish oil. In all groups, significant changes in plasma Hcy were observed during the study period. Vitamin B- 12, fish oil, and vitamin B-12+fish oil supplementation lowered plasma Hcy concentrations by 22%, 19%, and 39%, respectively. Conclusions: The combination of vitamin B-12 and fish oil has a synergistic effect on lower- ing plasma concentrations of Hcy.
Objectives: Total knee arthroplasty (TKA) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength. We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine (HMB/Arg/Gln) on the postoperative re- covery of quadriceps muscle strength in patients after TKA. Methods: Study subjects were 23 patients (12 wom- en; mean age: 70.5) who underwent TKA. The patients were randomly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation (HMB/Arg/Gln group). HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery, and maximal quadri- ceps strength was measured at 7 days before the surgery, and at 14, 28 and 42 days after the surgery. During the study, total energy expenditure was measured using a lifestyle recording device. The two groups followed the re- habilitation in the same way. Results: The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group (p=0.02), and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group. Although the control group experienced a sig- nificant loss of muscle strength after the surgery, the HMB/Arg/Gln group did not. There was no significant dif- ference in total energy expenditure between the two groups. Conclusions: Consuming HMB/Arg/Gln supplemen- tation may suppress the loss of muscle strength after TKA. Intervention with exercise and nutrition appears to en- able patients to maintain their quadriceps strength.
Objectives: Previous clinical trials have shown bowel function is improved through consumption of whole ki- wifruit (Actinidia deliciosa). This study investigated whether encapsulated kiwifruit extract (1 g/day) could alle- viate constipation in otherwise healthy adults. Methods: Forty adults with confirmed constipation entered this trial, of which 32 completed with >80% compliance. Two capsules were self-administered morning and evening for 2 periods, each of 3 weeks duration, separated by a 3+ week washout in a double blind, randomised, placebo controlled crossover. Inclusion criteria included constipation with ≤3 bowel movements (BM) per week. Daily records of defecation frequency and stool characteristics were obtained throughout treatment, as well as a meas- urement of gastrointestinal symptoms rating scale (GSRS) and quality of life (QoL) before and after each inter- vention arm. Results: There was no difference in total BM over 3 weeks (p>0.05) or mean BM during each of weeks 1, 2 and 3 (p>0.05) between the kiwifruit extract and placebo when assessed from a faecal diary. There was also no detectable difference in defecation related scores of BM ease of defecation, volume, consistency or BM type assessed using Bristol stool chart scores. Nor was there a significant change in GSRS or QoL between pre and post treatment measures, when compared to placebo (p>0.05). Conclusions: This trial showed that im- provement in bowel function or comfort was not achieved through supplementation with 1 g/day freeze dried ki- wifruit extract. Efficacy from prior kiwifruit powder and whole fruit trials indicate that investigating higher doses of encapsulated kiwifruit extract may be worthwhile.
The effects of patient characteristics on reported adherence to dietary self-care behaviours in 184 Taiwanese out- patients 40 years or older with type 2 diabetes was assessed. Patient characteristics included the presence of pre- disposing factors affecting diabetes adherence (knowledge and attitudes about the disease, self-efficacy, and the absence of psychological problems), enabling factors (understanding of diabetes and environmental factors affect- ing it), and reinforcing factors (presence of medical and social support) which were evaluated using a 72 item self-administered questionnaire with 8 subscales. Adherence was assessed by patients’ reports of carrying out 7 self-care behaviours (following a diabetic meal plan, following the diabetes exchange system, eating meals providing the same amount of carbohydrate every day, counting carbohydrates, reducing dietary fat, consuming high fiber foods, and keeping a daily food record). Reported adherence ranged from 17% to 74%. No single pre- disposing, enabling, or reinforcing factor predicted adherence to all of the dietary self-care behaviours. However, more self-efficacy, better understanding, and a better attitude toward diabetes were associated with performing five or more of the dietary self-care behaviours examined. With respect to specific self-care behaviours, women were more likely than men to count carbohydrates (OR=5.75) and reduce fat in their diets (OR=2.57). Patients who attended more nutrition education sessions were more likely to follow diabetes meal plans (OR=2.11) and the diabetes exchange system (OR=3.07). Efforts are needed to encourage providers to teach diabetes self-care behaviours to patients and to capitalize upon demographic and psychosocial characteristics that can enhance pa- tient adherence.