Background and Objectives: The Mediterranean diet has been demonstrated to provide a range of health bene- fits in observational and clinical trials and adopted by various dietary guidelines. However, a broad range of defi- nitions exist impeding synthesis across trials. This review aims to provide a historical description of Mediterrane- an diets, from the ancient to the modern, to inform future educational and diet index tool development represent- ing the ‘traditional’ Mediterranean diet. Methods and Study Design: Nine databases were searched from incep- tion to July 2015 to identify papers defining the Mediterranean diet. The definition accepted by the United Na- tions Educational, Scientific and Cultural Organization (UNESCO) was also reviewed. Results: The ‘traditional’ Mediterranean diet is described as high in unprocessed plant foods (grains, vegetables, fruits, legumes, nuts/seeds and extra virgin olive oil), moderate in fish/shellfish and wine and low in meat, dairy, eggs, animal fats and dis- cretionary foods. Additional elements relating to cuisine and eating habits identified in this review include fre- quent intake of home cooked meals; use of moist, lower temperature, cooking methods; eating main meals in company; reduced snacking occasions; fasting practice; ownership of a vegetable garden; use of traditional foods and combinations; and napping after the midday meal. Conclusions: Scope exists for future tools to incorporate additional elements of the ‘traditional’ Mediterranean diet to improve the quality, consistency, and synthesis of ongoing research on the Mediterranean diet.
Background and Objectives: Metoclopramide, a prokinetic agent, has been recommended to reduce incidence of pneumonia, but its efficacy is controversial. Thus, this systematic review aimed to evaluate the effectiveness of metoclopramide for pneumonia in patients fed via nasogastric tube. Methods and Study Design: Cochrane Cen- tral Register of Controlled Trials, PubMed, EMBASE, and OVID were searched from their inception to March 31th 2015. Randomized controlled trials (RCTs) of metoclopramide against placebo in patients fed via nasogas- tric tube were identified. The Cochrane risk of bias assessment tool was used for quality assessment. Results: Four trials involving 694 patients fed via nasogastric tube were identified. Compared with placebo, metoclo- pramide showed no significant effects in reducing pneumonia (n=694; risk ratio [RR]: 0.79; 95% CI: 0.45 to 1.38, p=0.40) or mortality (n=694; RR: 0.93; 95% CI: 0.78 to 1.11, p=0.44). In two trials using continuous data, meto- clopramide significantly delayed the development of nosocomial pneumonia (n=80; weighted mean difference [WMD]: 1.74 days; 95% CI: 1.03 to 2.46 days, p<0.00001). However, in two other trials using dichotomous data, metoclopramide increased the proportion of cases showing early-onset nosocomial pneumonia (n=103; RR: 1.32; 95% CI: 1.10 to 1.58, p=0.003). Adverse effects monitoring was reported in one included trial, No significant ad- verse reactions were noted in this study. Conclusions: Because of the poor methodological quality and high risk of bias in the included studies, this systematic review revealed no definite conclusion about the application of metoclopramide for the reduction of nosocomial pneumonia. Therefore, more high-quality studies with larger sample sizes are required.
Background and Objectives: To evaluate the effect of polishing on the glycemic properties of Indian parboiled brown rice. Methods and Study Design: We evaluated the effect of different degrees of polishing on the glyce- mic and insulinemic responses of Bapatla (BPT-5204), Indian parboiled Indica rice variety. Brown rice (BR), un- der milled rice (UMR) and white rice (WR) with 2.3% and 9.7% degree of polishing (DOP), respectively, were prepared and evaluated for the glycemic properties. Incremental Area Under the Curves (IAUC) were estimated for both glycemic index (GI) in 12 healthy participants (6 men, 6 women) and 24 hr glycemic response studies in 13 overweight participants (5 men, 8 women) using continuous glucose monitoring (CGM) system with ≈2000kcal/day rice diets. Differences in pre and post meal insulin (∆) were assessed. Results: The GI of WR (GI=79.6) and UMR (GI=73) were significantly higher than BR (GI=57.6) (p<0.01). Similar results were ob- tained for 24 hr glycemic responses [IAUC: WR=58.4, UMR=55.5, BR=34.7 mg*5 min/dL, respectively]. The ∆ Insulin responses were lower with BR meals compared with UMR and WR (p=0.025; p=0.003). Conclusions: Both UMR and WR had a high GI while BR had a medium GI. This could have influenced the 24 h glycaemic and insulinemic responses of BR which had the lowest responses as compared with UMR and WR, and the latter two had similar higher responses. Thus any degree of polishing leads to higher glycaemic responses.
Background and Objectives: Total fat intake is linked to the intake of other nutrients. Little data are available on the extent to which total fat affects diet quality in Japanese people. We investigated the relationship between total fat intake and other nutrient intake using INTERLIPID/ INTERMAP data on Japanese people living in Japan. Methods and Study Design: The participants included 371 men and 401 women with a healthy body mass in- dex and between the ages of 40 and 59 from 4 population samples in Japan. Nutrient intake data were based on four in-depth 24-hour dietary recalls per person. Results: Analysis of covariance adjusted for age revealed that total fat intake was positively related to intakes of calcium, thiamine, riboflavin, meat, eggs, and milks and dairy products for both sexes. Total fat intake was inversely associated with carbohydrate and cereals intake for both sexes. On average, men with total fat intake between 25.0 and 27.4% of total energy had saturated fatty acids above 7%, which is the upper limit recommended for preventing lifestyle-related diseases. Men with total fat in- take less than 20% of total energy had a higher risk of not meeting the Dietary Reference Intakes for Japanese (2015) for some nutrients. Conclusions: Total fat intake was positively associated with calcium, thiamine, and ri- boflavin intakes and inversely associated with carbohydrate intake. Our results suggest that in 40–59-year-old men with a healthy body mass index, total fat intake between 20 and 27% of total energy may best support ade- quate intake of other nutrients.
Background and Objectives: To investigate the association of serum 25-hydroxyvitamin D (25(OH)D) with skeletal muscle mass (SMM) and function among the elderly in an urban area in northern China. Methods and Study Design: A total of 912 participants (316 men, 596 women) aged more than 60 years from 4 communities in Beijing were enrolled. Serum concentrations of 25(OH)D were measured through radioimmunoassay. SMM was assessed through bioelectrical impendence analysis, whereas skeletal muscle function was assessed through grip strength and 4-m regular gait speed measurements. On the basis of expert consensus of the Asian Working Group for Sarcopenia, low muscle mass was defined as relative skeletal mass index (RSMI) <7.0 kg/m2 for men and <5.7 kg/m2 for women. A noncondition logistical regression model was employed to explore the association between vitamin D and both muscle mass and function. Results: Serum 25(OH)D was positively associated with grip strength (β=0.16, SE=0.05). The upper quartile of 25(OH)D was negatively associated with loss of grip strength (OR=0.05, 95% CI: 0.01–0.48) in men but not in women. No significant associations were noted be- tween 25(OH)D and appendicular skeletal muscle mass, RSMI, and gait speed. Conclusions: The present study demonstrated a positive association between vitamin D and skeletal muscle strength in elderly Chinese men but not women.
Background and Objectives: Differences in anthropometry and food acceptance among tasters and non-tasters of 6-n-propylthiouracil has been well studied in Western countries. However, reports on this issue from Asian countries are still limited. Methods and Study Design: Healthy Japanese students attending Nara Women’s University (n=153) were recruited and classified into 3 groups based on taste sensitivity to a 0.32 mM 6-n- propylthiouracil solution as scored on a labeled magnitude scale. Accordingly, the study population consisted of 34 non-tasters, 78 medium-tasters, and 41 super-tasters. Self-reported food intake was assessed using a food fre- quency questionnaire. Self-reported food preferences were established using a food checklist listing 63 food items. Results: Although subjects in the 6-n-propylthiouracil non-taster group showed a significantly higher body height and weight than subjects in the taster groups, body mass index was comparable among three groups. In- takes of calories, 3 macronutrients, β-carotene and vitamin C did not differ significantly between groups, but the intake of green and yellow vegetables was significantly lower in the taster groups. Among the 5 factors defined by a factor analysis performed with 277 age- and BMI-matched Japanese female students, the taster groups showed a significantly reduced preference for green and cruciferous vegetables alone. Conclusions: To the best of our knowledge, this is the first comprehensive report investigating associations between anthropometry, food intake, and food preference in relation to 6-n-propylthiouracil sensitivity in Asian countries. The effect of this tendency towards an aversion to vegetables including cruciferous ones among females on living a healthy life re- mains to be investigated.
Background and Objectives: In 2000, legislation on mandatory universal salt iodisation was enacted in Sabah, Malaysia, to reduce the incidence of iodine deficiency disorders among its population. To evaluate the iodine lev- els among pregnant women from selected rural divisions in Sabah 13 years after the enactment of the universal salt iodisation programme. Methods and Study Design: This cross-sectional study was conducted from 1 May to 30 June, 2013, in three rural divisions of Sabah (the Interior, the West Coast, and Kudat). Data regarding do- mestic iodised salt use and iodine-containing supplement consumption were obtained from respondents through face-to-face interviews; goitre enlargement was examined through palpation and graded according to the World Health Organization classification. Spot urine samples were also obtained to assess urinary iodine levels by using an in-house modified micromethod. Results: In total, 534 pregnant women participated. The prevalence of goitre was 1.0% (n=5), noted only in the West Coast and Kudat divisions. Although all pregnant women consumed io- dised salt, overall median urinary iodine concentration was only 106 μg/L, indicating insufficient iodine intake, with nearly two-thirds of the women (60%) having a median urinary iodine concentrations of <150 μg/L. Con- clusions: Pregnant women from the rural divisions in Sabah still exhibit iodine deficiency disorder despite the mandatory universal salt iodisation programme. Iodine supplementation programmes targeting pregnant women are warranted.
Background and Objectives: The associations of breastfeeding and early childhood caries (ECC) risk have been evaluated in several epidemiological studies with conflicting results. We performed an update meta-analysis to estimate the association of feeding patterns, breastfeeding durations and ECC risk. Methods and Study Design: Studies were identified through searching Pubmed, Web of Science, and Embase from January 1990 to December 2015. Results: Thirty-five studies involving 73,401 participants aged 0-71 months were included. The overall analysis showed children ever breastfed had a reduced risk of ECC compared with those never breastfed (OR=0.77, 95% CI: 0.61-0.97, p=0.026). Subgroup analysis revealed ever breastfeeding significantly reduced ECC risk for the studies with 3-6 years old children (OR=0.70, 95% CI: 0.54-0.90, p=0.005), with sample size >500 subjects (OR=0.63, 95% CI: 0.46-0.87, p=0.004), with Newcastle-Ottawa Scale (NOS) score ≥6 (OR=0.66, 95% CI: 0.46-0.94, p=0.023), published after 2010 (OR=0.50, 95% CI: 0.30-0.82, p=0.006), with ad- justed OR (OR=0.40, 95% CI: 0.18-0.88, p=0.023). Exclusive breastfeeding did not significantly decrease ECC risk compared with bottle feeding (OR=0.68, 95% CI: 0.35-1.31, p=0.248). The children breastfed ≥12 months significantly increased ECC risk compared with those breastfed <12 months (OR=1.86, 95% CI: 1.37-2.52, p<0.001). Whereas, children breastfed ≥6 months did not significantly increase ECC risk compared with those breastfed <6 months (OR=1.13, 95% CI: 0.83-1.53, p=0.428). Conclusions: Our analysis suggests ever breast- feeding may protect children from ECC, and breastfeeding duration ≥12 months is associated with higher ECC risk. Additional large cohort studies are required to illustrate the relationship in further study.
Background and Objectives: Childhood obesity is increasing. However, little is known about the changes in di- etary factors and supportive facilities associated with childhood obesity. We aimed to document the changes in various dietary factors and supportive facilities and their associations with obesity among pre-school children. Methods and Study Design: Among 42,531 children 4-5 years old, recruited between 2004 and 2013 in the Jiax- ing Birth Cohort, we examined the changes in the prevalence of various dietary factors and supportive facilities and overweight/obesity over 10 years. We used logistic regression to investigate the cross-sectional association between these factors and childhood overweight/obesity risk, adjusting for potential confounders. Results: The prevalence of childhood overweight/obesity increased steadily from 11.8% (boy: 14.8%; girl: 9%) during 2004- 2005 to 18% (boy: 21.4%%; girl: 15%) during 2012-2013. The prevalence of meal/snack frequency 3 times /day decreased substantially from 23% during 2004-2005 to 8% during 2012-2013, with more children having 5 times /day: from 32% to 45.6%. Children with a fair/bad appetite, compared with those with a good appetite, had a 45% (OR: 0.55; 95% CI: 0.49, 0.62) lower risk of overweight/obesity. Children with a meal frequency ≥6 times/day (compared with 3 times/day) had a 0.12 (95% CI: 0.03, 0.2) higher BMI-z-score. Conclusions: The prevalence of childhood overweight/obesity has increased substantially within a decade in southeast China. A better appetite and greater eating frequency were associated with the increased prevalence.
Background and Objectives: Obesity has become a global epidemic. In China, 42% of adults and about one- fifth of children are overweight or obese. In major cities, about one-third of boys are overweight or obese. This study aimed to understand how children and parents in China make eating and physical activity (PA) decisions, considering individual, family, community, social, and environmental factors, and to collect parents’ recommen- dations for interventions to promote healthy eating and physical activity. Methods and Study Design: Children (n=41, aged 10-15 years) and their parents (n=41) participated in eight semi-structured focus groups (FGs) in Bei- jing (in North China) and Nanjing (South China). Each site conducted two FGs with children and two FGs with parents. A framework analysis of FG data was conducted with NVivo. Results: Three main themes were identi- fied: Children chose food based on flavor, and consumption of unhealthy snacks was prevalent; there were incon- sistent standards and practices of school lunch services across schools; students had limited PA time due to aca- demic demand. Students favored high-calorie snacks over fruits or vegetables. Students’ and parents’ perceptions of school lunch services varied among schools in terms of operation, price, quality, nutritious options, and food taste. Most students reported enjoying PA but spent little time in PA, due to study burdens. Parents made recom- mendations for improving school food services and increasing PA during and after school. Conclusions: These findings will help develop family- and school-targeted health promotion interventions. Intervention framing must consider the unique Chinese social and cultural context.
Background and Objectives: Fast-food companies have been reproached for rising obesity levels due to aggres- sive marketing tactics targeted at children. They have countered that parents should be held responsible consider- ing their critical role as nutritional gatekeepers. This study examined the comparative effects of media exposure and parental mediation on Indonesian children’s fast food consumption and how the effects compare in the met- ropolitan versus suburban areas. Methods and Study Design: The sample consisted of 394 child-mother pairs comprising grade three and four children and their mothers from two schools each in Jakarta and Bogor represent- ing 40.9% metropolitan sample and 59.1% suburban sample, respectively. The children completed a guided in- class survey, while the mothers completed a paper-and-pen survey at home. Measures comprised children’s weekly media exposure to broadcast media, computer and mobile games, print media, and online and social me- dia, active and restrictive parental mediation strategies, children’s fast food consumption and nutrition knowledge. The relationship of media exposure and parental mediation with children’s fast food consumption was analyzed using Structural Equation Modelling. Results: Fast food consumption was positively influenced by exposure to broadcast media among metropolitan children, and by exposure to online and social media among suburban chil- dren. Active parental mediation was related to lower fast food consumption, but only for suburban children. Con- clusions: Active parental mediation is critical in preventing fast food consumption. The media play a key role in influencing fast food consumption, and hence, literacy education is important to alleviate the adverse effects of exposure to junk food marketing.
Uyghur food culture has a long history. It is rich in resources, with the strong characteristics of being “green” and healthy, and having high nutritional value. We analyze the development and current status of Uyghur food culture, and explore the value of developing this food culture’s resources. Traditional Uyghur food culture formed with influences from many ethnic groups, and has evolved into an intangible element of cultural heritage. It has several components with different healthy and therapeutic functions and is widely utilized in local communities. Overall, Uyghur food is rich in nutrients and beneficial for health. We propose strategies to address issues associated with Uyghur food culture and cultural resources, and specific measures for the development of these resources.
Background and Objectives: Sleep deprivation is a critical public health problem, especially in Korean adoles- cents. This study aimed to identify the association between sleep duration and dietary behaviors, physical activity, mental status, and nutritional status among high school students in South Korea. Methods and Study Design: Based on the data collected from the 2014 Korea Youth Risk Behavior Web-based Survey, 31,407 high school students who met the inclusion criteria were selected and the association between sleep duration and selected health risk factors was identified using multivariable logistic regression models. Results: The average daily sleep duration was 5.7 hours, and the mean BMI was 21.3 kg/m2. Participants with shorter durations of sleep (<7 hours versus ≥7 hours of sleep) were more likely to feel sad or hopeless (adjusted OR, 1.09; 95% CI, 1.00-1.18), have suicidal ideation (adjusted OR, 1.13; 95% CI, 1.01-1.27), and feel much or very much stressed (adjusted OR, 1.82; 95% CI, 1.66-2.00). Moreover, shorter sleep was associated with less frequent muscle-strengthening exer- cises, ≥3 times per week (adjusted OR, 0.86; 95% CI, 0.78-0.94), and more frequent cracker consumption, ≥3 times per week (adjusted OR, 1.24; 95% CI, 1.13-1.35). Conclusions: High school students in South Korea suf- fer from extreme sleep deprivation; only 16% of the students were found to have ≥7 hours of sleep during week- days. Sleep education should be provided to students to improve their physical and mental health.
Background and Objectives: Many studies have reported that fermented foods have favorable effects in pre- venting and managing atopic dermatitis (AD). Although kimchi, a major fermented food, is an important part of the traditional diet in Korea, only a few studies have investigated the relationship between AD and kimchi. This study aimed to examine the association between the risk of AD and kimchi intake among Korean adults aged 19 to 49 years. Methods and Study Design: We conducted a population-based, cross-sectional study among a total of 7,222 adults who participated in the 2010-2012 Korea National Health and Nutrition Examination Surveys. We defined AD based on responses to a health interview and assessed kimchi intake using a 24-hour recall method administered by well-trained interviewers. Results: In the multivariable logistic regression analysis, we observed a significantly decreased odds ratio (OR) of having AD according to kimchi consumption after adjustment for confounding factors. In particular, subjects in the third quartile of kimchi consumption (85.0-158 g) had a 32% lower presence of AD than those in the first quartile of kimchi consumption (0-36.0 g) (Odds ratio: 0.68, 95% confidence interval: 0.50-0.92). Conclusions: We found that consuming 85.0-158 g/day of kimchi was signifi- cantly associated with a lower presence of AD. Considering that one serving size of kimchi is 40 g, this corre- sponds to about 2-4 servings per day. This finding suggests that adequate amount of kimchi intake might have a protective effect against AD.
Background: Adolescence is an important period with rapid physical growth transitioning from childhood to adulthood. Distorted body image can result in eating disorders or inadequate nutrient intakes in adolescence. Lim- ited research has been done with high school boys in both Korea and China. Objectives: To examine body image, weight control behaviors, nutritional knowledge, and dietary habits in Korean and Chinese teenage boys, and to evaluate any differences in these measures between two countries. Methods and Study Design: High school boys in Yongin of Korea and Weihai region of China (n=201 Korean and n=196 Chinese) participated in a self- report survey. A previously validated questionnaire assessed height and weight, body image, nutritional knowledge, and dietary habits. Descriptive statistics, t-test, Chi-square, and Pearson correlations were used for data analysis. Results: About 41.4% of Korean students and 40.8% of Chinese students desired to be thinner. The majority of the students from both countries showed a perception gap between ideal body image and current body image. Korean students had a higher frequency of weight control attempts compared with Chinese students (p=0.004). Overall, Korean students had higher scores in nutritional knowledge (p<0.001), while Chinese stu- dents had higher scores in dietary habits (p<0.001). Nutrition knowledge in Korean students and dietary habit in Chinese students showed positive correlation with body shape satisfaction (p<0.01). Conclusions: The findings of this study support that developing proper body image among high school boys is important in Korea and China. Different educational strategies might be beneficial to Korean or Chinese students.
Background and Objectives: Although concerns regarding the influence of coffee consumption on human health have accompanied the massive increase in coffee consumption, the effects of coffee intake on the risk for coronary heart disease (CHD) remain controversial. Therefore, we evaluated the association between coffee con- sumption and CHD risk as estimated using the Framingham risk model in Korean adults. Methods and Study Design: This cross-sectional study involved 3,987 participants aged 30-74 years who participated in the fifth Ko- rea National Health and Nutrition Examination Survey conducted in 2010. The frequency of coffee consumption was self-reported and classified into 4 categories (non-drinker, 1, 2, and ≥3 cups/day). The 10-year risk for CHD was determined from the Framingham risk score. Results: Across the levels of coffee consumption, there were significant differences in the frequency of smoking among men and advanced age, low high-density lipoprotein cholesterol level, diabetes, and smoking among women. In the multiple logistic regression analyses, the adjusted odds ratios (95% CI) for ≥20% 10-year CHD risk was 0.211 (0.060-0.745) for women who consumed ≥3 cups of coffee per day compared with women who consumed <1 cup per day. For women, a significant dose-response in- verse association between the level of coffee consumption and 10-year CHD risk persisted even after adjusting for multiple confounding factors. For the men, however, there was no significant association between coffee con- sumption and 10-year CHD risk. Conclusions: Coffee consumption is associated with a lower risk for CHD in Korean women.
Background and Objectives: The consumption of fish and long chain omega-3 polyunsaturated fatty acids (n-3 PUFA) may influence the risk of all-cause mortality, but the findings have been inconsistent. The current system- atic review and meta-analysis is to clarify the association between fish and long chain n-3 PUFA consumption with risk of all-cause mortality. Methods and Study Design: Studies published before March 2017 were identi- fied through electronic searches using PubMed, Scopus and Web of Science database. We included prospective cohort studies that reported relative risks with 95% CI of all-cause mortality for fish and long chain n-3 PUFA consumption. Results were combined using a random effects model. Results: Twenty-three prospective cohorts with a total of 1,035,416 participants were included. Twenty-two pooled studies involving 985,126 participants indicated that fish intake was associated with 6% (RR: 0.94; 95% CI: 0.90, 0.98) reduction in risk of all-cause mortality. Six studies with 430,579 participants investigated the association between long chain n-3 PUFA and all-cause mortality risk, the relative risk for highest versus lowest category was 0.86 (95% CI: 0.80, 0.93). Dose- response analysis suggested that the risk of all-cause mortality was reduced by 7% (RR: 0.93; 95% CI: 0.88, 0.99) for every 0.2 g per day increment in long chain n-3 PUFA consumption. Conclusions: Current meta-analysis in- dicates that both fish and long chain n-3 PUFA consumption are inversely associated with risk of all-cause mor- tality. These findings could have public health implications with regard to lowering risk of all-cause mortality through dietary interventions.
Background and Objectives: The human being is a complex entity, involving interaction between microbes and the human host. Evidence shows that the nutritional value of food is influenced in part by the structure and opera- tions of an individual’s gut microbial community, and food in turn shapes the individual’s microbiome. A confer- ence was held to promote understanding of the intestinal microbiome and its implications for health and disease, particularly among Asian populations. Methods and Study Design: Papers describing 1) the intestinal ecosys- tem in Asian populations, 2) changes in intestinal microbiota through life and its effects, 3) the Asian gut micro- biota in disease conditions, 4) indigenous probiotics to maintain a healthy gut microbiota, 5) probiotic regulation in an Asian country, and 6) the results of a panel discussion are included in this report. Conclusions: The gut mi- crobial inhabitants of Asian people differ from those of Europe and North America. Geographic location, diet, and ethnic background influence intestinal microbial composition. Urbanization and economic development have brought changes in traditional Asian diets, which in turn affected the gut microbiome, contributing to a shift in the region’s health burden from infectious diseases to non-communicable chronic diseases. Novel probiotic strains of Indonesian origin demonstrated significant enhancement of humoral immune response in human studies. Knowledge gaps and implications for research to further understand the Asian gut microbiome were discussed.
Background and Objectives: Findings from observational studies in China show that increased dietary fat con- sumption might be a contributor to the developing obesity epidemic. However, some cohort studies suggest that carbohydrate intake, especially from white rice, is a risk factor for obesity, type 2 diabetes and coronary heart dis- ease in China. Our study aims to determine whether the traditional lower-fat, higher-carbohydrate Chinese or the Western higher-fat, lower-carbohydrate dietary pattern is more effective for weight control and the related cardi- ometabolic profiles increasingly found among contemporary Chinese. Methods and Study Design: The Optimal Dietary Macronutrient Distribution in China (ODMDC) trial is a 6-month, multi-centre, three-arm controlled feeding study. Based on the macronutrient transition in the past 30 years in China, three isoenergetic diets with a spectrum of fat and carbohydrate intake, but same protein contents, have been formulated. Percentages of fat, carbohydrate, and protein energy are one of 20, 66 and 14%; 30, 56 and 14%; 40, 46 and 14%, respectively. Par- ticipants will be provided with all their food and most beverages for 6 months. Results: The study population is planned to be 300 healthy non-obese adults aged 18 to 35 years. The primary outcome is body weight and the secondary variables are waist circumference and cardiometabolic risk factors. Conclusions: The ODMDC trial will have implications for nutrition policy in regard to weight control and related cardiometabolic disturbances among otherwise healthy non-obese Chinese.
Background and Objectives: To clarify whether six conventional ‘high-risk’ behaviors toward excess salt intake captured by simple questions such as frequency of salty food consumption are related to actual salt intake. Also, to examine the relationship of nutrition knowledge, food label use, and food preparation with actual salt intake. Methods and Study Design: Study participants were 742 subjects (370 men and 372 women) aged 20-69 years from 20 areas of Japan. Salt intake and dietary knowledge/behavior were evaluated with two 24-hour urine col- lections and a questionnaire, respectively. Multivariable linear regression analyses by sex included sodium excre- tion as a dependent variable, each knowledge/behavior item as an independent variable, and with age, body mass index, education, and smoking as covariates. Results: Four ‘high-risk’ behaviors (frequency of miso soup and salty foods consumption, proportion of consumed noodle soup, and amount of seasoning/condiment use) were as- sociated with higher sodium excretion in men (p for trend 0.04) and were marginally associated in women (p for trend 0.06). Combination of these behaviors elevated the odds ratios for excess salt intake (sodium excretion: >136 mmol/day). Most of the other nine dietary factors were not associated with sodium excretion. Interestingly, women who decided to purchase foods after referring to the salt/sodium content information on food label, had significant lower sodium excretion than other women (p for trend=0.03). Conclusions: High-risk behaviors to- ward excess salt intake captured by simple questions were actually related to excess salt intake. Specific and prac- tical advice based on answers to these questions might contribute to salt reduction in Japanese population.
Background and Objectives: Assessment of the nutrition care process (NCP) knowledge, attitudes, practices, and perceived barriers (KAPB) of dietetics practitioners is imperative before NCP is implemented completely in dietetics practice. No questionnaire assessing NCP KAPB has been developed and validated. Hence, we devel- oped an NCP KAPB questionnaire called the KAPB-NCP and established its content validity. Methods and Study Design: A total of 116 items associated with sociodemographic characteristics (7 items), professional de- velopment (3 items), organisational culture’s support for the NCP (2 items), knowledge (27 items), attitudes (39 items), practices (20 items), and perceived barriers to implementing the NCP (14 items) were generated for poten- tial inclusion in the KAPB-NCP questionnaire. The questionnaire was reviewed online by an expert panel for its content validity. An in-depth review was conducted by the research team for evaluating the overall comprehen- siveness of the questionnaire. Results: In total, 87 of 100 items of the KAPB sections showed an excellent con- tent validity index (CVI; k* >0.74), whereas 10 showed a satisfactory CVI (k=0.60–0.74). Only 3 items had a low CVI (k <0.40). According to the expert panel revisions and the in-depth review, 72 items were incorporated into the questionnaire. Conclusions: The KAPB-NCP questionnaire is a content-valid instrument that can assess NCP KAPB.
Background and Objectives: To examine the association between quantified urine color and urine osmolality, and its validity in distinguishing hydration status among college men in Hebei, China. Methods and Study De- sign: Sixty-eight college men aged 18~25 years completed a cross-sectional study. All participants were asked to complete a 24-h fluid intake record to estimate fluid intake from beverages after anthropometric measurements. The foods eaten by participants were weighed to assess fluid intake from foods. All urine samples for the day were collected by participants to determine urine osmolality and urine color by chromatogram spectrophotometry (in accord with the Commission Internationale de l'Eclarige (CIE) notation Lab). Results: A total 413 urine samples from 68 participants were collected and 151 (36.6%) samples indicated dehydration according to urine osmolality. The dehydrated group versus hydrated group had a smaller urine color L (94.88 vs 98.06) and a* (- 2.39 vs -1.91), bigger b* (30.41 vs 15.15), and higher osmolality (958 mOsm/kg vs 486 mOsm/kg). Urine color and osmolality were closely correlated, especially for b* (0.86, p<0.0001). The percentage variance in urine os- molality (R2) explained by a partial least squares (PLS) model was 79%. Urine color b* contributed most substan- tially to the PLS model, with variable importance for projection of 1.35. The cutoff for b* for adequate hydration was 17.78 (area under the curve=0.899). Conclusions: Differences in urine color between dehydrated and hy- drated status related to urine osmolality. Urine color quantification is a reliable method to assess hydration status among young Chinese men.
Background and Objectives: Energy expenditure in severe sepsis/septic shock patients was measured by indi- rect calorimetry and the correlation of energy expenditure between indirect calorimetry and predictive equations was determined. Methods and Study Design: This was a prospective, observational analytical study. Severe sepsis or septic shock patients were measured for energy expenditure over 72 hours by indirect calorimetry that was measured by a mechanical ventilator (EngströmCarestation, GE Healthcare). Predictive equations for energy expenditure by the Harris-Benedict equation (HBE), Ireton-Jones 1992 equation (IRE) and ACCP equation (ACCP) were calculated and then correlations and agreement between indirect calorimetry and predictive equa- tions were tested. Results: The 16 patients had a mean age of 71.6±5.5 years and a mean APACHE II score of 26.9±4.0. The average energy expenditure by indirect calorimetry over 72 hours per kilogram body weight was 26.7±5.3 kcal/kg/day. For predictive equations, IRE was moderately significantly correlated with indirect calo- rimetry over 72 hours (intraclass correlation 0.46, 95% CI -0.01 to 0.77, p=0.028), but the HBE and ACCP equa- tions were not significantly correlated (intraclass correlation for HBE -0.52, 95% CI -0.8 to -0.06, p=0.985 and intraclass correlation for ACCP 0.29, 95% CI -0.21 to 0.68, p=0.121). Conclusions: Energy expenditure over 72 hours in severe sepsis or septic shock was about 26.7±5.3 kcal/kg/day. The use of predictive equations should be further examined in future studies.
Background and Objectives: Enteral nutrition (EN) can improve clinical outcomes as an important treatment in critically ill patients. However, when patients suffer from gastrointestinal function disorders, intestinal intoler- ance occurs and EN administration may be delayed and even fails to perform. Pectin, a structural heteropolysac- charide, could protect gastrointestinal function from disorders in many gastrointestianl diseases. The present study aimed to determine whether pectin-supplemented EN was safe and improved clinical outcomes in intensive care unit (ICU) patients. Methods and Study Design: Patients enrolled in ICU from August 2014 to January 2015 were randomized to EN group and pectin-supplemented EN group (PEC/EN group). Both group received isonitrogenous, isocaloric EN support within 36 hours after ICU admission, and last for 6 days. The primary end- points were 30-day mortality and gastrointestinal intolerance. Results: There were 125 patients included in this study (63 in EN group, and 62 in PEC/EN group). The results showed that the 30-day mortality was 4.8% in EN group and 1.61% in PEC/EN group (p=0.317). PEC/EN group had a smaller gastrointestinal intolerance rate than EN group (41.3% vs 27.4%, p=0.04). Furthermore, there were shorter times to reach full EN (13.0±5.12 vs 9.99±1.91, p=0.05), length of ICU stay (17.9±9.72 vs 13.8±8.59, p<0.001), and length of hospital stay (32.9±19.0 vs 23.4±13.2, p<0.001) in EN group than those in PEC/EN group. Conclusions: These results revealed that pec- tin-supplemented EN was safe, and could improve clinical outcomes in ICU patients.
Background and Objectives: We aimed to characterize the effect of home enteral nutrition (HEN) on the nutri- tional status and the quality of life (QOL) of esophageal cancer patients who underwent Ivor Lewis esophagecto- my for cancer. Methods and Study Design: Sixty patients with esophageal cancer were assigned to receive ei- ther HEN (n=30) or standard care only (n=30) from 1 week to 24 weeks following surgery. Nutritional status was evaluated using The Mini Nutritional Assessment at 1 week preoperatively and at 12 and 24 weeks postoperative- ly. QOL-related parameters were analyzed in all patients using the QOL-core 30 questionnaire and the supple- mental QOL-esophageal module 18 questionnaire for patients with esophageal cancer from 1-24 weeks after sur- gery. Results: At 12 weeks after surgery, the incidence of malnutrition or latent malnutrition in the HEN group was lower than that in the control group despite the absence of a significant difference between the two groups before surgery. Compared to the control group, the HEN group achieved higher Global QOL scores, and most of their functional index scores were better. Most of the symptomatic index scores were more reduced at 4 weeks and 12 weeks postoperatively in the HEN group. However, at 24 weeks after surgery, the incidence of malnutri- tion or latent malnutrition and most of the QOL indexes did not differ significantly between the two groups. Con- clusions: HEN can reduce the incidence of malnutrition or latent malnutrition and help restore the QOL in the pa- tients with esophageal cancer in the early period (24 weeks) after surgery.
Background and Objectives: This study aimed to evaluate the efficacy of post-operative oral nutrition supple- mentation after major gastrointestinal surgery. Methods and Study Design: A prospective randomized con- trolled trial was conducted to evaluate 174 subjects who were discharged within 2 weeks after major gastrointes- tinal surgery. The subjects in the study group were prescribed 400 ml/day of Encover® from the day of discharge for 8 weeks, but no supplementation was allowed in the control group. The primary endpoint was the weight loss rate at 8 weeks after discharge compared with the pre-operative weight, and the secondary endpoints included changes in body weight, body mass index, Patient-Generated Subjective Global Assessment score/grade, hemato- logical/biochemical parameters, and adverse events evaluated at 2, 4, and 8 weeks after discharge. Results: The weight loss rate at 8 weeks after discharge did not differ between two groups (4.23±5.49% vs 4.80±4.84%, p=0.481). The total lymphocyte count, the level of total cholesterol, total protein, and albumin were significantly higher in the study group after discharge. Diarrhea was the most frequent adverse event, and the incidence of ad- verse events with a severity score of ≥3 did not differ between groups (2.3% vs 1.2%). Conclusions: The utility of routine oral nutritional support after major gastrointestinal surgery was not proven in terms of weight loss at 8 weeks after discharge. However, it can be beneficial for early recovery of biochemical parameters.