Effective clinical nutrition practice depends on a sound knowledge of biomedical, societal and environmental sci- ence and the skills to diagnose, prevent and manage the health problems related to food patterns, energy equilib- rium (mostly to do with physical activity) and nutrient metabolism. Its delivery needs to be accessible, equitable, affordable and sustainable. Ordinarily, this will require both local and widely distributed health services. In North-East (NE) Asia, these requisites are being met to an ever increasing extent. The roots of this progress are steeped in cultures which acknowledge the food-health connections and support education which pays regard to these connections. As elsewhere, however, the food and health systems, their safety and security are threatened by exploitative operatives. In China, a concerted effort was made in the mid-1980s to foster clinical nutrition in major hospitals throughout the country by programs directed at medical graduates, nursing and kitchen staff; die- tetics has appeared much more recently. By contrast, Japan has had an extensive and well-trained dietetic work- force for much longer, alongside a vibrant basic nutrition science constituency in its universities and food- nutraceutical industry. South Korea and Taiwan have traversed a similar course to that in Japan. Now, all of these NE Asian economies have gathered rapid momentum in the publication of innovative approaches to public health and clinical nutrition which have the prospect of not only improving health outcomes, but also reducing the socie- tal and financial burden of health care. This is particularly important in rapidly ageing societies, which they are. It is also a growing challenge where climate change threatens to engulf the lives and destinies of hundreds of mil- lions of Asians on account of natural disasters, water and food insecurity.
Critically ill patients usually suffer from catabolic stress that could lead to malnutrition and nutritional support therefore is essential to maintain lean body mass, improve metabolic and immune response and decrease rate of mortality and comorbidity in these patients. This meta-analysis was aimed to evaluate effect of glutamine- enriched enteral nutrition in critically ill patients. In order to obtain randomized clinical trial studies (RCTs), in- ternational databases including MEDLINE and Google scholar and also electronic resources in Iran, including IRAN MEDEX, IRAN DOC, SID, Magiran were systematically searched without language and publication re- striction before December 2014. The final included number of studies for meta-analysis was 10. The methodolog- ical quality of eligible studies was assessed by four investigators using the Jadad 5-point scale, a scale containing three items describing randomization, blinding and fate of participants. We analyzed data from the included stud- ies using STATA version 12.0, and calculated a pooled odds ratio for dichotomous data and mean differences for continuous data with 95% confidence intervals (CIs). There was no significant difference in mortality in elevated pooled odds ratios (p-value=0.070). A funnel plot was drawn for evaluation of publication bias, but none was found. The fixed effect model shows significant reduction in gut permeability in who received enteral feeding en- riched with glutamine (-0.84, 95% CI=-1.25 to -0.44), moreover the funnel plot did not show publication bias. Based on the available data, our meta-analysis showed that enteral glutamine (Gln) supplementation increased mortality rate, though non-significantly, but decreased gut permeability significantly.
Background and Objectives: The nutritional status and hospital feeding practices of surgical patients in Vi- etnam are not well documented. Based on a cross-sectional study at Bach Mai Hospital (BMH), the prevalence of malnutrition was found to be 33% in the surgical ward using a body mass index (BMI<18.5 kg/m2. We conducted an observational study over a three month period to evaluate the feeding practices in the gastrointestinal (GI) sur- gery ward at Bach Mai Hospital (BMH) in Hanoi, Vietnam. Methods and Study Design: Investigators from the U.S. and the Vietnamese National Institute of Nutrition (NIN) enrolled 72 subjects admitted for elective GI sur- gery in an observational study at BMH. Baseline anthropometrics and changes over time, body mass index (BMI), Subjective Global Assessment (SGA) and daily kcal and protein intake from oral diet, tube feeding, and parenter- al nutrition (PN) from admission until discharge were documented. Results: A total of 50% of subjects scored a B or C on the SGA; 48% of subjects had a BMI<18.5, while mean mid upper arm circumference was in the low- normal range (24±4 cm). Nearly all patients (98%) were given PN postoperatively, with oral feeding starting on an average of postoperative day 4. Only one patient was tube fed. Mean daily total calorie intake was 15 kcal/kg/day and protein intake was 0.61 g/kg/day during hospitalization. Micronutrient supplementation was min- imal in subjects receiving PN. Conclusions: Hospital malnutrition in surgical patients in Vietnam is a significant problem, peri-operative feeding appears suboptimal and use of early postoperative PN was routine.
Background and Objectives: With the development of enteral nutrition in patients with neurological disorders in China, related guidelines were published in 2011. The Chinese Society for Parenteral and Enteral Nutrition conducted a survey to evaluate the status quo of enteral nutrition practices in these patients. Methods and Study Design: This multicenter prospective investigation was conducted from April 2012 to April 2013 and involved 18 tertiary hospitals in China. The survey using standardized questionnaires sought information about the basic pro- tocols for enteral nutrition (devices and staffing) and specific information about patients with neurological condi- tions who received nutrition by way of enteral feeding. Results: In the 18 hospitals from 13 provinces, 83.3% pa- tients were configured with an enteral nutrition infusion pump, 77.8% had a percutaneous endoscopic gastrosto- my (PEG) device, and 88.9% had a clinical nutrition support group. Four hundred four patients participated in this survey (259 men, 145 women; mean age 61.3±14.7 years), 85.7% had suffered a stroke, 83.9% had impaired consciousness, and 98.0% had dysphagia. Of the 10 guidelines for enteral nutrition practices, setting the energy target, choosing the enteral nutrition tube, and monitoring the patient received unsatisfactory ratings were in poor compliance (56.2%, 30.0% and 38.9%, respectively); the remaining seven guidelines were in good compliance (each >75%). Conclusion: The survey suggested that configuration of the enteral nutritional devices and staffing was adequate in China’s tertiary hospitals. However, some associated practices had not yet reached the desired levels of competency, indicating a need for this to be understood and for improved training.
Background and Objectives: Food intolerance is believed to be a source of frequent medical problems in ulcera- tive colitis (UC), which closely correlate with patients’ dietary pattern. Living in an underdeveloped area of Chi- na, residents in southwestern region have diverse dietary habits. The objective of this study is to determine the prevalence of food intolerance in the UC patients in this area and to discuss some of the possible risk factors lead- ing to the condition. Methods and Study Design: Food antibodies in serum of 80 patients with active UC were determined by standard enzyme-linked immuno sorbent assay (ELISA). This study examined the risk factors con- tributing to high titers of food antibodies and the dietary patterns correlating with food intolerance in these de- mographics. Results: 83.8% of patients (67/80) were found to be seropositive for food intolerance. Patients of female, aged between 20 to 40 and the one who tended to have a high fat diet were tested to be highly seroposi- tive (p<0.05). Neither spicy food intake nor the course the disease manifested any relationship with the presence of food intolerance (p>0.05). Conclusion: Active UC patients in southwestern region of China have showed to be high seropositive in food intolerance, particularly in female and young patients. Dietary patterns with high in fat intake seem to have caused high prevalence of seropositivity in food intolerance. Although rice has been taken as staple food and the spicy food has been popular among citizen in this region, these foods have indicated to no ef- fect on food intolerance in this study.
Background and Objectives: A recent observational study conducted in European intensive care units (ICU) showed that body mass index (BMI) is associated with mortality. We hypothesized that a lower BMI amongst critically ill Japanese patients was associated with increased hospital mortality, similar to findings noted among critically ill European patients. Therefore, we retrospectively investigated the relationship between BMI and pa- tient outcomes in an ICU. Methods and Study Design: We included consecutive patients who were admitted to our ICU between January 2012 and December 2013. Patients were divided into 3 groups based on their BMI at ICU admission. The underweight (“lower”) group (group L) included patients with a BMI below 18.5 kg/m2, the normal weight group (group N) included patients with a BMI between 18.5 and 24.9 kg/m2, and the over- weight/obese (“higher”) group (group H) included patients with a BMI above 25.0 kg/m2. Patient data were retro- spectively obtained from electronic patient records. Results: A total of 1,616 patients were admitted to our ICU. Of these patients, 346 patients were ineligible, and therefore, 1,270 were included in the analysis. There were 169 patients in group L, 779 patients in group N and 322 patients in group H. Overall, the mortality rate was 8.1% and the median hospital stay was 21 days. The mortality rate in group L was significantly higher than that in both group N and group H (13.6% vs 7.8% vs 5.9%, p=0.01). Conclusions: Our retrospective study suggests that low- er body mass index may be associated with increased hospital mortality in critically ill Japanese patients.
The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thai- land and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (≥75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, ex- cept Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (≥75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of chil- dren in all countries. Logistic regression showed that girls, urban area, region within the country and religion sig- nificantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vita- min D intake can be feasible options.
Phosphorus homeostasis is determined by dietary intake, intestinal absorption, and renal tubular reabsorption of phosphorus. Serum fibroblast growth factor-23 (FGF-23) is considered to be a sensitive early biomarker of disor- dered phosphorus metabolism in both patients with chronic kidney diseases and healthy subjects. However, the number of studies evaluating serum FGF-23 concentrations in healthy subjects is limited. The objective of this cross-sectional study was to examine the relationship between serum FGF-23 concentrations and phosphorus re- lated factors in 182 young Japanese women (mean age, 19.5±0.4 years). We found that higher serum concentra- tions of inorganic phosphorus and lower serum concentrations of 1,25-dihydroxy vitamin D as well as lower fat but higher phosphorus and calcium intake were weakly but significantly associated with high serum concentra- tions of FGF-23, adjusted for postmenarcheal age and body weight. These results suggested that in young Japa- nese women, serum FGF-23 might be indicative of phosphorus nutrition status. However, it is worthy of note that maturity factors, including postmenarcheal age and physical attributes, such as body weight, might be related to serum FGF-23 concentrations.
Background and Objectives: Lactation places enormous demands on maternal bone mineral homeostasis. Indi- an middle class women (MSC) consume energy dense food supplements to meet these demands post-partum (PP) along with restricted physical activity (PA). Effects of these changes on body composition (BC) of PP women have not been studied. To examine longitudinal changes in: a) bone mineral density (BMD) at total body (TB), AP-spine (APS) and dual femur neck regions (DF) b) BC by body weight, lean mass, fat mass using dual energy X-ray absorptiometry (DXA) at baseline, 6-months and 1-year in urban MSC women. Methods and Study De- sign: 76-primi-parous (28±3.2 yrs) randomly selected PP women (<7-days) were studied; 70 reassessed at 6- months and 42 1-yr PP. Data on anthropometry, BC, BMD at TB, APS & DF by DXA collected (baseline, 6- months, 1-yr PP). Results: Weight, waist and body mass index (BMI) decreased both at 6-month & 1-yr PP with respect to baseline (p<0.05). BC changes showed increase in android fat % at 1-yr by 10% over base- line (p<0.05). BMD with initial decline at 6-months (-2.8%, -2.3% and -2.3% respectively) recovered partially by 1-yr (+2.5% +1.2% and +4.8% respectively) at DF and TB with complete recovery at APS (p<0.05). Conclu- sion: These urban relatively sedentary MSC women consumed fat rich food PP with higher android fat retention and partial recovery of BMD at DF and TB at 1-year. Modifications in activity and dietary nutrient intakes may be necessary to prevent cardiovascular and bone health related risks.
The aim of our study was to examine the association of vitamin A status with obesity and the metabolic syndrome (MS) in school-age children in Chongqing, China. A cross-sectional study was conducted of 1,928 children aged 7~11 years from 5 schools in Chongqing, China. Body height, weight, waist circumference (WC) and blood pres- sure were measured. Blood glucose, lipids and vitamin A were determined. Overall prevalences for overweight, obesity and MS were 10.1%, 6.7% and 3.5%, respectively. There were 274 (14.2%) marginally vitamin A defi- cient (MVAD) children and 53 (2.8%) vitamin A deficient (VAD) children, respectively. Serum vitamin A in the obese group was significantly lower than in the overweight and normal weight groups (p<0.001). Body mass in- dex (BMI), WC, high density lipoprotein cholesterol (HDL-C) and glucose were strongly associated with vitamin A status (p<0.05). In a separate model adjusted for age and sex, compared with normal children, participants with obesity had a significantly higher risk of having vitamin A insufficiency (≤1.05 μmol/L) (OR: 2.37; 95% CI: 1.59, 3.55) (p<0.001), and participants with MS had a 1.99-fold (95% CI: 1.14, 3.47) greater risk of having vitamin A insufficiency (p=0.016), while participants with VAD had significantly higher risk of having MS (OR: 3.82; 95% CI: 1.44, 10.2) (p=0.007). Vitamin A insufficiency among Chongqing urban school-age children was found to be a severe health problem, significantly associated with obesity, hypertriglyceridemia and MS.
Background and Objectives: Predictive factors for parental accuracy in perception of their children’s weight and state of health have been unknown in Taiwan. Methods and Study Design: Data were obtained on children aged 3-12 years from the 2005 Taiwan National Health Interview Survey (NHIS). The comparison of measured BMI and parents’ perception of their children’s weight operationalized “weight perception”. A structured ques- tionnaire ascertained demographic characteristics, and logistic regression determined demographic variables as- sociated with a weight misperception. Results: The prevalence of parental misperception of children who were overweight or obese was 50%; the ratio was higher in younger parents, parents with younger children, and those with overweight or obese children. In fact, only 1.7% of children whose parents misperceived overweight or obe- sity were engaged in weight management. Conclusions: Most parents viewed excessive weight in their children as better health than normal weight. Parental age, children’s age, and weight loss management may be predictive factors in parents’ perceptive accuracy regarding children who are overweight or obese.
Knee height has been the most frequently used measure for height prediction where full height is difficult to measure. The aim of this study was to develop and validate predictive equations using knee height to estimate the height of Thai women. The female participants were 18-59 years of age and lived in Bangkok or three surround- ing provinces. They were assigned to one of two groups; the equation development group (n=488) and the equa- tion validation group (n=188). Standing height and knee height were measured in duplicate using a stadiometer and a knee height calliper. Age and physical characteristics of the equation development group and the validate group were comparable. The measured heights showed a significant strongly positive correlation with the mean knee height (r=0.84, p<0.001). Mean knee height in a regression model exhibited the most accurate height predic- tion (adjusted R2=0.718, standard error of estimate=2.80), according to the equation “Height=38.1+2.45 (average knee height) - 0.051(age)”. This study proposes a new height estimation equation for Thai adult women using knee height. The equation shows more estimation power than the previous studies conducted in Thailand.
Background and Objectives: Coffee is one of the most widely consumed beverages worldwide, and many stud- ies have investigated the association between coffee consumption and gastric cancer. However, the results are in- consistent. We conducted a systematic analysis of relevant population studies to derive a more precise estimation. Methods and Study Design: Cochrane library, PubMed and Embase databases were searched to identify studies that met predetermined inclusion criterion through July 2014. All epidemiologic studies regarding coffee con- sumption and gastric cancer risk were selected, and relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Results: Twenty two studies (9 cohort and 13 case-control studies) involving 7,631 cases and 1,019,693 controls were included. The summary RR of gastric cancer was 0.94 (95% CI: 0.80-1.10) for the high- est category of coffee consumption compared with the lowest category, and 0.93 (95% CI: 0.88-0.99) for coffee drinkers compared with nondrinkers. We stratified the population by coffee consumption. The pooled RR for the population with <1 cup/day, 1-2 cups/day and 3-4 cups/day coffee consumption compared with nondrinkers were 0.95 (95% CI: 0.84-1.08), 0.92 (95% CI: 0.82-1.03) and 0.88 (95% CI: 0.76-1.02), respectively, indicating that an increase in coffee consumption was associated with a decreased risk of gastric cancer. Furthermore, we stratified the studies by design, sex, population and time. A significant association between coffee intake and decreased gastric cancer risk was shown in case-control studies (RR=0.85, 95% CI: 0.77-0.95) and among the studies pub- lished over the last ten years (RR=0.88, 95% CI: 0.77-1.00). Conclusions: Our meta-analysis suggested that cof- fee consumption might be associated with a decreased risk of gastric cancer.
Background and Objectives: School-based nutrition education has been widely implemented in recent years to fight the increasing prevalence of childhood obesity in China. Methods and Study Design: A comprehensive lit- erature search was performed using six databases to identify studies of school-based nutrition education interven- tions in China. The methodological quality and the risk of bias of selected literature were evaluated. Stratified analysis was performed to identify whether different methodologies influenced the estimated effect of the inter- vention. Results: Seventeen articles were included in the analysis. Several of the included studies had inadequate intervention duration, inappropriate randomization methods, selection bias, unbalanced baseline characteristics between control and intervention groups, and absent sample size calculation. Overall, the studies showed no sig- nificant impact of nutrition education on obesity (OR=0.76; 95% CI=0.55-1.05; p=0.09). This can be compared with an OR of 0.68 for interventions aimed at preventing malnutrition and an OR of 0.49 for interventions aimed at preventing iron-deficiency anemia. When studies with unbalanced baseline characteristics between groups and selection bias in the study subjects were excluded, the impact of nutrition education on obesity was significant (OR=0.73; 95% CI=0.55-0.98; p=0.003). An analysis stratified according to the duration of intervention revealed that the intervention was effective only when it lasted for more than 2 years (OR=0.49, 95% CI=0.42-0.58; p<0.001). Conclusion: Studies of school-based nutrition education programs in China have some important limi- tations that might affect the estimated effectiveness of the intervention.
Background and Objectives: The incidence of atopic dermatitis (AD) is continuously increasing in industrial- ized countries, possibly due to dietary and lifestyle changes. However, the association between processed food in- take and AD has not been studied in a large adult population. Methods and Study Design: We investigated the association between dietary habits and AD in 17,497 adults in the 2009-2011 Korean National Health and Nutri- tion Examination Survey (KNHANES). Results: We identified 4 dietary patterns using principal components analysis of a 63-item food frequency questionnaire: the “traditional dietary pattern”, rich in rice and kimchi; the “processed food pattern”, with more meat, instant noodles, soda, and processed foods; the “healthy dietary pat- tern”, high in grains, vegetables, fruits, and seaweeds; and the “drinking dietary pattern”, mainly drinking coffee and alcohol. Adjusted odds ratios (ORs) for AD were calculated according to dietary patterns after adjusting for potential confounders with incorporation of sample weights for the complex sample design. The “meat and processed food” pattern was associated with a significant 1.57 fold higher OR for atopic dermatitis than the low consumption group. Further analysis revealed that the increased atopic dermatitis was most closely associated with instant noodles. In contrast, the groups with high intake of rice and kimchi exhibited lower ORs, 0.38 and 0.43 folds, compared to the low intake group. Conclusion: Consuming instant noodles, meat and processed foods was associated with increased prevalence of atopic dermatitis, whereas consuming rice and kimchi, and coffee was associated with decreased prevalence of atopic dermatitis.
Background and Objectives: Vitamin D receptor (VDR) genetic polymorphisms are considered to be associated with type 2 diabetes mellitus (T2DM), but this is inconclusive. The aim of this study is to quantify the association between polymorphisms of BsmI and FokI in the VDR gene and T2DM risk through literature review. Methods and Study Design: Original articles published from 1999 to June 2014 were discovered through PubMed, ISI Web of Science, China National Knowledge Infrastructure, Chinese Wanfang Database, and the Chinese Biomed- ical Literature Database. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with software STATA version 12.0. Results: Twenty-three articles containing 30 case-control studies were included. The association between the BsmI polymorphism and T2DM was weak in two genetic models (Bb vs bb and BB+Bb vs bb). The subgroup analysis showed that this association was only found in the studies with a small sample size (<200). A strong association between FokI polymorphism and T2DM indicated that this gene poly- morphism was possibly a risk factor for T2DM (ff vs FF: OR=1.57, 95% CI: 1.28-1.93, p<0.001; Ff vs FF: OR=1.54, 95% CI: 1.31-1.81, p<0.001; ff+Ff vs FF: OR=1.57, 95% CI: 1.35-1.83, p<0.001), especially in Chi- nese populations. Conclusion: More reliable conclusions about associations between VDR genetic polymor- phisms and T2DM will depend on studies with larger sample size and by ethnicity.
The flood that hit Kelantan in December 2014 was the worst in Malaysian history. Women and their infants ac- counted for a large proportion of the people at risk who were badly affected, as almost half of the population in Kelantan was in the reproductive age group. This report serves to raise awareness that breastfeeding mothers and infants are a special population with unique needs during a disaster. Four of their concerns were identified during this massive flood: first, the negative impact of flood on infant nutritional status and their health; second, open space and lack of privacy for the mothers to breastfeed their babies comfortably at temporary shelters for flood victims; third, uncontrolled donations of infant formula, teats, and feeding bottles that are often received from many sources to promote formula feeding; and lastly, misconceptions related to breastfeeding production and quality that may be affected by the disaster. The susceptibility of women and their infant in a natural disaster en- hances the benefits of promoting the breastfeeding rights of women. Women have the right to be supported which enables them to breastfeed. These can be achieved through monitoring the distribution of formula feeding, providing water, electricity and medical care for breastfeeding mothers and their infants. A multifaceted rescue mission team involving various agencies comprising of local government, including the health and nutrition de- partments, private or non-governmental organizations and individual volunteers have the potential to improve a satisfactory condition of women and infants affected by floods and other potential natural disasters.
Congenital chylous ascites in the neonatal period is a rare entity. Total parenteral nutrition (TPN), medium chain triglyceride (MCT)-based diet, octreotide and repeated paracentesis are regarded as appropriate medical treatment for congenital chylous ascites, and surgery is recommended when conservative therapy has failed. We present two cases in which ascites were confirmed via an abdominal sonogram and diagnostic paracentesis. In our clini- cal experience, rice soup combined with PN can be a safe and effective intervention.
Background and Objectives: This work represents the second part of a progressive review of AuSPEN’s 1999 Guidelines for Provision of Micronutrient Supplementation in adult patients receiving parenteral nutrition. Meth- ods and Study Design: A systematic literature review was undertaken and recommendations made based on the available evidence and with consideration to specific elements of the Australian and New Zealand (NZ) practice environment. The strength of evidence underpinning each recommendation was assessed. A multidisciplinary steering committee and external reviewers provided feedback on the guidelines. Results: On review of the avail- able literature it appears that the parenteral multivitamin preparations presently available in Australia and NZ are to sufficient avoid deficiency without causing toxicity in most clinical situations for adults receiving PN when provided regularly as part of the PN prescription. Vitamin D is the most vulnerable vitamin for the Australian and NZ PN population. Conclusions: Vitamins are an essential component of PN and should be provided from com- mencement for all patients receiving PN. With the exception of vitamin D, which is recommended to be moni- tored annually, routine monitoring of vitamin levels is unlikely to be necessary in patients receiving regular par- enteral multivitamin preparations. Clinical judgement is an important element when assessing, prescribing and monitoring patients receiving PN. Areas requiring further research have been identified.
Background and Objectives: Glutamine is a nonessential amino acid which improves intestinal mucosal regen- eration and absorption. Glutathione is a vital molecule for antioxidant reactions and is synthesized from cystine. The first aim of the study is to measure the plasma glutamine and cystine in children with celiac disease (CD) and compare them with controls. The second aim of this study is to investigate whether these amino acids are corre- lated with endomysial antibody (EMA) or not. Methods and Study Design: Fifty children with CD were com- pared to 50 healthy, age, and sex matched normal children as control. Plasma glutamine and cystine levels of the children were measured by using tandem mass spectrometry. Results: Plasma glutamine (808 vs 870 μmol/L) and cystine (19 vs 48.5 μmol/L) were significantly lower in the celiac group than the controls (p<0.05). The lev- els of plasma glutamine (797 vs 928 μmol/L, n=42) and cystine (18 vs 31.5 μmol/L, n=8) were lower (p<0.05) in the EMA-positive than the EMA-negative celiac patients. We could not find any statistically significance be- tween EMA-negative celiac patients and controls for the plasma glutamine (928 vs 870 μmol/L) and cystine (31.5 vs 48.5 μmol/L) (p>0.05). Serum EMA was negatively correlated with plasma cystine (r=-0,321, p=0.023), glu- tamine (r=-0.413, p=0.003). Conclusions: Our study indicated that plasma glutamine and cystine were signifi- cantly lower in the celiac children than the controls. Also, these amino acids were negatively correlated with EMA.
Background and Objectives: The purpose of this study was to investigate the contributing value of nutrition re- lated blood parameters to one-year mortality following intertrochanteric fracture surgery in a Chinese population over the age of 65. Methods and Study Design: Nutritional status was evaluated by using admission serum al- bumin and total lymphocyte count (TLC). One hundred and seventy-four intertrochanteric fracture patients were entered into this study for nutritional status assessment. Gender differences were evaluated by univariate analysis. The predictive value of the variables for one-year mortality was assessed by multiple logistic regression analysis. Results: The mean albumin was 31.0 g/L with 73% of patients less than 35 g/L and the mean TLC was 1.19×109 cells/L with 81% less than 1.50×109 cells/L. There were no significant differences in albumin (p=0.674) or TLC (p=0.804) between men and women. Survival information was obtained in 149 patients who received surgical treatment. The general one-year mortality was 31% with 35% in men and 29% in women, respectively. The sur- viving patients were younger and had higher albumin, TLC and calcium than those who died. However, multivar- iate analysis identified only serum albumin and TLC as independent and significant risk factors associated with one-year mortality; the optimal cut-off points were 29.5 g/L and 0.93×109 cells/L, respectively, based on the re- ceiver operating characteristic (ROC) curve. Conclusions: Malnutrition is a common phenomenon in an aged Chinese population suffering from intertrochanteric fractures. A lower serum albumin level and total lymphocyte count at admission are significant risk factors to predict the one-year mortality.
Background and Objectives: Mola (Amblypharyngodon mola) is a nutrient-rich, small fish found in ponds and rice fields in Bangladesh. The aim of the present intervention was to assess the effect of mola consumption on iron status in children with marginal vitamin A status. Methods and Study Design: Bangladeshi children (n=196), aged 3-7 years, with marginal vitamin A status were randomly allocated to one of three intervention groups served different fish curries: mola curry (experimental group); rui (Labeo rohita) curry with added retinyl palmitate (positive control group); or rui curry (negative control group). The intervention meals were served 6 days/week for 9 weeks. The experimental and positive control meals were designed to contain similar amounts of retinol activity equivalents per portion. The mola curry contained four times more iron compared to the rui curries due to different iron content in the two fish species. Haemoglobin, ferritin, serum transferrin receptor and C- reactive protein were measured at screening and endpoint. Results: In the experimental group receiving mola, se- rum transferrin receptor concentration declined 0.73 mg/L (95% CI 0.17, 1.28, p=0.01) compared to the positive control group, while there were no differences between groups in ferritin or haemoglobin. Conclusions: Con- sumption of mola instead of rui has potentially an effect on iron status in children with marginal vitamin A status, seen as a decrease in serum transferrin receptor concentration.
Background and Objectives: Reports on the mortality and its contributing factors after vertebral fracture (VFx) has been scarce, and limited to prevalent VFx. In this paper, we have studied the factors influencing mortality af- ter freshly diagnosed VFx. Methods and Study Design: 759 subjects aged 78.8±8.5 years old with back or lum- bar pain, and diagnosed as fresh VFx by MRI were studied for their age, gender, number of prevalent fracture (s), survival or the date of death, circulating concentrations of Hb, albumin, C reactive protein, and estimated glomer- ular filtration rate (eGFR). Cox’s proportional hazard analysis was performed to assess the significant predictors for mortality. The cut-off concentrations of the variables for mortality were analyzed using the receiver operator characteristic (ROC) curve. Results: The median observation duration was 3.8 years, and 3-year survival rate was 78.8%. Cox’s proportional hazard analysis has shown that serum albumin concentration (hazard ratio (HR) =0.355) and eGFR (HR=0.993) were significant predictors for mortality. The cut-off concentrations were 3.6 g/dL and 60 mL/min/1.73m2, respectively. Kaplan-Meier curves revealed that survival rates were significantly decreased in patients with both serum albumin concentration and eGFR below these cut-off concentrations. Con- clusions: The present study has revealed that malnutrition and impaired renal function were significant predictors for mortality after VFx.
Background and Objectives: Although high energy density foods are highly palatable, their overconsumption leads to obesity because of high fat content. Low energy density foods are more effective for preventing individu- als from becoming overweight. We investigated how different amounts of a single vegetable affect the sensory properties of meals with different energy densities. Methods and Study Design: In a randomized crossover de- sign, 40 young Japanese women consumed control and high-fat (HF) lunches. Control meals contained the same amount of rice and hamburger and 80 g (C80), 120 g (C120), 160 g (C160), 200 g (C200), 240 g (C240), or 280 g (C280) of broccoli. HF meals were control meals to which 38.1 g of oil was added (HF80, HF120, HF160, HF200, HF240, and HF280). Sensory properties before intake and 0.5, 1, 2, 3, 4, and 5 h after meals were assessed using a visual analog scale. Results: Fullness was significantly lower with C80 than with C200 and C280 at 0.5 h and all time points, respectively, after consumption. In contrast, satisfaction with all HF meals was similar at all time points. Fullness and satisfaction were higher with almost all HF meals than with control meals; however, fullness and satisfaction were similar between HF200 and all control meals 1-4 h after consumption. Conclusions: Fat increases satiety when a single vegetable is included in the meal; however, at least of 200 g of vegetable in a 500- kcal meal with low fat content provides fullness and satisfaction similar to those provided by an HF meal.
Background and Objectives: Constipation affects up to 20% of the world’s population. The aim of this study was to investigate whether supplementation with Ficus carica paste could be used to treat constipation in Korean subjects with functional constipation. Methods and Study Design: We conducted a randomized, double-blind, placebo-controlled trial. Subjects with functional constipation were orally supplemented with either F. carica paste (n=40) or placebo (n=40) for 8 weeks. We measured the efficacy and safety of F. carica paste. Primary out- comes (colon transit time) and secondary outcomes (questionnaire related to defecation) were compared before and after the 8-week intervention period. Results: F. carica paste supplementation was associated with a signifi- cant reduction in colon transit time and a significant improvement in stool type and abdominal discomfort com- pared with the placebo. Blood parameters and clinical findings for organ toxicity remained within normal ranges. Conclusion: These results suggest that F. carica paste may have beneficial effects in subjects suffering from constipation.
Background and Objectives: Hepatic encephalopathy is a common complication in patients who have received transjugular intrahepatic portosystemic shunt (TIPS) as treatment for cirrhosis. The objective of this study was to reduce the incidence of post-TIPS hepatic encephalopathy for these patients via positive diet intervention. Meth- ods and Study Design: As a control group, 99 cirrhosis patients who underwent TIPS treatment in our depart- ment between August 2011 and February 2013 were chosen. Among these, postoperative hepatic encephalopathy occurred in 28 cases. After analyzing the possible causes and incentives of hepatic encephalopathy by applying retrospective analysis, it was seen that hepatic encephalopathy was caused mostly by improper diet (85.7%). The experimental group was comprised of 83 cirrhosis patients who underwent TIPS treatment during the period from May 2013 to September 2014. In view of the influence of improper diet, appropriate intervention measures were taken, including developing a postoperative nursing routine, training nurses about nutrition and the protein con- tent of kinds of various common foods, customizing low-protein meals, training nurses in communication skills to improve the education of patients and establishing family support systems. Results: For the experimental group, hepatic encephalopathy occurred in 10 patients, for an incidence of 12.1%, which is significantly lower than the control group (28.3%). This is a statistically significant difference (p<0.01) in the occurrence of this complication. Conclusions: After TIPS, early positive dietary intervention can significantly improve the compli- ance of cirrhosis patients to consume a low-protein diet and reduce the incidence of hepatic encephalopathy.