Background and Objectives: Height is an essential measurement in clinical medicine. It allows the calculation of body mass index, ideal body weight, basic energy requirements and tidal volumes. In many patient groups, such as the critically ill, height cannot be measured easily and surrogate anthropometric measures are used. Re- gression equations estimating height are specific to ethnicity. We aimed to develop the regression equation for Vietnamese men and women to predict height from ulna length and so improve prescription of life-saving treat- ment in the intensive care units. Methods and Study Design: A cross-sectional survey of patients and relatives at the National Hospital for Tropical Diseases was undertaken. Ulna length, standing height and weight were measured. The first two thirds of participants’ data, stratified by sex and age, were allocated to a model training group, the subsequent participants entered the validation group. Linear regression equations were calculated for the model group by sex, then applied to the validation group and assessed for precision. Other international equa- tions were also compared. Results: 498 males and 496 females were recruited. There was good correlation be- tween ulna length and height in those aged 21-64, r=0.66, p<0.001 in males and females. The regression equa- tions were: male: height = 85.61 + (3.16 x ulna length), female: height = 85.80 + (2.97 x ulna length). Equations from other populations were less accurate. Conclusions: The regression equations calculated for men and women aged 21-64 showed good correlation and can be used to predict height in those where direct measurement is im- possible.
Background and Objectives: Obesity has become a public health problem and is a cause of some preventable illnesses. Among several methods for treating obesity, the use of food supplements is highly common. A com- monly used food supplement is green coffee bean extract. The objective of this study was to evaluate the efficacy of green coffee bean extract combined with an energy-restricted diet on the body composition and serum adipo- cytokines in obese women. Methods and Study Design: In this randomised clinical trial, 64 obese women aged 20–45 years were selected and divided into two groups: an intervention group (receiving 400 mg green coffee bean extract for 8 weeks) and control group (receiving placebo). All participants were on an energy-restricted diet. The body composition, leptin, adiponectin, lipid profile, free fatty acids (FFAs), and fasting blood sugar were compared between the two groups. Results: We observed significant reductions in the body weight, body mass and fat mass indices, and waist-to-hip circumference ratio in both groups; however, the decrease was higher in the intervention group. Moreover, serum total cholesterol, low-density lipoprotein, leptin, and plasma free fatty acids significantly decreased in the intervention group (p<0.05) after adjustment for energy and fibre intake. The serum adiponectin concentration significantly increased in the intervention group (p<0.05). Conclusions: Green coffee bean extract combined with an energy-restricted diet affects fat accumulation and lipid metabolism and is thus an inexpensive method for weight control in obese people.
Background and Objectives: Strategies to prevent and treat overweight/obesity are urgently needed. This study assessed the effect of a short-term intake of ready-to-eat cereal on body weight and waist circumference of over- weight/obese individuals in comparison to a control group. Methods and Study Design: A randomized, con- trolled 2-arm trial was carried out on 101 overweight/obese (Body Mass Index – 29.2±2.4 kg/m2) females aged 18 to 44 years, at St. John’s Medical College Hospital. The intervention group received a low fat, ready to eat cereal, replacing two meals/day for two weeks. The control group was provided with standard dietary guidelines for weight loss and energy requirements for both groups were calculated similarly. Anthropometric, dietary, appetite and health status assessments were carried out at baseline and at the end of two weeks. Results: At the end of two weeks, the mean reductions in body weight and waist circumference were significantly greater in the intervention group, -0.53 kg; 95% CI (-0.86 to -0.19) for body weight and -1.39 cm; 95% CI (-1.78, -0.99) for waist circum- ference. The intervention group had a significantly higher increase in dietary intakes of certain vitamins, fiber and sugar, and significantly higher reductions in total and polyunsaturated fats and sodium intakes, as compared to the control group (p≤0.05). No significant differences were observed between the groups, in change of appetite, health and perception scales. Conclusions: Portion controlled, ready to eat cereal could be effective for short- term weight loss, with some improvements in the nutrient intake profile. However, studies of longer duration are needed.
Background and Objectives: Oligosaccharide or oligopeptide supplementation may have a significant impact on endurance performance. This study evaluated the effects of adding maltooligosaccharides (MO) or soy oligopep- tides (SO) to compressed food (CF) on the physical response of soldiers to daily military training. Methods and Study Design: Twelve soldiers were randomized to four diet groups: regular meals, CF, CFMO, and CFSO (crossover design). They participated in exercise tests including 90 minutes running at 55-65% VO2max and ex- haustive running. Heart rates, rating of perceived exertion (RPE), and blood and urine samples were collected during exercise and recovery. Results: The recovery heart rates were significantly lower with the CFMO diet compared with the other diets. Compared with all other diets, blood glucose levels were higher, post-exercise blood lactate levels were lower, and lactate clearance during recovery was higher with the CFMO diet, followed by the CFSO diet. Post-exercise levels of erythrocytes and hematocrit were significantly higher with the CFSO diet. Post-exercise urine specific gravity was lower with the CFMO diet and urine pH was decreased with the CFSO diet. Blood urea nitrogen (BUN) and uric acid (UA) were significantly higher with the CFSO diet than with the other diets. There was no significant difference in skeletal and cardiac muscle injury indices and RPE among diets. Conclusions: CFMO led to better heart rate recovery, improved and maintained blood glucose and increased removal of blood lactate. CFSO accelerated removal of blood lactate during recovery, maintained oxy- gen supply, and increased fluid retention.
Background and Objectives: In Crohn’s disease (CD), belonging to inflammatory bowel disease, the small in- testine is involved in most cases. Most frequently affected is the distal ileum, where vitamin B-12 is specifically absorbed. Therefore, malabsorption of vitamin B-12 is quite likely to occur in patients with CD. In this study, we have studied the vitamin B-12 status in CD patients. Methods and Study Design: Forty eight patients with CD were evaluated for their food intake, and circulating concentrations of vitamin B-12, folic acid, and homocysteine (Hcy) as a sensitive marker for the insufficiency of these vitamins and a risk factor of atherosclerosis. Results: Plasma Hcy concentration was significantly correlated with serum vitamin B-12 concentration alone, and 60.4 % of the subjects had hyperhomocysteinemia. Receiver Operating Characteristics (ROC) analysis showed that se- rum concentration of vitamin B-12, but not folic acid, predicted hyperhomocysteinemia. Their intake of vitamin B-12 was much higher than the Japanese RDA, but not correlated with blood concentrations of vitamin B-12 or Hcy, probably due to malabsorption. Conclusions: Vitamin B-12 insufficiency and hyperhomocysteinemia were highly prevalent in CD patients. Recently, the significance of extra-intestinal complications of CD has been in- creasingly recognized, and our finding is likely to be of clinical importance.
Background and Objectives: The C3 complement component (C3) is increasingly recognized as a cardiometa- bolic risk factor. We aimed to examine the role of C3 in insulin resistance (IR) and its association with adiposity. Methods and Study Design: Sixty-seven obese (18-35 years) participants were matched with normal weight participants from the University of Jordan. BMI, waist-hip ratio (WHpR), and waist-height ratio (WHtR) were calculated. Body percent fat mass (%FM) was determined using the bioelectrical impedance analysis. C3, insulin, and glucose serum concentrations were measured. IR was assessed by the homeostasis model assessment of IR (HOMA-IR). Results: Serum concentrations of C3 and IR were significantly higher in the obese group than that in the normal body weight, regardless of gender (women: 1.2±0.08 and men: 1.2±0.08 vs women: 0.88±0.07 and men: 0.94±0.05, p<0.01; women: 3.6±0.34 and men: 3.9±0.43 vs women: 1.7±0.12 and men: 2.0±0.24, respec- tively; p<0.001). After adjustment for the potential confounders, BMI, waist circumference, WHtR and %FM were correlated positively with C3 (r=0.44; 0.42; 0.47; 0.43, respectively; p<0.001), and with IR (r=0.67; 0.61; 0.59; 0.59, respectively; p<0.001). C3 was correlated with IR (r=0.35, p<0.001). In linear regression analysis, C3 was not associated with IR independent of BMI (p>0.05). Conclusions: C3 may be a marker of chronic inflam- matory process independently underlying IR obese individuals regardless of gender, which may have a role in the progression of IR during obesity.
Background and Objectives: Reasons for intolerance to commercial amino acid-based formulas (cAAF) in in- fants diagnosed with cow’s milk protein allergy (CMA) remain unknown. We assume that minute amounts of proteins, presenting in the glucose polymers derived from corn starch (cGPs), can elicit the intolerance to the cAAFs observed in some infants with CMA. By replacing cGPs with glucose polymers derived from rice starch (rGPs), a new amino acid-based (nAAF) formula has been shown to be better tolerated than an existing cAAF. This study was carried out to corroborate the superiority of nAAF over a different commercially available cAAF. Methods and Study Design: Infants with CMA aged less than 4 months underwent a double-blind, placebo- controlled food challenge. They consumed each of the 2 test formulas for 14 days before switching to the other one. Following the 28-day challenge period, infants consumed the tolerated formula for 4 weeks as an at-home open challenge. Results: Out of 36 infants who completed the study, 18 were intolerant to the cAAF, seven of whom (38.8%) were also intolerant to the nAAF. Eleven of the 18 infants who were intolerant to the cAAF toler- ated the nAAF (p˂0.01). Conclusions: This study reconfirms that substitution of rGPS for cGPs in the amino ac- id-based formula improves tolerance of young infants with CMA.
Background and Objectives: Some potential role of iron overload in the development of diabetes mellitus have been suggested. Our study aimed to systematically assess the association between the risk of gestational diabetes mellitus (GDM) and iron intakes/body iron status. Methods and Study Design: PubMed and Web of Science were searched for relevant articles. Relative risks (RR) of GDM in relation to dietary iron intakes and body iron stores were pooled with the random-effects model. Weighted mean differences of iron blood markers between GDM and non-GDM individuals were also analyzed. Results: Twenty-five studies were included in the qualita- tive analysis, and 23 studies with 29,378 participants and 3,034 GDM patients were included in the quantitative analysis. Dietary intake of heme iron was significantly associated with GDM risk (RR=1.65, 95% CI: 1.28 to 2.12), and the pooled RR for each 1mg/day increment of heme iron intake was 1.38 (95% CI: 1.19 to 1.61). No association between GDM and the intakes of nonheme iron, total iron, or supplemental iron was detected. Body iron stores, as represented by serum ferritin level, were correlated with GDM risk (RR=1.64, 95% CI: 1.27 to 2.11). Moreover, the concentrations of both serum ferritin and serum iron were increased in GDM patients, com- pared with non-GDM individuals. Conclusions: Increased dietary intake of heme iron and body iron status are positively associated with the risk of GDM development in pregnant women. Future studies are warranted to bet- ter understand the role of iron in GDM development.
Background and Objectives: Malnutrition is a major contributor to morbidity and mortality from pediatric liver disease. We investigated the prevalence of both malnutrition and high nutritional risk in hospitalized children with liver disease as well as the rate of in-hospital nutritional support. Methods and Study Design: A total of 2,874 hospitalized children and adolescents with liver disease aged 1 to 17 years (inclusive) were enrolled. Mal- nutrition was screened by anthropometric measures (height-for-age, weight-for-height, weight-for-age, and BMI- for-age z-scores). The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) was used to evaluate nutritional risk status. Nutrition markers in blood, rate of nutritional support, length of hospital stay, and hospital fees were compared among nutritional risk groups. Results: The overall prevalence of malnutrition was 38.6%. About 20.0% of children had high nutritional risk, and prevalence of malnutrition was markedly greater in the high nutritional risk group compared with the moderate risk group (67.9% vs 31.3%). Serum albumin and prealbumin differed significantly between high and moderate risk groups (p<0.001). Only 8.9% of children with high nutritional risk and 3.5% with moderate nutritional risk received nutrition support during hospitalization. Children with high nutritional risk had longer hospital stays and greater hospital costs (p<0.001). Conclusions: The prevalence of malnutrition is high in children with liver disease. High nutritional risk is also prevalent at ad- mission. Albumin and prealbumin are sensitive markers for distinguishing nutritional risk groups. High nutrition- al risk prolongs length of stay and increases hospital costs. The nutritional support rate is still low and requires standardization.
Background and Objectives: Childhood obesity is a serious public health issue globally and poor eating habits are an important contributing factor. This study aimed to explore the perceptions, practices and attitudes towards healthy eating in Bruneian primary school children. Methods and Study Design: A qualitative study was con- ducted among 40 subjects involving 18 children (aged 9-10 years old), 12 parents and 10 teachers, who were re- cruited from two primary schools using convenience sampling. Five focus group discussion sessions were con- ducted, and recorded discussions were translated. The transcripts were entered into NVivo10 and thematic analy- sis was conducted. Results: All participants had differing perceptions of the term ‘healthy eating’. Children re- ported ‘healthy eating’ by identifying foods or food groups they perceived as healthy and unhealthy. Only a few mentioned fruits and vegetables as essential to a healthy diet. Parents mainly perceived ‘healthy eating’ as con- suming ‘any quality food’ that contains ‘vitamins and minerals’. Teachers described a healthy diet as including balanced and varied dietary practices, having breakfast and eating regularly at the right, set times. They also asso- ciated eating healthily with traditional, home-grown and home-cooked food. All participants had positive atti- tudes towards healthy eating, however most children demonstrated unhealthy eating habits and frequently con- sumed unhealthy foods. Conclusions: The Bruneian primary school children reported favourable knowledge de- spite having poor healthy eating habits. The factors influencing participants eating behavior included food prefer- ences, familial factors (parental style and parenting knowledge), food accessibility and availability, time con- straints, as well as convenience. These factors hindered them from adopting healthy eating practices.
Background and Objectives: A high prevalence of vitamin B-12 (B-12) deficiency among young women of South Asian origin predisposes to significant health risks for these women and their future offspring. Vegetarian or low-meat based dietary practices contribute to B-12 deficiency. This study validated a nutrient-specific, semi- quantitative food frequency questionnaire (B12FFQ), developed to estimate dietary B-12 intake in South Asian women. Methods and Study Design: The B12FFQ was developed, then tested in 60 apparently healthy South Asian women aged 18-50 years, living in Auckland, New Zealand. Participants recalled the frequency and quanti- ty of vitamin B-12-containing foods consumed in the preceding three months. Pearson’s correlations measured the associations between dietary B-12 intake and B-12 biomarkers (serum B-12 and holotranscobalamin [holoTC]). Likelihood of B12 insufficiency was calculated for vegetarian and non-vegetarian dietary practices. Results: The B12FFQ was a valid measure of dietary B-12 intake - supported by moderate positive associations with serum B-12 (r=0.50, p<0.001, 95% CI [0.28, 0.67]) and holoTC (r=0.55, p<0.001, 95% CI [0.34, 0.71]). A dietary B-12 intake of less than 2.4 μg/day increased the likelihood of serum B-12 (X2 (1)=11.79, p=0.001) or holoTC (X2 (1)=6.33, p=0.012) insufficiency. A dietary B-12 intake of less than the recommended dietary allow- ance (2.4 μg/day), occurred in 61% (n=20/33) of participants with vegetarian and 22% (n=6/27) with non- vegetarian dietary practices. Conclusions: The B12FFQ provides a valid estimate of dietary B-12 intake. This easily administered food frequency questionnaire has the potential to identify low dietary B-12 intake as a con- tributor to B-12 depletion or deficiency.
Background and Objectives: Assay cost, quality, and availability pose challenges for vitamin D surveys in lim- ited resource settings. This study aimed to validate an inexpensive vitamin D assay (ELISA) under real-world conditions in Mongolia, the northernmost developing country, to characterize the assay’s usefulness and inform the design of epidemiologic studies in similar regions. Methods and Study Design: We collected paired sum- mer and winter serum samples from 120 men and women (aged 20-57 years) in urban and rural Mongolia, ana- lyzed each sample for 25(OH)D concentration using both Immunodiagnostic Systems ELISA and DiaSorin LI- AISON 25(OH)D TOTAL, and compared the assays using multiple statistics. LIAISON was itself validated by participation in the DEQAS program. Results: Correlation and agreement between assays were higher in sum- mer (Pearson’s correlation=0.60, Spearman’s rank correlation=0.67, Lin’s concordance correlation=0.56) than winter (rP=0.37, rS=0.43, rC=0.33), although ELISA less accurately assigned subjects to sufficiency categories in summer (percent agreement=44%) than winter (58%), during the latter of which most subjects were deficient ([25(OH)D] categories used: >75 nmol/L (optimal), 50-75 nmol/L (adequate), 25-50 nmol/L (inadequate), <25 nmol/L (deficient)). Compared with LIAISON, ELISA tended to indicate higher vitamin D status in both seasons (mean paired difference: 7.0 nmol/L (95% CI: 3.5-10.5) in summer, 5.2 nmol/L (95% CI: 2.9-7.5) in winter). Conclusions: ELISA proved useful for measuring and ranking subjects’ vitamin D status in Mongolia during summer, but levels were too low in winter to sensitively discriminate between subjects, and ELISA overestimated status in both seasons. These findings have implications for the timing and interpretation, respectively, of vitamin D surveys in highly deficient populations.
Background and Objectives: The consumption of unhealthy snack and beverages can lead to childhood obesity, which has become a major concern globally. Television food advertisements may influence children's snack and beverages preferences. This article aims to explore children's snack and beverage consumption habits; examine the extent of television advertising for non-core (energy-dense, nutrient poor) snack and beverages; and assess the influence of television advertising on children's snack and beverages preferences in Harbin, China. Methods and Study Design: The study consisted of two components, a recall survey on the snack and beverage consumption and preferences of 9-11 years old school children; and recording snack and beverage advertisements on three popular television channels. Odds Ratio (OR) was used to estimate the likelihood of children selecting particular snack and beverages as their top three choices according to whether their preferences were influenced by televi- sion advertisements. Results: The majority of children consumed non-core snacks (100%) and beverages (80%) in the four weeks prior to the survey. Nearly 40% of television food advertisements were for non-core snacks and beverages. Non-core snacks (OR of 1.13) and non-core beverages (OR of 1.23) were more likely chosen as chil- dren’s top three snack/beverage choices, particularly, “puffed food and tubers” snack and carbonated beverages (OR of 1.31 and 1.45, respectively). Conclusions: The snack and beverage preferences appeared to be influenced by television advertisements in this sample of Chinese children, highlighting the potential health and nutritional value of policy to reduce advertising of non-core foods in China.
Background and Objectives: The Tick programme of the National Heart Foundation (NHF) is the longest stand- ing voluntary front of pack signpost nutrition logo in New Zealand. It provides a platform for collaboration with the food industry to encourage development of healthier products. This study evaluated the impact of the Tick programme on sodium in processed food. Methods and Study Design: Fifty-two Tick programme products from food categories known to contribute substantially to sodium intake were identified. Sales volumes (kg) from Jan- uary 2011 to December 2013 were multiplied by changes in sodium content over that time, producing an estimate of programme impact. Five semi-structured interviews with industry representatives were conducted, to look at other influences for sodium reduction, and themes identified through methods of thematic analysis. Results: Over the period, the Tick programme influenced food companies to remove approximately 16 tonnes of salt through the reformulation and formulation of 52 Tick-approved breakfast cereals, edible oil spreads, cooking sauces and pro- cessed poultry products. Other factors influencing sodium reduction reported by company representatives includ- ed increased consumer and industry interest in healthier product nutrition profiles and other sodium reduction programmes targeting reformulation/formulation. Conclusions: The Tick remains a credible and well-recognized brand and may provide a competitive edge for participating food manufacturers in the current market. The Tick programme is effective in influencing industry to reduce sodium in processed foods in New Zealand. The com- bined impact of the Tick and other NHF programmes has the potential to reduce population sodium intake and improve health outcomes.
Background and Objectives: With prevalence of childhood obesity increasing rapidly, developing of effective and sustainable intervention strategies is becoming more and more important for the prevention of childhood obe- sity in China. A trial was developed to evaluate the effect of comprehensive school-based intervention on child- hood obesity. Methods and Study Design: A multi-center cluster randomized controlled trial was conducted among urban children (n=9,867) aged 6-13 years in 38 primary schools from six large cities. Comprehensive in- tervention, nutrition education and physical activity interventions were carried out among children. Nutrition ed- ucation was also targeted towards teachers, parents and health workers in intervention schools. The program was implemented for 2 semesters from May 2009 to May 2010. Results: The combined prevalence of overweight and obesity increased by 1.5 percent (22.7% vs 24.2%, p<0.001) in control group while 0.2 percent in comprehensive intervention group (23.6% vs 23.8%, p=0.954) after intervention (p=0.067). The effect was significantly stronger among girls than boys (-1.4% vs -0.9%, p=0.028). A significant intervention effect was found on BMI for -0.3 kg/m2 (95% confidence interval (CI): -0.4, -0.2; p<0.001), BMI z scores for -0.14 (95% CI: -0.18, -0.11; p<0.001)，body fat for -0.8 percent (95% CI: -0.9, -0.6; p<0.001), waist circumference for -0.5 cm (95% CI: -0.6, -0.3; p<0.001), blood serum glucose for -0.20 mmol/L (95% CI: -0.24, -0.16; p<0.001) and cholesterol for -0.32 mmol/L (95% CI: -0.34, -0.30; p<0.001). Conclusions: We observed moderately significant effects on combined prevalence of overweight and obesity, BMI, BMI z scores, waist circumference, percentage body fat, glucose and lipid for a comprehensive school-based intervention of childhood obesity in China.
Background and Objectives: The few studies that have assessed the association between rice intake and mor- tality have generated inconsistent results. We assessed whether rice intake was associated with cardiovascular disease (CVD) mortality, cancer mortality and all-cause mortality in a prospective cohort of the Chinese popula- tion. Methods and Study Design: We prospectively studied 2,832 adults aged 20 years and above with a mean follow up of 10 years. Rice intake was measured by a 3-day weighed food record (WFR) in 2002. Hazard ratios (HRs) and 95% CI were calculated by competing risks regression (CVD and cancer mortality) and Cox propor- tional hazards analysis (all-cause mortality). Results: We documented 184 deaths (including 70 CVD deaths and 63 cancer deaths) during 27,742 person-years of follow-up. No association between rice intake and all-cause mor- tality was found. After adjusting for sociodemographic and lifestyle factors as well as energy and fat intake, HRs for CVD mortality across tertiles of rice intake were 1.00,0.47 (95% CI 0.25-0.87), and 0.49 (95% CI 0.21-1.13) (p for trend 0.049). Conclusions: There was no association between rice intake and all-cause mortality.
Background and Objectives: Emerging evidence suggests potential effects of nutrients/foods on sleep parame- ters. However, no studies have addressed the complex interactions among nutrients/foods and relate them to sleep outcomes. To investigate the associations between dietary patterns and sleep parameters (polysomnography (PSG) measured and self-reported sleep symptoms) in a large sample of community dwelling men in South Aus- tralia. Methods and Study Design: Cross-sectional analysis was conducted of participants in the Men Andro- gen Inflammation Lifestyle Environment and Stress cohort enrolled in a sleep sub-study (n=784, age 35-80 years). Dietary intake was measured by a validated food frequency questionnaire. Dietary patterns were identi- fied by factor analysis. Sleep was assessed by an overnight home PSG and self-reported questionnaires. Results: Two factors were obtained by factor analysis: Factor 1 was characterised by high intakes of vegetables, fruits, and legumes and factor 2 was characterised by processed meat, snacks, red meat and take-away foods. Three cat- egories of the dietary patterns were defined (prudent, mixed and western) through classification of the sample according to the actual consumption higher or lower of each factor. The prudent (factor 1 dominant) and mixed dietary patterns were inversely associated with sleep onset, compared with the western dietary pattern (factor 2 dominant) (β=-6.34 (95% CI-1.11, -11.57), β=-4.34 (95% CI-8.34, -0.34) respectively)). The association was on- ly significant with the prudent dietary pattern after multiple comparison adjustment. No associations were found with between dietary patterns and other sleep outcomes. Conclusions: The prudent dietary pattern was associat- ed with a faster sleep onset, which may provide a solution for sleep management.
Background and Objectives: Associations between genetic variants in the hepcidin regulation pathway and iron status have been reported in previous studies. Most of these studies were conducted in populations of European descent and relatively few studies have been conducted in Chinese populations. In this study, we evaluated asso- ciations between single-nucleotide polymorphisms (SNPs) in the hepcidin regulation pathway, serum ferritin (SF) and soluble transferrin receptor (sTfR) in Chinese adolescents. Methods and Study Design: In total, 692 stu- dents from rural boarding schools were selected from six cities in China. The participants were divided into case and control groups according to criteria for SF and sTfR. Furthermore, 33 SNPs in TMPRSS6, TF, TFR2, BMP2, BMP4, HJV, CYBRD1, HFE, IL6, PCSK7, HAMP, KIAA1468, and SRPRB were selected. Associations between the genetic variants and SF or sTfR were detected. Results: For SF, rs4820268 in TMPRSS6 was associated with an SF <25 ng/mL status. Carriers of the G/G genotype of rs4820268 exhibited significantly lower SF levels than A allele carriers did (p=0.047). For sTfR, rs1880669 in TF, rs4901474 in BMP4, and rs7536827 in HJV were sig- nificantly associated with an sTfR ≥4.4 mg/L status. However, in general linear model analysis, after adjustment for age, sex, and location, only rs1880669 exhibited a stable association with higher sTfR levels (p=0.032). Con- clusions: We found rs4820268, in TMPRSS6 that was associated with a low SF level, as previously reported, and a new association between 1880669 in TF and sTfR.
Background and Objectives: This study validated the Malnutrition Universal Screening Tool (MUST) for nutri- tional screening in acutely unwell elderly patients against a reference assessment tool – Patient-Generated Subjec- tive Global Assessment (PG-SGA). Methods and Study Design: One hundred and thirty two acutely admitted general medical patients contributed data for this study. In addition to performance of MUST and PG-SGA the following nutritional parameters were measured: weight loss >5% in previous 3-6 months, handgrip strength, tri- ceps skinfold thickness, Mid-arm circumference, Mid-arm muscle circumference (MAMC). Quality of life (QoL) was determined using the EuroQoL Questionnaire (EQ-5D 5 level). Sensitivity, specificity, predictive values and concordance were calculated to validate MUST against PG-SGA. Results: MUST when compared to PG-SGA gave a sensitivity of 69.7%, specificity of 75.8%, positive predictive value of 75.4%, negative predictive value of 70.1% and kappa statistics showed 72.7% agreement (k=0.49) for detecting malnutrition. The MUST score had significant inverse correlation with body mass index, Triceps skinfold thickness and Mid-arm muscle circumfer- ence but not with Handgrip strength. Malnourished patients (PG-SGA class B/C) were found to have a signifi- cantly worse QoL. Conclusions: This study demonstrates that MUST can be confidently administered with re- spect to validity in acutely unwell general medical elderly patients to detect malnutrition. In this study, significant recent weight loss also seems to have validity, almost comparable to MUST, for predicting the risk of malnutri- tion. Further research is needed to verify this finding, as a single item may be more feasible to complete than an instrument consisting of two or more items.
Background and Objectives: Restriction of dietary sodium intake for peritoneal dialysis (PD) patients is rec- ommended, but there is limited information on the measurement and monitoring of sodium intake. We have de- veloped a simple method to estimate daily sodium intake during the measurement of dialysis adequacy in PD pa- tients. Methods and Study Design: A total of 83 PD patients were enrolled in the study. The patients were di- vided into two groups based on residual renal function (RRF). We measured total sodium removal and estimated daily sodium intake using dietary recall for one day, during the assessment of dialysis adequacy. Results: There were 39 patients in the RRF(−) group and 44 in the RRF(+) group. In both groups, and all patients, there were significant positive correlations between sodium intake and total sodium removal: RRF(−) group, r=0.598; RRF(+) group, r=0.577; total patients, r=0.595. There were linear relationships between dietary sodium intake and total sodium removal in both groups: RRF(−) group, sodium intake (mg/d) = 19.3 × peritoneal sodium re- moval (mEq/d) + 211;RRF(+) group, sodium intake (mg/d) = 15.4 × total sodium removal (mEq/d) + 609. All PD patients, sodium intake (mg/d) = 15.6 × total sodium removal (mEq/d) + 646. Conclusions: The measurement of total sodium removal during the assessment of dialysis adequacy could be an effective and simple method to es- timate dietary sodium intake in PD patients. A dietary intake of 2,000 mg of sodium corresponds to a total sodi- um removal of approximately 87 mEq/d.
Background and Objectives: Our aim was to investigate the safety of iEAT (a food that is softened by heat and enzyme homogeneous permeation) and iEAT-affected nutrition parameters, e.g., nutrition intake (calculated from the consumption rate in patients with impaired mastication and those with mild dysphagia). Methods and Study Design: A multicenter, randomized, cross-over study of iEAT was conducted in 50 patients (mean age 77.0±11.0 years) with dysphagia due to Occasional aspiration (4 points on the Dysphagia Severity Scale [DSS]) or Oral problems (5 points) randomly assigned to the study diet (iEAT) or its opposite (the modified traditional [control] diet) for 1 week and then switched for 1 week to the opposing diet. Intake of energy, protein, lipid, carbohydrate, and sodium were evaluated along with questionnaire-assessed levels of satisfaction. Results: The mean intake was significantly lower for the study diet, whereas the intakes of energy, protein, carbohydrate on day 1, intake of protein on day 7, and body weight on day 7 were significantly higher for the study diet. We found no between- group differences in hematologic and blood biochemistry parameters, no diet-related adverse events, greater satis- faction with the appearance of the study diet (p<0.001), and comparable levels of satisfaction with ease of eating, ease of swallowing, and taste for both diets. Conclusions: iEAT was provided to patients with mild dysphagia as safely as a blender diet or other diets usually provided at each study site, and can serve as an efficient nutrition source.
Background and Objectives: The American Society for Parenteral and Enteral Nutrition recommends hy- pocaloric feeding for critically ill patients with a BMI of ≥30.0 kg/m2. However, the cut-off value of obesity in Japan is BMI >25.0 kg/m2, due to the higher prevalence of type 2 diabetes mellitus, and cardiovascular risk fac- tors, even at a lower BMI than in Western populations. Thus, the optimal energy intake for critically ill, over- weight Asian patients is unknown. Methods and Study Design: A retrospective chart review was conducted in patients with BMI of ≥25.0 kg/m2 in an emergency intensive care unit (EICU). Patients were categorized into two groups by average daily energy intake during the first week in the EICU, with Group A at <50% of requirement and Group B at ≥50%. Results: A total of 72 patients with a median BMI of 27.5 kg/m2 were included in the study. No significant differences between the groups were observed for all-cause mortality, ICU-free days, or length of hospital stay. The number of ventilator-free days (VFDs) was significantly higher in Group A than Group B (20.0 [15.5-24.5] vs 17.0 [2.0-21.0] days; p=0.042). On multiple adjusted analysis, however, we found that %energy intake/requirement was not independently associated with VFDs (regression coefficient=0.019; 95% confidence interval, −0.115–0.076). Conclusions: Energy intake in the first week in the EICU did not influ- ence clinical outcomes in critically ill, overweight Japanese patients. Confirmation of these results in larger, ran- domized trials is required.
Background and Objectives: A prior meta-analysis showed favorable metabolic effects of structured triglycer- ide (STG) lipid emulsions in surgical and critically ill patients compared with mixed medium-chain/long-chain triglycerides (MCT/LCT) emulsions. Limited data on clinical outcomes precluded pharmacoeconomic analysis. We performed an updated meta-analysis and developed a cost model to compare overall costs for STGs vs MCT/LCTs in Chinese hospitals. Methods and Study Design: We searched Medline, Embase, Wanfang Data, the China Hospital Knowledge Database, and Google Scholar for clinical trials comparing STGs to mixed MCT/LCTs in surgical or critically ill adults published between October 10, 2013 and September 19, 2015. New- ly identified studies were pooled with the prior studies and an updated meta-analysis was performed. A determin- istic simulation model was used to compare the effects of STGs and mixed MCT/LCT’s on Chinese hospital costs. Results: The literature search identified six new trials, resulting in a total of 27 studies in the updated meta- analysis. Statistically significant differences favoring STGs were observed for cumulative nitrogen balance, pre- albumin and albumin concentrations, plasma triglycerides, and liver enzymes. STGs were also associated with a significant reduction in the length of hospital stay (mean difference, −1.45 days; 95% confidence interval, −2.48 to −0.43; p=0.005) versus mixed MCT/LCTs. Cost analysis demonstrated a net cost benefit of ¥675 compared with mixed MCT/LCTs. Conclusions: STGs are associated with improvements in metabolic function and re- duced length of hospitalization in surgical and critically ill patients compared with mixed MCT/LCT emulsions. Cost analysis using data from Chinese hospitals showed a corresponding cost benefit.
Background and Objectives: This study investigated whether total parenteral nutrition combined with enteral nutrition is associated with improved biochemical and clinical outcomes in cancer patients with gastrointestinal dysfunction. Methods and Study Design: From January to December 2014, the clinical data of 68 patients in a cancer ward were retrospectively collected, and these patients were classified into two groups according to nutri- tion delivery, through parenteral nutrition, combined with enteral nutrition more (group A) or less (group B) than 250 kcal/day. The following variables were analyzed: the route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, diagnosis at admission, complications of intestinal failure, modified Glasgow Prognostic Score, co-morbidities, duration of total parenteral nutrition support, performance status scale, and plasma nutritional markers. Results: A significant difference was observed between the two groups in functional capacity, including the Karnofsky index, World Health Organization/Eastern Cooperative Oncology Group score, body-weight loss, and serum albumin levels. However, no significant difference was ob- served in the modified Glasgow Prognostic Score. Conclusions: Cancer patients receiving total parenteral nutri- tion who were fed enterally more than 250 kcal/d exhibited more favorable clinical outcomes than those who were fed enterally less than 250 kcal/d. Enteral nutrition should be considered for these severely ill patients.
Background and Objectives: Kale is a rich source of provitamin A- β-carotene. This study used intrinsically la- beled kale [2H9] β-carotene to determine the effect of peanut butter on the bioconversion of kale β-carotene to vit- amin A in preschool children. Methods and Study Design: Preschool children (n=37; age 12-36 mo) were ran- domly assigned to 50 g cooked kale (1.5 mg β-carotene content) with either 33 g peanut butter (PBG) or with 16 g lard (LG) and a reference dose of 1 mg [13C10] retinyl acetate capsule. Blood samples were processed to serum and analyzed by Negative Chemical Ionization-Gas Chromatography Mass Spectrometry (NCI-GCMS) for the enrichments of [2H] retinol from kale [2H9] β-carotene and [13C10] retinol from reference dose. Results: The area under curves (AUCs) of molar enrichment at days 1, 2, 3, 6, 15, and 21 after the labeled doses was 56.3±10.5 and 84.8±16.2 (nmole) for [2H] retinol from LG and PBG kale [2H9] β-carotene, respectively. The AUC of [13C10] ret- inol from reference dose was 432.6±54.9 (LG) and 560.3±156.7 (nmole) (PBG), respectively. The calculated β- carotene conversion factors were 13.4±3.1 and 11.0±3.9 to 1 (p>0.05) by weight for LG and PBG, respectively. Conclusions: This study showed that peanut butter enhances the vitamin A value of kale.