Background and Objectives: Consumption of foods made with wheat flour, particularly instant noodles, is increasing in Asia. Given this trend, fortifying wheat flour with vitamins and minerals may improve micronutrient intake in the region. The objective of this review was to understand what is known about fortifying wheat flour used to make instant noodles. Methods and Study Design: A literature review of seven databases was performed using the search terms “noodle” and (“Asian” or “instant”). Grey literature was requested through a food fortification listserv. Articles were title screened first for relevance and duplicity, with exclusion criteria applied during the second round of abstract-level screening. This review considered studies examining simulation, retention,
sensory, bioavailability, efficacy, and effectiveness of instant noodles made with fortified wheat flour. Results: Fourteen relevant documents were reviewed for simulation (n=1), retention (n=11), and sensory studies (n=3).
The documents revealed that instant noodles produced from fortified wheat flour have potential to improve nutrient intakes, have high retention of most nutrients, and provoke no or minimal changes in sensory characteristics. Conclusions: The available literature indicates that using fortified wheat flour for instant noodle production results in retention of the added nutrients, except thiamin, with no significant sensory change to the final product. Given the rising consumption of instant noodles, production of this item with fortified wheat flour has potential to improve nutrient intakes in Asia. This review provides a resource for the design of a wheat flour fortification program in countries where a large proportion of wheat flour is consumed as instant noodles.
Little is known about the dietary patterns of Asian populations aged ≥85 years and their associated factors. Thus, we aimed to (1) identify these dietary patterns and (2) clarify the relationships between the dietary pattern and health outcomes in a community-dwelling very old population. The Tokyo Oldest Old Survey on Total Health study is an observational cohort study comprising 512 Japanese subjects (women, n=288; men, n=224; age, 87.8±2.2 years). Dietary patterns were assessed by principal component analysis using a brief self-administered diet history questionnaire. Barthel index, Mini-Mental State Examination, and oral health status [maximum oc- clusal force (MOF), denture use, and dentulous / edentulous state] were also measured. Two dietary patterns were identified. The first factor component “traditional Japanese” was characterized by a high consumption of vegeta- bles, seaweed, legumes, and fish. The second factor component “noodles and confectioneries” was characterized by a high consumption of noodles, confectioneries, and non-alcoholic beverages. Multivariable analysis showed that the “traditional Japanese” dietary pattern was inversely associated with dentulous state (OR: 0.53; 95% CI: 0.34–0.82), the lowest tertile of MOF (OR: 0.64; 95% CI: 0.42–0.99), and denture use (OR: 2.42; 95% CI: 1.26– 4.63) even after adjustment for potential confounders. Furthermore, the “noodles and confectioneries” dietary pat- tern was inversely associated with the lowest tertile of MOF (OR: 0.62; 95% CI: 0.40–0.94). However, there were no significant associations between these dietary patterns and disability or cognitive function. We identified two dietary patterns in the very old population, which were associated with oral health status.
Background and Objectives: Several epidemiological studies investigating the association between dietary vit- amin E intake and the risk of lung cancer have demonstrated inconsistent results. Hence, a meta-analysis was conducted to summarise evidence of the association of dietary vitamin E intake with the risk of lung cancer. Methods and Study Design: In this meta-analysis, a systematic literature search of PubMed and Web of Science was conducted to identify relevant studies published from 1955 to April 2015. If p<0.05 or I2 >50%, a random ef- fect model was used to estimate overall relative risks (RRs) and 95% confidence intervals (CIs). Otherwise, a fixed effect model was applied. Publication bias was estimated using the funnel plot and Egger’s test. The dose- response relationship was assessed using the method of restricted cubic splines with 4 knots at percentiles 5, 35, 65, and 95 of the distribution. Results: The pooled RR of lung cancer for the highest versus lowest categories of dietary vitamin E intake was 0.84 (95% CI=0.76-0.93). With every 2 mg/d increase in dietary vitamin E intake, the risk of lung cancer statistically decreased by 5% (RR=0.95, 95% CI =0.91-0.99, plinearity=0.0237). Conclu- sions: Our analysis suggests that higher dietary vitamin E intake exerts a protective effect against lung cancer.
Background and Objectives: Nutrition and physical activity interventions is beneficial in reversing obesity. However far too little attention has been paid to the effect of these interventions on breast tissues. Thus, the aim of this study was to explore the effect of a home-based dietary and physical activity intervention (the Her Shape Program) on metabolic parameters, blood biomarkers and adiposity at the breast. Methods and Study Design: A randomized controlled study was conducted on obese women with high breast adiposity (<0.1 Sm−1), aged 40-60 years in Klang Valley, Malaysia. Subjects were assigned to intervention (n=16) and control group (n=15). Inter- vention group received a home based health education package with close monitoring weekly, personal diet con- sultation and physical training in group. Assessment was ascertained at three time points; baseline, weeks 8 and 16. Outcome measures were the energy intake, physical activity, body composition, blood tests, blood biomarkers and electrical impedance tomography (EIT) quantitative values. Analyses were done using 2-way repeated measures ANOVA. Results and Conclusions: All subjects completed the program without any drop-out. The HSI group had 100% compliance towards the intervention program; their energy intake was reduced for approxi- mately 35% and their activity score was increased for approximately 11%. A significant interaction effect was found in body weight, body mass index (BMI), total cholesterol/HDL, vitamin C intake and matrix metallopepti- dase 9 (MMP-9) (p<0.05). Interestingly, their EIT extremum values were also significantly increased indicating a reduction of breast adiposity. The intervention program was successful in improving body composition, physical activities, MMP9 and breast adipose tissue composition.
Background and Objectives: Pregnancy complications hypothesized to be related to vitamin D include preeclampsia, gestational diabetes, low birth weight, preterm delivery, Cesarean section and infectious disease. There have been a few studies which have demonstrated maternal serum vitamin D to be associated with preterm labor. The objective was to evaluate the serum vitamin D concentrations in Thai pregnant women with and with- out preterm labor and to find the prevalence of vitamin D deficiency and insufficiency in both groups. Methods and Study Design: Blood samples were collected from pregnant women with and without preterm labor (matched for gestational age). Serum 25-hydroxyvitamin D (25-OHD) concentrations were measured by chemi- luminescence method. Results: A total of 60 pregnant women were included into the study, 30 patients in the preterm labor group and another 30 patients in the control group. The serum 25-OHD concentration was 21.07.5 ng/mL and the prevalence of vitamin D deficiency was 48.3% in total group of pregnant women. The serum 25- OHD concentrations were not different between the preterm labor and the control groups (20.9±8.4 vs 21.2±6.7 ng/mL, p=0.91). The prevalence of vitamin D deficiency and insufficiency were not different between the pre- term labor and the control groups (53.3% vs 43.3%, p=0.44 and 83.3% vs 90%, p=0.45, respectively). Conclu- sion: The serum 25-hydroxyvitamin D concentrations and the prevalence of vitamin D deficiency and insuffi- ciency were not different between the preterm labor and the control groups. The serum 25-OHD could not predict preterm labor in this Thai population.
Background and Objectives: This study evaluated the association of maternal excessive gestational weight gain with saturated and polyunsaturated fatty acid concentrations in maternal and cord serum. Methods and Study Design: We included 77 pairs of women and their newborns and classified them into three groups as follows: mothers with normal gestational weight gain and their babies with normal birth weight in group I (30 pairs), mothers with excessive gestational weight gain and their babies with normal birth weight in group II (30 pairs), and mothers with excessive gestational weight gain and their macrosomic babies in group III (17 pairs). Serum fatty acid concentrations were determined through gas chromatography–mass spectrometry. Results: No remark- able difference in maternal dietary intake was observed among the three groups. C16:0, C18:0, eicosapentaenoic acid, and docosahexaenoic acid concentrations were significantly higher in group III mothers than in group I mothers. Compared with group I neonates, total saturated and polyunsaturated fatty acid concentrations were sig- nificantly lower but total n-3 polyunsaturated fatty acid and docosahexaenoic acid concentrations were signifi- cantly higher in group II neonates (p<0.05). The n-6: n-3 ratio in maternal and cord serum was approximately 10:1 and 1.5:1, respectively. Conclusion: Women with excessive gestational weight gain who deliver a macro- cosmic neonate tend to have higher total saturated fatty acid concentrations but lower docosahexaenoic acid con- centrations in their neonate cord serum. Fatty acid concentrations in maternal and cord serum are not associated with maternal dietary pattern.
Background and Objectives: To assess the diet quality and eating behaviour of preschool children, investigate parents’ feeding practices, and obtain information on the kindergarten nutrition environment of Hong Kong chil- dren aged 30-60 months. Methods and Study Design: Dietary information was obtained using multiple 24-hour recalls. Questionnaires were developed to obtain information on children’s eating behaviour, parents’ feeding practices and preschool nutrition environment. Results: A total of 302 children and 23 local kindergartens from three regions of Hong Kong were surveyed. The results showed consumption of vegetable, fruit, and grain were adequate; however, consumption of meat were excessive, while milk and dairy intakes were inadequate. On aver- age, the children consumed 1,280 kcal per day, or 92% of the Chinese Nutrition Society’s energy recommendation. For macronutrients, the mean percentages of energy from carbohydrate, protein and fat were 55%, 17% and 28%, respectively, which are within the United States Acceptable Macronutrient Distribution Ranges. The mean intakes of carbohydrate and protein were 175 g and 53.4 g, respectively. For micronutrients, the mean intakes of vitamin D, calcium, iron and zinc were significantly lower than the reference nutrient intake or adequate intake (p<0.05), but those of sodium and niacin were significantly higher than the tolerable upper intake levels (p<0.05). Conclu- sion: This study showed that diet quality among children in Hong Kong needs to be improved, as some nutrients are consumed in excess whereas others are consumed in inadequate amounts. Other results on children’s eating behaviour, parent’s feeding practices and school nutrition environment are also reported.
Background and Objectives: This study aimed to collect information on experiences in the Great East Japan Earthquake (hereafter, 3.11), current preparedness, and barriers to building up stockpiles in nursery schools in af- fected areas. Based on the needs heard from the staff, we decided what contents should be included in our manual developed with the Japan Dietetic Association. Methods and Study Design: A group interview was held in Sep- tember 2012. We interviewed a principal, nurses, and registered dietitians working for a public and a private nursery school in Town A. We also invited an administrative dietitian who was an employee of Town A. Results: One of the barriers to building up stockpiles was that they did not have any idea of what and how many items they should store. To deal with this situation, we developed a formula that could be used to calculate the quantity of stockpiles for their facilities in a newly developed feeding manual. In terms of current preparedness, the regis- tered dietitians were not prepared for alternative menus in emergencies or how to manage garbage when the gar- bage collection was disrupted by disasters. The manual recommends to obtain the services of at least two food service personnel and spare space for storing filled garbage bags until garbage collection resumes. Conclusion: Some improvements in stocks were found in both of the public and private nursery schools. To improve the situa- tion further, more financial support and detailed guidelines should be provided by the local government and au- thoritative organizations. Our manual should be a great asset for all nursery schools to improve their stockpiles.
Background and Objectives: Malnutrition is a health problem among under-five children in Indonesia. The mothers’ knowledge on nutrition and health in addition to growth monitoring program are essential components that may influence nutritional status of children under-five. The objective was to observe the importance of ma- ternal information exposure along with growth monitoring program to the nutritional status of children in rural areas. Methods and Study Design: A cross sectional study of 233 randomly selected mothers of under-five chil- dren from different geographical rural settings in Indonesia were interviewed and observed as to their exposure to nutrition and health information, growth monitoring program and nutritional status of the children. Results: The prevalence of underweight, stunting, and wasting was 50.5%, 18.0%, and 28.4%, respectively. The mean of height-for-age z score was similar across villages, however, the mean of weight-for-age (p=0.039) and weight- for-height (p=0.047) were significantly lower in Kenduren compared with Karangrejo village. The possession of a growth monitoring card in Kenduren was significantly lower compared with Karangrejo (p<0.001) or Buko vil- lages (p<0.001). The prevalence of underweight (p=0.001) or stunting (p=0.021) was higher among children who did not possess a growth monitoring card. The prevalence of stunting was higher among children who did not routinely go to Posyandu (Integrated Health Post) in the last 3 months (p=0.018). Conclusion: Maternal exposure to nutrition and health information, along with growth monitoring programs, contribute to the prevalence of un- derweight and stunting among rural children who are under-five years old.
Background and Objectives: More than one-quarter of under-five children in the developing world are stunted, and those with poor nutrient intake are at risk of irreversible cognitive impairment. The purpose of this study was to determine the relationship between dietary diversity . and child stunting in an Indonesian context.Methods and Study Design: Dietary diversity was assessed using a maternal-reported checklist of 12 food groups, summed as a Household Dietary Diversity Score. Stunting was defined as ≤-2.0 height-for-age z-score by WHO-Anthro 2005. Trained interviewers administered the household dietary diversity questionnaire to 768 households with children aged <5 years in East Java, Indonesia. Logistic regression models were constructed to test the association between dietary diversity and child stunting. Results: The prevalence of child stunting was 39.4%, and the percent- age of households consuming food groups high in protein and calcium, like dairy products (41%), and meat/poultry, (65%) was lower compared with other food groups. The unadjusted model revealed that higher die- tary diversity scores were associated with lower likelihood of child stunting (OR=0.89; 95% CI=0.80–0.98). This relationship remained significant after adjustment for family size, maternal literacy, food expenditure, breastfeed- ing, energy, and protein intake (OR=0.89; 95% CI=0.80–0.99). Conclusions: The dietary diversity score was moderate, with consumption of dairy products and meat/poultry lowest among 12 food groups. Hence, population interventions should focus on promoting food groups currently lacking in maternal and child diet, including those rich in growth-promoting nutrients like dairy, meat/poultry. These results, from an Indonesian context, confirm the widely observed protective relationship between dietary diversity and child stunting.
Background and Objectives: To determine the associations between socio-demographic characteristics and pu- bertal status with disordered eating among primary school children. Methods and Study Design: Using a strati- fied multi-stage sampling, a total of 816 children (282 boys and 534 girls) aged 10 to 11 years from 12 selected primary schools in the state of Selangor, participated in this study. Data were collected on socio-demographic characteristics, pubertal status and disordered eating behaviors. The Pubertal Development Scale and the Chil- dren's Eating Attitudes Test (ChEAT) were used to assess pubertal status and disordered eating, respectively. Lo- gistic regression analysis was conducted to determine the risk factors of disordered eating. Results: The preva- lence of disordered eating was 30.8% (32.8% in boys and 29.7% in girls). However, the sex difference in the prevalence was not statistically significant. Age, ethnicity and pubertal status were significantly associated with disordered eating in univariate logistic regression analysis. Multivariate logistic regression analysis showed that among boys, being either in an advanced or post-pubertal stage (adjusted OR=8.64) and older age group (adjusted OR=2.03) were risk factors of disordered eating. However, among girls, being a Malay (adjusted OR=3.79) or Indian (adjusted OR=5.04) in an advanced or post-pubertal stage (adjusted OR=2.34) and older age group (ad- justed OR=1.53) were risk factors of disordered eating. Conclusion: This study found one in three children had disordered eating. Since ethnicity and pubertal status were identified as risk factors, ethnicity-specific interven- tion programs on the prevention of disordered eating among children should take into consideration their pubertal status.
Malnutrition is common in Asia, especially among people who are critically ill and/or older. Study results from China, Japan, and Taiwan show that malnutrition or risk of malnutrition is found in up to 30% of communitydwelling people and as much as 50% of patients admitted to hospitals—with prevalence even higher among those older than 70 years. In Asia, malnutrition takes substantial tolls on health, physical function, and wellbeing of people affected, and it adds huge financial burdens to healthcare systems. Attention to nutrition, including protein intake, can help prevent or delay disease- and age-related disabilities and can speed recovery from illness or surgery. Despite compelling evidence and professional guidelines on appropriate nutrition care in hospital and community settings, patients’ malnutrition is often overlooked and under-treated in Asian healthcare, as it is worldwide. Since the problem of malnutrition continues to grow as many Asian populations become increasingly “gray”, it is important to take action now. A medical education (feedM.E.) Global Study Group developed a strategy to facilitate best-practice hospital nutrition care: screen—intervene—supervene. As members of a newly formed feedM.E. Northeast Asia Study Group, we endorse this care strategy, guiding clinicians to screen each patient’s nutritional status upon hospital admission or at initiation of care, intervene promptly when nutrition care is needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans, including post-discharge. To encourage best-practice nutrition in Asian patient care settings, our paper includes a simple, stepwise Nutrition Care Pathway (NCP) in multiple languages.
Background and Objectives: Experimental and observational studies suggest a role for increased uric acid in non-alcoholic fatty liver disease (NAFLD). This study aimed to systematically review the association between se- rum uric acid (SUA) levels and NAFLD. Method and Study Design: We used PubMed, and the EMBASE data- base to identify all applicable studies through November 2015. We used the weighted mean difference (WMD) to demonstrate the differences between the control and NAFLD groups in continuous data. We calculated the odds ratios (ORs) for dichotomous data using the Mantel-Haenszel method. A total of 16 observational studies were identified and used for the analysis of continuous data, and 4 studies were analyzed for dichotomous data. Results: The WMD was 52.3 (95% CI: 39.0, 65.5, p<0.00001). The pooled OR in observational studies was 2.08 (95% CI: 1.93-2.24, p<0.00001). The results were heterogeneous for the comparison of continuous data and homogeneous for the comparison of dichotomous data. The SUA cutoff value for the occurrence of NAFLD was 308, with a sensitivity of 94.12% [71.3-99.9] and specificity of 70.6% [44.0-89.7]. Conclusion: We observed a positive as- sociation between increased SUA levels and the diagnosis of NAFLD in all analyses. Our results suggest that SUA is upregulated in patients with NAFLD and might be related to the pathogenesis of NAFLD.
Background and Objectives: The objective was to determine whether serum uric acid concentrations were asso- ciated with metabolic syndrome in a population from Wuhan. Methods and Study Design: 5,628 subjects (2,838 men, 2,790 women) aged 18-80 years were recruited in Wuhan, China. Biochemical parameters of venous blood were measured by standard methods and metabolic syndrome was defined by Chinese Diabetes Society criteria. Association analysis was performed by logistic regression. Results: 8.2% of the included subjects were con- firmed as having metabolic syndrome and 14.4% were confirmed as having hyperuricemia. After multivariable adjustment, logistic regression showed the odds ratios of metabolic syndrome for subjects in the highest quartile of serum uric acid concentration was 2.84 (95% CI: 2.09-3.86) compared with those in the lowest quartile and no gender difference was found. For each component of metabolic syndrome, subjects in the highest quartile of se- rum uric acid concentrations had increased multivariable odds ratios for high BMI (OR: 3.29, 95% CI: 2.71-3.98), for hypertension (OR: 3.54, 95% CI: 2.93-3.86), for dyslipidemia (OR: 2.49, 95% CI: 1.98-3.14), but not for hy- perglycemia (OR: 1.21, 95% CI: 0.87-1.67). Conclusions: Odd ratio of metabolic syndrome was significantly positively associated with serum uric acid concentration among the present sample of 5,628 subjects in Wuhan.
Background and Objectives: To identify dietary practice patterns for Japanese adults and investigate the links between health behaviours and these patterns. Methods and Study Design: A random sample, stratified accord- ing to area, sex, and age, of 4570 adults aged 20-80 years completed a survey conducted in 2011 in a city, in Yamagata Prefecture, Northeast Japan. Results: Cluster analysis of 16 dietary practice items revealed four pat- terns labelled as: low fat, sugar, or salt; emphasis on nutrition; regular breakfast and staples; and meals not snacks. Findings from multiple linear regression analyses showed that those not engaged in habitual physical ex- ercise had lower scores on low fat, sugar, or salt (beta coefficient -0.22: 95% confidence intervals -0.30, -0.14); emphasis on nutrition (-0.17: -0.25, -0.09); meals not snacks; (-0.38: -0.46, -0.3) that other participants. Current smokers had lower scores than never smokers on low fat, sugar, or salt (-0.23: -0.32, -0.14); emphasis on nutri- tion (-0.28: -0.37, -0.19); regular breakfast and staples (-0.42: -0.51, -0.33) patterns. Compared with non- drinkers, those who had reduced their consumption of alcohol had higher scores on low fat, sugar, or salt (0.19: 0.09, 0.29) and emphasis on nutrition (0.17: 0.07, 0.27). These relationships were adjusted for other dietary prac- tice patterns, sociodemographic factors, body mass index, and the presence of major illness or pain. Conclusions: Findings support an integrated and targeted approach as part of public health policy by considering links between dietary practices and other health behaviours, such as habitual exercise and smoking behaviour that may facilitate changes in dietary practices.
Background and Objective: Nutrition transition is rapid in developing countries, but Nepalese transition is rela- tively unknown. This study aimed to describe nutrition transition in Nepal over the past 40 years by identifying the shifts in the Nepalese diets and nutritional status and the underlying shifts associated with this. Methods and Study Design: Popkin’s framework was used to identify shifts in Nepalese diet and the inter-relationship of diet with epidemiological, demographic and economic shifts. The current study used quantitative methodology includ- ing secondary data analysis based on food balance sheets, economic surveys and the government databases. Re- sults: The Nepalese diet is shifting away from agricultural staple based foods to modern processed foods with higher total energy, total fat, and sugar. The prevalence of overweight/obesity and diet related non-communicable diseases are increasing. Urbanisation is rapid and nutrition transition already advanced in urban area. The Nepa- lese economic structure has also changed shifting away from agricultural food supply system towards modern processing based food supply system. These changes in the Nepalese diet are triggered by income and urbanisa- tion. The trade liberalisation has made processed foods, edible oil and sugar easily available at supermarkets and fast food outlets. Conclusion: It is clear that Nepal has now entered into the fourth stage of nutrition transition according to Popkin’s framework. As a result, overweight, obesity and the prevalence of many non- communicable diseases are all rapidly growing. A further study is recommended to identify whether urban versus rural, rich versus poor and educated versus uneducated families are experiencing the transition in similar way.
Background and Objectives: Hibiscus sabdariffa L. (HS) and Gynostemma pentaphyllum Makino (GP) have been used as traditional medicines to treat diabetes and hypercholesterolemia. Nevertheless, there is inter- individual variation in the metabolic responses to HS and GP consumption. This may be due to genetic factors. The aim of this study was to investigate the effects of HS and GP tea consumption on anthropometric data, fast- ing blood glucose (FBG), and lipid concentrations in hypercholesterolemia subjects with different genotypes of the APOE and CETP TaqIB polymorphisms. Methods and Study Design: Forty-eight subjects with hypercholes- terolemia were given either HS or GP tea for 30 days. Anthropometric and biochemical variables were deter- mined, and APOE and CETP TaqIB polymorphisms were analyzed using the polymerase chain reaction– restriction fragment length polymorphism (PCR-RFLP). Results: E4 (p=0.008) and homozygous B1B1 (p=0.010) carriers had significantly decreased HDL-C concentrations after HS consumption; in addition, B2 carriers who consumed HS showed significantly decreased triglyceride (TG) concentrations (p=0.039). Regarding GP con- sumption, non-E4 carriers had significantly decreased HDL-C (p=0.009) and FBG (p=0.042) concentrations. Fur- thermore, B2 carriers had significantly decreased total cholesterol (TC) (p=0.045), HDL-C (p=0.004), and FBG (p=0.026) concentrations. Conclusions: HS consumption may have beneficial effects with respect to TG concen- trations in the B2 carriers, but it may adversely affect HDL-C concentrations in homozygous B1B1 and E4 carri- ers. In contrast, GP consumption may have favorable effects on TC and FBG concentrations but not on HDL-C concentrations for B2 and/or non-E4 carriers.
Introduction: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during “re-
feeding” of malnourished patients. In these patients, thiamin deficiency may develop and “risk awareness” is the
most significant factor in the management of these patients. In this case report, the treatment is presented of an
elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluid-
electrolyte imbalance. Case: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneu-
monia. On day 4, during parenteral nutrition (30 kcal/kg/day), severe electrolyte imbalance developed. Total par-
enteral nutrition (TPN) was stopped, and enteral feeding together with potassium (90 mmol/day, i.v.) were started.
During follow-up, plasma potassium values remained less than 3 mmol/L. Despite replacement therapy, hypoal-
buminemia, hypomagnesemia, hypocalcemia, and hypophosphatemia persisted. Considering the parenteral nutri-
tion (30 kcal/kg/day) during the hospitalization period, a diagnosis of RS was made. On day 10, thiamin (200
mg/day, i.v.) and folic acid (5 mg/day) were added, and the patient subsequently responded to electrolyte re-
placement treatment. The patient was discharged on day26 with a home-care plan. Conclusion: In patients with malnutrition, thiamin replacement should be given before starting nutrition to prevent RS. Energy intake should
be 10kcal/kg/day at the start, and be gradually increased between days 4-10. Hemodynamic-laboratory parameters
should be closely monitored. All these measures may be life-saving for patients at high risk.
Background and Objectives: This study aimed to determine the accuracy of a diet quality measurement tool, the Total Diet Score (TDS) using two validation methods; firstly the TDS calculated from a food frequency questionnaire (FFQ) was compared to the TDS calculated from weighed food records (WFRs); secondly the TDS was compared to a number of dietary biomarkers. Methods and Study Design: Data were collected from a population based cohort study located in the Blue Mountains region of Sydney, Australia. To compare dietary assessment tools, a sub sample of 75 subjects (aged 63 to 83 years) completed the FFQ and three, four-day WFRs at baseline. Fasting blood samples were collected from 2897 subjects at the first follow up in 1997-1999. TDS scores were calculated from both WFRs and FFQs. Methods to compare FFQ TDS scores to WFR TDS scores included paired t-tests, Pearson correlations, Bland-Altman plots, joint classification quartiles and weighted kappa scores. Linear regression analyses were used to assess the relationship between TDS and biomarkers. Results: No significant mean difference was found between FFQ TDS and WFRs TDS (p=0.63) with a significant positive correlation seen between the two methods (r=0.75, p<0001). The Bland-Altman method found no linear trend between the differences and means of TDS scores between the FFQ and WFR (p=0.38). A significant trend for higher serum vitamin B-12, serum folate, homocysteine and lower total cholesterol was found with increasing TDS. Conclusions: These findings suggest that the TDS is a useful tool for assessing diet quality in an older population.
Background and Objectives: There is a need for simple risk scores that identify individuals at high risk for metabolic syndrome (MetS). Therefore, this study was performed to develop and validate a self-assessment score for MetS risk in non-obese Korean adults. Methods and Study Design: Data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2007-2009 were used to develop a MetS risk score. We included a total of 5,508 non-obese participants aged 19-64 years who were free of a self-reported diagnosis of diabetes, hyperlipidemia, hypertension, stroke, angina, or cancer. Multivariable logistic regression model coefficients were used to assign each variable category a score. The validity of the score was assessed in an independent population survey performed in 2010 and 2011, KNHANES V (n=3,892). Results: Age, BMI, physical activity, smoking, alcohol consumption, dairy consumption, dietary habit of eating less salty and food insecurity were selected as categorical variables. The MetS risk score value varied from 0 to 13, and a cut-point MetS risk score of ≥7 was selected based on the highest Youden index. The cut-point provided a sensitivity of 81%, specificity of 61%, positive predictive value of 14%, and negative predictive value of 98%, with an area under the curve (AUC) of 0.78. Consistent results were obtained in the validation data sets. Conclusions: This simple risk score may be used to identify individuals at high risk for MetS without laboratory tests among non-obese Korean adults. Further studies are needed to verify the usefulness and feasibility of this score in various settings.
Background and Objectives: Patients undergoing endoscopic gastrostomy (PEG) present with protein-energy malnutrition (PEM) but little is known about zinc status. Our aim was to evaluate serum zinc, its relationship with serum proteins and with the nature of the underlying disorder, during the first 3 months of PEG feeding. Methods and Study Design: Prospective observational study during a 3-month period after gastrostomy. Data was collected at initial PEG procedure (T0), after 4 (T1) and 12 weeks (T3). Initial evaluation included: age, gender, disorder causing dysphagia, Neurological Dysphagia (ND) or Head and Neck Cancer (HNC), NRS-2002, BMI, albumin, transferrin, zinc. At T1 and T3, a blood sample was collected for zinc, albumin, transferrin. Serum zinc evaluation was performed with ICP-AES – Inductively Coupled Plasma-Atomic Emission Spectroscopy. Patients were fed with homemade meals. Results: A total of 146 patients (89 males), 21-95 years were studied: HNC-56, ND-90 and low BMI in 78. Initial low zinc in 122; low albumin in 77, low transferrin in 94; low values for both proteins in 66. Regarding the serum protein evolution, their levels increase T0-T3, most patients reaching normal values. zinc has a slower evolution, most patients still displaying low zinc at T3. Significant differences between the 3 moments for zinc (p=0.011), albumin (p<0.0001) and transferrin (p=0.014). Conclusion: PEG patients are prone to PEM and zinc deficiency. Most patients present decreased zinc, suggesting that zinc deficiency is common in PEG candidates and is not corrected during 3 months of enteral feeding. Zinc deficiency should be expected and teams taking care of PEG patients should use zinc supplementation.
Background and Objectives: Mechanically ventilated patients often face progressive and rapid losses of body mass and muscle because of hypermetabolism and increased protein catabolism. To investigate the impact of adequate nutritional provision during the early phase of intensive care unit (ICU) admission on the clinical outcomes in patients with medical illnesses receiving mechanical ventilation support. Methods and Study Design: Two hundred and eleven mechanically ventilated patients admitted to a 30-bed medical ICU were included. Three groups, based on nutrition intake, were examined: adequate protein intake (aPI), n=34; insufficient protein intake/ adequate energy intake (iPI/aEI), n=25; insufficient protein and energy intake (iPI/iEI), n=152. Results: Patients’ mean age was 65±14 years; body mass index, 22±4; Acute Physiology and Chronic Health Evaluation II score, 24±7. The aPI group had significantly lower rates of in-ICU (14.7%) and in-hospital (23.5%) mortality than patients with insufficient protein intake: in-ICU mortality, iPI/aEI, 36%; iPI/iEI, 44.1% (p=0.006); in-hospital mortality, iPI/aEI, 56.0%; iPI/iEI, 52.0% (p=0.008). In the multivariate analysis, the hazard ratios (95% confidence intervals) for 60-day survival were 2.59 (1.02-6.59; p=0.046) and 2.88 (1.33-6.26; p=0.008) for the iPI/aEI and iPI/iEI groups, respectively. Conclusions: Despite possible selection bias owing to the retrospective nature of the study, achievement of >90% of target protein intake was associated with improved ICU outcomes in mechanically ventilated critically ill patients, based on real-world clinical circumstances.
Background and Objectives: Although vitamin D is implicated in the generation of anti-microbial peptide cathelicidin, which plays a key role against pulmonary tuberculosis (PTB), and may have an inverse association with the risk of type 2 diabetes (DM), its role in the co-existence of these two diseases (PTB-DM) is still uncertain. This study explored the association of vitamin D status with prevalent PTB, PTB-DM and DM. Methods and Study Design: We randomly selected 130 PTB patients, 90 PTB-DM, 91 DM and 134 controls. Serum 25(OH)D was determined. A structured questionnaire and anthropometric measurements were administered. Results: Serum 25(OH)D in PTB and PTB-DM were 12.2±2.2 ng/mL and 12.9±2.5 ng/mL, respectively, which were lower than those in DM and control groups. Odds ratios of PTB and PTB-DM comparing extreme quartiles of 25(OH)D (lower than 8.6 ng/mL versus ≥26.6 ng/mL) were 3.26 and 2.27, respectively. These associations remained after adjustment for possible risk factors [OR (95% CI)=4.73 (2.04-10.9) and 2.50 (1.04-6.02), respectively]. A synergistic interaction was observed between low 25(OH)D and underweight in respect to prevalent PTB-DM [OR=24.6 vs 2.50 for lowest quartile of 25(OH) D and 4.59 for underweight]. Conclusions: Odds ratios of low serum 25(OH)D for PTB and PTB-DM were greater than 1.0, and were even much greater when combined with underweight. However, since the association of serum 25(OH)D with PTB was stronger than with PTB-DM, we could not draw the conclusion that vitamin D is a link between PTB and DM.
Background and Objectives: Protein-energy and micronutrient malnutrition are global public health problems which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. Methods and Study Design: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire comprised questions regarding a country’s economy, reimbursement for CNS, education about and the use of EN and PN. Results: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). Conclusions: A worldwide survey by nutri tion support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.
Background and Objectives: Fruit, vegetable, seafood, and dairy intake may reduce the risk of type 2 diabetes, but this relationship is unclear. We aimed to examine the associations between fruit, vegetable, seafood, and dairy intake and type 2 diabetes prevalence in a Chinese population. Methods and Study Design: A total of 4,343 individuals aged 35-74 years participated in a population-based cross-sectional study in Qingdao, China. The frequency and quantity of fruit, vegetable, seafood, and dairy intake were determined using a standard food frequency questionnaire. Diabetes was classified according to the WHO/IDF 2006 criteria. Logistic regression analysis was employed to estimate odds ratio (OR) for type 2 diabetes in relation to fruit, vegetable, seafood, and dairy intake in a multivariable model. Results: The multivariate-adjusted ORs (95% confidence interval) for the presence of type 2 diabetes were 0.68 (0.46-0.98), 0.50 (0.37-0.68), and 0.91 (0.66-1.25), respectively, for the highest versus the lowest groups regarding total fruit and vegetable, fruit or vegetable intake in women. The ORs for type 2 diabetes prevalence regarding the quantity of fruit and vegetable, fruit, and yogurt intake were 0.88 (0.78-0.99), 0.71 (0.61-0.82), and 0.56 (0.32-0.98) in women, but not in men. Seafood consumption was inversely associated with diabetes risk in men, but not in women; the corresponding figures were 0.58 (0.35-0.96) and 0.92 (0.63-1.36), respectively. Conclusions: Fruit, vegetable, and yogurt intake in women and seafood intake in men were inversely associated with type 2 diabetes prevalence in this Chinese population. These findings require confirmation in a prospective study