The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Aus- tralia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to de- velop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nu- trient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to sup- port the older persons, most of these efforts targeted the general population rather than the older persons popula- tion segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different coun- tries, initiatives, and programs to further evaluate the available data to underpin future research.
Background and Objectives: Information about an association between animal food intakes and risk of anemia is still limited. This study aimed to investigate the association between fish and meat intake and anemia risk in the Japanese elderly. Methods and Study Design: A nationally representative sample of 6,469 aged 65 years and over was obtained from pooled data of annual National Health and Nutritional Survey in Japan during 2002–2011. Anemia was defined as hemoglobin concentrations <13.0 g/dL in males and <12.0 g/dL in females. Logistic re- gression analysis, with the lowest intake tertile as the reference, was applied to estimate anemia risk for each nu- trient and food group. Results: After adjustment for putative confounding factors, males in the highest tertile of animal protein intake had significantly lower risk of anemia than those in the lowest tertile (odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63, 0.95; p for trend=0.017). These associations were not seen in females (OR: 0.72, 95% CI: 0.49, 1.06; p for trend=0.100). Multivariate analyses revealed that anemia risk (OR: 0.80; 95% CI: 0.65, 0.97; p for trend =0.002) was lower for males in the highest tertile of fish intake than in the lowest tertile; this effect was also observed for females (OR: 0.64; 95% CI: 0.45, 0.92; p for trend =0.014). In both sexes, the highest tertile of meat intake was not associated with lower anemia risk in the multivariate-adjusted models. Conclusions: The current cross-sectional study in Japanese elderly males suggests that higher animal protein, specifically the high protein content of fish may be associated with a lower prevalence of anemia.
Background and Objectives: Metabolic syndrome is a leading global public health concern. Nutritional ap- proaches are important for preventing and managing cardiometabolic risks, including metabolic syndrome. The aim of this study was to examine the potential association between riboflavin intake and cardiometabolic risks ac- cording to sex among Koreans. Methods and Study Design: We used data from the Korea National Health and Nutrition Examination Survey 2015–2016, a nationwide cross-sectional survey that assesses the health and nutri- tional status of the Korean population. A total of 6,062 individuals aged ≥19 years were included. The nutrition survey was performed using 24-h dietary recall. Results: A significant association was observed between low ri- boflavin intake with only increased HDL-cholesterol (OR 1.362, 95% CI 1.017-1.824, p=0.038) among metabolic syndrome and its components in men, whereas insufficient riboflavin intake was positively associated with hyper- tension (OR 1.352, 95% CI 1.085-1.685, p=0.007), diabetes (OR 1.493, 95% CI 1.137-1.959, p=0.004) and meta- bolic syndrome (OR 1.289, 95% CI 1.014-1.640, p=0.038) in women after adjusting for the other covariates. For post-menopausal women, central obesity was also correlated with insufficient riboflavin intake (OR 1.315, 95% CI 1.019-1.696, p=0.035). Conclusions: Insufficient riboflavin intake may contribute to development of cardi- ometabolic disorder, particularly in women. It was also found that riboflavin may have different influences on its risks in women according to menopausal status. This study highlighted the importance of public policies targeted at these sex-specific groups for reducing cardiometabolic risks.
Background and Objectives: Types and amounts of nutrients may influence the volume of subcutaneous adi- pose tissue (SAT) and visceral adipose tissue (VAT). This study targeted to investigate the relationship between SAT and VAT volumes and macro- and micronutrients intake among adults. Methods and Study Design: Data were collected via a private face-to-face interview, in which diet history was obtained using validated quantitative food frequency questionnaire. The different fat volumes were assessed using magnetic resonance imaging (MRI) scanning. Results: Participants with the lowest VAT volume had the highest intake of saturated fats, monoun- saturated fatty acids and omega-3 and omega-6 fatty acids (p<0.05). VAT volume was significantly associated with the highest level of total energy and energy from carbohydrate consumption among participants while signif- icantly associated with the lowest energy intake from fat among participants (p=0.013). There was a significant relationship with the highest consumption of total carbohydrate, soluble fiber, and insoluble fiber and VAT vol- ume (p<0.05). Participants in the highest VAT volume had significantly the highest intake of vitamin A, β- carotene, and copper. Conclusions: This study underscores the importance of quantifying depot-specific body fat and highlights the unique responsiveness of various fat depots to dietary intake.
Background and Objectives: Considering the impact of unfavorable dietary practices on inadequate nutrient in- take, this cross-sectional study aimed to explore dietary practices, including problem nutrients, and develop local food-based recommendations (FBRs) to improve the intake of problem nutrients among women of reproductive age (WoRA) with dyslipidemia in Minangkabau, Indonesia. Methods and Study Design: The study was con- ducted in the Padang township inhabited mostly by the Minangkabau tribe. Accordingly, 74 WoRA with dyslipidemia completed the study. Two replicate 24-h recalls and a 5-day food record were used to assess food consumption patterns. Then, linear programming (LP) analysis using three modules of the WHO Optifood soft- ware was employed to identify problem nutrients and develop FBRs. Results: Median (5th and 95th percentiles) weekly consumption frequencies for grain; meat, fish, and eggs; and added fat were 18 (14–27), 11 (6–16), and 15 (7–30), while those for fruits and vegetables were 2 (0–11) and 7 (2–16), respectively. Based on the aforemen- tioned food pattern, PUFA (both n-3 and n-6 fatty acids), dietary fiber, iron, and zinc were identified as typical problem nutrients. The final FBR emphasized on incorporating locally available nutrient-dense foods, as well as food groups and sub-groups, which would improve the intake of problem nutrients. Conclusions: Minangkabau WoRA have dietary practices that predispose them to dyslipidemia. Moreover, the LP approach is a sensitive tool for identifying nutrient-dense foods that could potentially improve problem nutrient intake, as well as those that need to be limited in the final FBR.
Background and Objectives: Increased consumption of folic acid is prevalent, raising concerns about possible adverse effects. This prospective study aimed to explore the associations between the duration of folic acid sup- plementation and the risk of gestational diabetes mellitus (GDM) in Chinese women. Methods and Study De- sign: A total of 326 pregnant women were prospectively included for detailed information on folic acid supple- mentation during pre-pregnancy and early pregnancy, lipid profiles at 16-18 weeks, and subsequent GDM diag- nosis at 24-28 weeks. Associations among folic acid supplementation, lipid profiles, and risk of GDM were ana- lyzed using linear and logistic regression models, adjusting for potential confounders. Results: The incidence of GDM in participants was 10.1%. We observed a U-shape relation between duration of folic acid supplementation and risk of GDM. Women who did not take folic acid and took folic acid for >90 days had a higher incidence of GDM compared to those who took folic acid for ≤60 days. Moreover, lipid profiles were positively correlated with duration of folic acid supplementation and risk of GDM. After adjusting for demographic characters, energy and nutrients intakes and lipid profiles, the adjusted OR of GDM comparing taking folic acid for >90 days with taking folic acid for ≤60 days was 3.45 (95% CI: 1.01, 11.8). Conclusions: This prospective study indicate a pos- itive association among prolonged folic acid supplementation, lipid profiles in the second trimester, and risk of GDM. Future studies are warranted to verify the causal relationship and underlying mechanisms.
Background and Objectives: Few studies have described the socioeconomic disparity of dietary quality in Northwest China. The present study aimed to evaluate the diet quality of pregnant women in Shaanxi province of Northwest China by using the Diet Balance Index for Pregnancy (DBI-P) and explored the relationships with so- cioeconomic status (SES). Methods and Study Design: A cross-sectional analysis of data from 7,630 women who were pregnant during 2012-2013 was performed. Dietary intake during the whole pregnancy was assessed by FFQ within 12 months (median, 3 months; 10th-90th percentile, 0-7 months) after delivery. Diet quality evaluat- ed by the DBI-P was related to socioeconomic factors. Results: Most women had insufficient consumption of vegetables (72.27%), dairy (89.58%), meat (82.07%), fish and shrimp (92.23%), eggs (62.54%), and dietary vari- ety (97.92%). 67.76% of women had excessive intake of grains, and 87.77% and 69.79% of participants had sur- plus consumption of edible oil and salt respectively. Women with higher education, occupation and household wealth index (HWI) consumed more vegetables, fruit, dairy, soybean and nuts, meat, fish and shrimp, eggs, edi- ble oil, alcohol and dietary variety but less grains and salt. After adjusting for confounders, education, occupation and HWI were negatively associated with the level of inadequate dietary intake. Conversely, individuals with medium HWI had higher level of excessive dietary intake compared to low HWI groups. Conclusions: The diet quality of pregnant women in Northwest China was associated with SES. Socioeconomic disparities in diet quali- ty should be considered when planning nutrition interventions for pregnant women.
Background and Objectives: A reliable biomarker for optimal selenium (Se) intake in lactating women is not currently available. Methods and Study Design: Daily dietary Se intake in lactating women was calculated from a 24-hour meal record survey for over 3 days. Se levels in plasma and breast milk were measured through induc- tively coupled plasma mass spectrometry. Plasma selenoprotein P 1 levels and glutathione peroxidase 3 activity were measured using an enzyme-linked immunosorbent assay. Ultra-performance liquid chromatography-tandem mass spectrometry was used to analyze proteinaceous Se species in enzymatically digested breast milk. Results: Dietary Se intakes of lactating women from Liangshan, Beijing, and Enshi were 41.6±21.2 ng/d, 51.1±22.6 ng/d, and 615±178 ng/d, respectively (p<0.05). The Se levels in the blood and breast milk were significantly associated with the dietary Se intake (p<0.05). The proteinaceous Se species in breast milk were SeMet and SeCys2. The levels of SeMet in the lactating women from Liangshan, Beijing, and Enshi were 3.31±2.44 ng Se/mL, 7.34±3.70 ng Se/mL, and 8.99±9.64 ng Se/mL, while that of SeCys2 were 13.7±12.0 ng Se/mL, 35.6±20.9 ng Se/mL, and 57.4±13.2 ng Se/mL, respectively. Notably, the concentration of SeCys2, the metabolite of unstable SeCys, reached a saturation platform, whereas no similar phenomenon were found for the total Se SeMet from Se- containing proteins. Conclusions: SeCys2 in breast milk is a potential biomarker for determining the optimal Se intake in lactating women.
Background and Objectives: The Chinese national standard of formula for 6–12-month-old infants (GB 10767- 2010) requires review and revision because it does not correspond to current scientific knowledge and data. The aim of this paper was to summarize the formula composition recommended for 6–12-month-old infants by a Chi- nese expert group. Methods and Study Design: Formula composition recommendations for 6–12-month-old in- fants were devised by a Chinese expert group based on a detailed systematic review, which included nutrient in- take, nutrient content of Chinese women’s breast milk, and the latest adequate intake and tolerable upper intake levels, also referencing the Codex Alimentarius recommendations and those of other countries and considering the practice in products on the market. Results: Compared with current standards, it was recommended that most compositional requirements be modified, including decreasing the maximum energy density from 85 to 75 kcal/100 mL, decreasing the protein content in milk-based formula from 2.9–5.0 g/100 kcal to 1.8–3.5 g/100 kcal, increasing the minimum content of lipids from 2.9 g/100 kcal to 3.5 g/100 kcal, providing the maximum amount of vitamins and minerals (including vitamin E, vitamin K, thiamin, riboflavin, vitamin B6, vitamin B12， niacin, folic acid, pantothenic acid, vitamin C, biotin, magnesium, calcium, phosphorus, and iodine), and chang- ing the content of optional components such as taurine, docosahexaenoic acid, and arachidonic acid. Conclusions: These nutrient standard modifications based on recent evidence are expected to enhance feeding practices and further guarantee the health of 6–12-month-old infants in China.
Background and Objectives: Iodine Deficiency Disorders has been a major public health challenge for the Indian subcontinent over many years. Our study was conducted in Tikamgarh district of Madhya Pradesh, an Iodine deficiency disorders-endemic district, with the objective to estimate Total Goitre rate and iodine nutrition status. Methods and Study Design: A cross-sectional study with 30 cluster sampling was conducted between June to July 2016 among school-going children in the age group of 6-12 years. 90 children from each school (30x90=2700) were selected for the assessment of Goitre. Total 540 salt samples and 270 urine samples were collected to estimate salt iodine content from their house-hold and Urine Iodine Excretion (UIE) respectively. A total of 150 households and 30 shopkeepers were interviewed to understand the awareness level for salt iodization. Results: Goitre rate in Tikamgarh district was 1.9% with prevalence of Grade I&II was 1.7% and 0.2% respectively. The median UIE level was 200 mcg/L. The 20% the population had iodine deficiency, 28.9% population had adequate iodine nutrition and 51.1% population had either more than adequate level of Iodine. The 72.4% of the population consume adequately iodized salt (≥15 ppm). Conclusions: Our study concludes that Tikamgarh district is non-endemic for IDDs against the earlier classification as an IDD-endemic district. About 20% population has ‘Iodine deficiency’ and approximately 51.1% population has ‘more than adequate iodine intake’. We recommend stringent programme monitoring, undertake periodic assessment of IDD and explore manifestations of excess iodine intake (≥300 mcg/L) such as Iodine-induced hyperthyroidism in future.
Background and Objectives: The aim of this study was to examine the reproducibility of a self-administered food frequency questionnaire (FFQ) originally developed for the Japan Public Health Center-Based Prospective Study (JPHC study) and modified for use in the Next Generation (JPHC-NEXT) study. Methods and Study De- sign: Participants included 98 men and 142 women aged 40–74 years from the five areas included in the JPHC- NEXT protocol. In November 2012, participants were recruited and asked to complete the first nutrition survey. The second nutrition survey was completed after 1 year. Results: We estimated daily energy as well as 53 nutri- ent and 29 food group intakes using the FFQ. To assess reproducibility, we calculated Spearman correlation coef- ficients between both FFQs, which showed mostly intermediate-to-high values. Median (range) correlation coef- ficients and quartile distribution in the same and adjacent categories for energy-adjusted nutrient intakes were 0.55 (0.42–0.84) and 84.7% (76.5%–98.0%) in men and 0.54 (0.35–0.80) and 84.5% (76.1%–94.4%) in women. The respective values for energy-adjusted food group intakes in men and women were also mostly intermediate to high: 0.54 (0.39–0.79) and 83.7% (75.5%–90.8%) in men and 0.57 (0.40–0.83) and 84.5% (77.5%–93.7%) in women. Conclusions: The FFQ developed for the JPHC-NEXT study has reasonable reproducibility. Because this FFQ has also been validated in a previous study, it can be considered a useful dietary assessment tool to ex- amine associations between dietary consumption and lifestyle-related diseases.
Background and Objectives: This study assessed the bioavailability and biological incorporation of nonheme iron from staple food diets in healthy young urban Chinese women and determined the relevant effects of typical regional patterns of staple foods in South and North China. Methods and Study Design: Twenty-two young ur- ban Chinese women aged 20–23 years were enrolled and randomly allocated to two groups, with rice (rice group) and steamed buns (steamed buns group) as the staple food, respectively. Each participant received three meals daily containing approximately 3.25 mg of stable 57FeSO4 for 2 consecutive days, along with daily intravenous injection of approximately 2.0 mg of 58FeSO4. Nonheme iron absorption and infused iron incorporation rates were assayed. Results: In all participants, the rice group, and the buns group, nonheme iron intake was 7.2±1.6, 5.9±0.6, and 8.4±1.2 mg, respectively; mean 57FeSO4 absorption rate was 22.2%±9.6%, 22.2%±10.6%, and 22.2%±8.9%, respectively; and the mean infused 58FeSO4 incorporation rate was 91.6%±8.2%, 93%±7.3%, and 90%±9.1%, respectively. No substantial differences existed in the nonheme iron intakes and the 57FeSO4 absorp- tion and 58FeSO4 incorporation rates between the rice and buns groups (all p>0.05). Conclusions: The bioavaila- bility and incorporation rates of nonheme iron from representative comprehensive Chinese diets in healthy young urban Chinese women were evaluated. Our results can facilitate the establishment of dietary reference intake for iron in Chinese women.
Background and Objectives: Taiwan has a high density of convenience stores and beverage shops, which makes sugar-sweetened beverages (SSBs) very accessible to teenagers. This study examined the changes and the associ- ation between SSBs and biomarkers and nutrient intake, for teenagers over the course of 18 years using a national representative sample. Methods and Study Design: This cross-sectional study used data from the Nutrition and Health Survey in Taiwan (NAHSIT). Complete data for teenagers aged 13 to 19 years including a 24-hour dietary recall, anthropometric and clinical measurements, and SSBs from two periods were analyzed (1993-1996: N=1820; 2010-2011: N=2513). SAS callable SUDAAN was used for statistical analysis, adjusting for the sam- pling scheme. Log transformation was used for non-normal variables before linear models were used. Coffee or tea and SSB (excluding tea or coffee) consumers were categorized as non-drinkers, low (below), or high (above) consumers based on median intake during 1993-1996. Results: Intake of coffee or tea increased significantly in the 18 years of this study (p<0.01), whereas intake of SSBs (excluding coffee or tea) decreased significantly (p<0.05). Intake was significantly higher among second survey and those with high total energy intakes (p<0.01). For both coffee/tea and SSB, the high-intake groups had higher serum uric acid and intake of carbohydrates (p<0.05), lower intake of protein and phosphorus and lower dietary diversity score (p<0.05). Conclusions: Con- sumption of coffee or tea increased in adolescents during the 18 years. High intakes of SSB, coffee or tea was as- sociated with high serum uric acid values and worse dietary quality.
Background and Objectives: The association between a vegetarian diet and bone mineral density (BMD) re- mains unclear, particularly in young adults. This study was designed to compare the bone health status of young vegetarians and omnivores in Shanghai, China. Methods and Study Design: A total of 246 vegetarians (follow- ing a vegan or lacto-ovo-vegetarian diet for at least 1 year) and 246 age- and sex-matched omnivores were re- cruited among young adult residents of Shanghai, China. The ultrasound bone mineral density analyser CM-200 was employed to measure calcaneus mineral densities, and blood samples were collected to determine serum 25- hydroxyvitamin D status. Intakes of protein, calcium and vitamin D were assessed by the 24-hour dietary recall method. Results: The average age of the vegetarians was 32.7±6.5 years, 83.3% of whom were female; 71.3% of the participants had been vegetarians for no more than 5 years. After adjusting for some potential cofounding fac- tors, the serum 25-hydroxyvitamin D concentration of vegans (15.0±13.4 μg/L) was significantly lower than that of omnivores (17.6±8.8 μg/L, p<0.05). The protein, calcium and vitamin D intakes of vegetarians were all lower than those of omnivores (p<0.05). However, there was no significant difference in calcaneus mineral density be- tween vegetarians and omnivores or between vegans and lacto-ovo vegetarians. Conclusions: Serum 25- hydroxyvitamin D concentrations in vegans, but not in lacto-ovo vegetarians, were slightly lower than those in omnivores. However, short-term vegetarian diets did not result in adverse effects on bone mineral density in young Chinese adults.
Background and Objectives: Lifestyle-related risks are linked to several non-communicable diseases, with enormous global mortality and economic cost. Women in Saudi Arabia are faced with high prevalence of obesity, inactivity and sedentary behaviours. This study examined the interaction effects of gender with obesity status and lifestyle behaviours among Saudi adolescents. Methods and Study Design: A total of 2888 adolescents (1500 females) aged 15-19 years were randomly selected from secondary schools in three major cities in Saudi Arabia, using a multistage stratified cluster sampling technique. Weight, height and waist circumference were measured and physical activity (PA), screen time, sleep duration and dietary habits were assessed using a validated ques- tionnaire. ANCOVA and multivariate tests were used while controlling for age. Results: A number of lifestyle behaviours displayed significant gender effects, with some selected variables having multiple interaction effects. Total activity energy expenditure and sum of vigorous-intensity PA showed significant interaction effects be- tween gender and obesity status, whereas sum of moderate activity energy expenditure, non-leisure-time PA and sleep duration exhibited significant interaction effects between gender and screen time. Vegetable intake showed significant three-way interaction effects between gender, waist/height ratio and screen time. Conclusions: The presence of several lifestyle behavioural risks, including physical inactivity, sedentary behaviours and some die- tary habits was confirmed. The high inactivity level and screen time represents a double burden on the health of young Saudi females. Future studies must address the psycho-social, cultural and environmental determinants as- sociated with healthy lifestyle relative to gender and initiate novel interventions to reduce sedentary behaviour.
Background and Objectives: Poor sleep quality is prevalent among hemodialysis (HD) patients and leads to ad- verse health outcomes. This study investigated the association of nutritional parameters with sleep quality among Malaysian HD patients. Methods and Study Design: A cross-sectional study was conducted among 184 Malay- sian HD patients. Anthropometric measurements and handgrip strength (HGS) were obtained using standardized protocols. Relevant biochemical indicators were retrieved from patients’ medical records. Nutritional status was assessed using the dialysis malnutrition score. The sleep quality of patients was determined using the Pittsburgh Sleep Quality Index questionnaire on both dialysis and non-dialysis days. Results: Slightly more than half of the HD patients were poor sleepers, with approximately two-third of them having a sleep duration of <7 hours per day. Sleep latency (1.5±1.2) had the highest sleep component score, whereas sleep medicine use (0.1±0.6) had the lowest score. Significantly longer sleep latency and shorter sleep duration were observed in the poor sleepers, re- gardless of whether it was a dialysis day or not (p<0.001). Poor sleep quality was associated with male sex, old age, small triceps skinfold, hypoproteinemia, hyperkalemia, hyperphosphatemia, and poorer nutritional status. In a multivariate analysis model, serum potassium (β=1.41, p=0.010), male sex (β=2.15, p=0.003), and HGS (β=−0.088, p=0.021) were found as independent predictors of sleep quality. Conclusions: Poor sleep quality was evident among the HD patients in Malaysia. The sleep quality of the HD patients was associated with nutritional parameters. Routine assessment of sleep quality and nutritional parameters indicated that poor sleepers have a risk of malnutrition and may benefit from appropriate interventions.
Background and Objectives: By combining the techniques of metabolomics and computational biology, this research aims to explore the mechanism of metabolic dynamics in critically injured patients and develop a new early warning method for mortality. Methods and Study Design: A prospective cohort study was conducted, group plasma samples of critically injured patients were collected for 1H-NMR metabolomics analysis. The data was processed with partial least squares regression, to explore the role of enzyme-gene network regulatory mechanism in critically injured metabolic network regulation and to build a quantitative prediction model for early warning of fast death. Results: In total, 60 patients were enrolled. There were significant differences in plasma metabolome between the surviving patients and the deceased ones. Compared to the surviving patients, 112 enzymes and genes regulating the 6 key metabolic marker disturbances of neopterin, corticosterone, 3-methylhistidine, homocysteine, Serine, tyrosine, prostaglandin E2, tryptophan, testosterone and estriol, were observed in the plasmas of deceased ones. Among patients of different injury stages, there were significant differences in plasma metabolome. Progressing from T0 to T50 stages of injury, increased levels of neopterin, corticosterone, prostaglandin E2, tryptophan and testosterone, together with decreased levels of homocysteine, and estriol, were observed. Eventually, the quantitative prediction model of death warning was established. Cross-validation results showed that the predictive effect was good (RMSE=0.18408, R2=0.87 p=0.036). Conclusions: Metabolomics approaches can be used to quantify the metabolic dynamics of patients with critically injuries and to predict death of critically injured patients by plasma 1H-NMR metabolomics.
Functional foods (FF) are commonly consumed by Asians, and this trend has increased in recent years. Despite the reported health benefits of FF, it is necessary scrutiny and updates of the underpinning research are important. The first international conference on functional food innovation in Asia (IFFA 2018) took place on January 22nd-24th, 2018, at the University of Phayao, Thailand. Domestic and international speakers, researchers, nutritionists, dieticians, research scholars and students shared their knowledge and experience in FF research. Key features were the potential beneficial roles of FF in health and disease, the current situation with FF in Asia and innovative trends. The IFFA 2018 involved 2 keynote speakers, 34 invited speakers and 10 sessions. About 250 people from across Asia participated. Key themes, discussions, innovative opportunities, and future directions to link research in academia with health-directed applications as FF are summarised.
Background and Objectives: Head and neck cancer patients often experience nutritional deterioration, which decreases their treatment tolerance and is associated with poor outcomes. We analyzed nutritional status in head and neck cancer patients before and during treatment, and its impact on clinical outcomes. Methods and Study Design: Between January 2009 and April 2012, 336 head and neck cancer patients receiving radiotherapy or chemoradiotherapy were prospectively entered into the study. The Nutritional Risk Screening 2002 (NRS 2002) assessment was used to evaluate their nutritional status. Results: A total of 227 patients with nasopharyngeal car- cinoma and 109 patients with head and neck cancers were analyzed. The proportion of patients receiving radio- therapy or chemoradiotherapy at nutritional risk was 61.3%, with 11.9% at risk before treatment and 49.4% de- veloping risk during treatment. In multivariate analysis, nutritional risk before treatment was associated with T stage for the two groups. Risk was significantly higher in patients receiving concurrent chemoradiotherapy during treatment for nasopharygeal carcinoma patients. The prognosis of pretreatment nutritional risk patients was worse than those becoming at risk during treatment and those without nutritional risk (3-year overall survival 62.9% vs 81.7% vs 80.6%, p=0.026; 3-year disease-free survival 64.8% vs 84.5% vs 84.4%, p=0.019). Conclusions: The incidence of nutritional risk is high in head and neck cancer patients receiving radiotherapy or chemoradiotherapy, especially during treatment. Pretreatment nutritional risk evaluated using the NRS 2002 can predict patient prog- nosis.
Background and Objectives: The optimal delivery of enteral nutrition in shock patients has an important prog- nostic clinical value; thus, checklists for standardizing enteral nutrition should be developed. This study exam- ined whether the use of an enteral feeding checklist can improve enteral nutrition in shock patients. Methods and Study Design: A retrospective cohort study was conducted. A multidisciplinary working group developed an en- teral feeding checklist. Information on patients’ demographics, checklist items, and clinical outcomes was col- lected. Results: In total, 148 patients were included. The checklist was used for 35 patients but not for the re- maining 113 patients. Patients in the checklist group received enteral nutrition earlier (2.6 vs 4.6 days, p=0.017) and had a lower mechanical ventilation rate (62.9% vs 85.0%, p=0.004). The checklist group had shorter inten- sive care unit stay (mean 17.3 vs 25.7 days, p=0.043). No significant differences were observed in 28- and 90- day mortality, mechanical ventilation duration, and intolerance to enteral nutrition. Conclusions: The use of an enteral feeding checklist in shock patients was associated with earlier enteral nutrition delivery and decreased in- tensive care unit stay.
Background and Objectives: Evaluating barriers to provision of enteral nutrition in intensive care units and planning an appropriate intervention can improve nutritional nursing practice in these units. This study aimed to develop a Korean version of the Barriers to Enterally Feeding Critically Ill Patients Questionnaire (BEFIP-K) and to explore the barriers to enteral feeding of critically ill patients in Korea. Methods and Study Design: The 24- item BEFIP-K was developed according to the process laid down by the World Health Organization. Its psycho- metric properties were assessed, including acceptability; validity, which included content validity and construct validity; and reliability, which consisted of internal consistency and item–total correlation, using data from 207 critical care nurses in four tertiary hospitals in South Korea. Results: The calculated content validity indices for each item were from 0.88 to 1.00. As for the exploratory factor analysis, 24 items were loaded on five domains, accounting for 56.9% of the total variance. The Cronbach’s alpha coefficient of the total scale was 0.913 and the coefficients for item–total correlation analyses ranged from 0.469 to 0.694. The total BEFIP-K score was 32.1, with a range from 18.5 to 45.4. Conclusions: The findings support that the BEFIP-K is a feasible, valid instru- ment for assessing barriers to provision of enteral nutrition.
Background and Objectives: The participation of a nutrition support pharmacist (NSP) in a multidisciplinary team (MDT) for patients receiving nutrition support therapy (NST) may lead to more favourable outcomes and fewer complications and adverse events. However, few studies have demonstrated the role of NSPs in MDTs in China. To investigate pharmacy interventions and physician acceptance of these interventions for patients receiv- ing NST in an intensive care unit (ICU). Methods and Study Design: A prospective study over a 12-month peri- od was conducted in an ICU at an academic hospital in China. Interventions were documented and divided into the following categories: indication of NST, parenteral nutrition (PN) prescription and delivery, enteral nutrition (EN) route and formulation, fluids and electrolytes, laboratory test monitoring, nutritional supplements, and other medication-related problems. Data regarding the intervention categories, timing, acceptance rates, and methods of communication to discuss pharmacy interventions were collected. Results: In total, 247 interventions for 120 pa- tients were identified. The overall acceptance rate of interventions was 85.0% (210/247), and more than half of the interventions (143, 57.9%) were performed during daily follow-up. The most common intervention categories were PN prescription and delivery (81/247, 32.8%), EN route and formula (33/247, 13.4%), indication of NST (33/247, 13.4%), and nutritional supplements (30/247, 12.1%). The most accepted intervention category was PN prescription and delivery (79/81, 97.5%), and the most common method of communication was oral communica- tion during MDT rounds (201/247, 81.4%). Conclusions: This study demonstrated the unique perspectives of- fered and importance of having pharmacists as members of MDTs.
Background and Objectives: Malnutrition has high prevalence among hospitalized patients but goes unrecog- nized in many patients. Early detection of malnutrition using an effective screening tool is required. This study aimed to examine the effects of nutritional status determined by the Nutrition Alert Form (NAF) and its individu- al sections on length of stay (LOS) and hospital costs in hospitalized patients, to investigate their associated fac- tors, and to determine hospital malnutrition prevalence. Methods and Study Design: This retrospective cohort study enrolled 2,906 hospitalized patients aged ≥15 years in Ramathibodi Hospital between January and Septem- ber 2016. At admission, nutritional status was screened using NAF. Nutrition status was defined as: NAF-A (normal/mild malnutrition; scores of 0–5), NAF-B (moderate malnutrition; 6–10), and NAF-C (severe malnutri- tion; ≥11). Information regarding LOS and hospital costs during patients’ hospitalization was also collected. Re- sults: The prevalence of malnutrition was 15.3%. After adjusting for age, sex and primary diagnosis, we found significantly longer LOS and higher hospital costs among those with NAF-B and NAF-C, in comparison with pa- tients having NAF-A. The highest increase in LOS was in male patients aged ≥60 years with NAF-C. The highest increase in LOS and hospital costs was associated with higher scores for functional capacity. Conclusions: High- er levels of malnutrition screened using the NAF were significantly associated with longer LOS and higher hospi- tal costs. Older adult patients had the highest risk of being malnourished and developing negative consequences. A prospective study of nutritional support by a nutrition care team is underway.
Background and Objectives: Oats contain antioxidant phytochemicals that may help reduce inflammation as well as oxidative stress. In this study we aimed to investigate the effect of oat porridge consumption on inflam- matory marker levels and oxidative stress in Thai adults with high blood lipid levels. Methods and Study Design: A randomized crossover study was conducted. Hypercholesterolemic adults were randomly assigned to a 4-week daily consumption of oat or rice porridge. After 4 weeks, they were switched to alternate intervention arms for 4 weeks. At baseline, before and after each intervention period, inflammatory markers including hsCRP, IL-6, IL-8, TNF-α, and MCP-1 and antioxidant status markers including ORAC, FRAP, and MDA of all subjects were measured. Results: Compared to baseline, levels of hsCRP, IL-6, IL-8, and TNF-α were significantly decreased after oat porridge consumption (mean change: -0.6±0.9 mg/L, -26.9±27.6 pg/mL, -56.3±27.6 pg/mL, and - 9.7±11.6 pg/mL, p<0.05 for all, respectively). In addition, consumption of oat porridge also increased antioxidant capacity; ORAC and FRAP levels (mean change: 2.7±1.0 μmol of Trolox/L and 2.4±0.8 μmol of Fe2+/L, p<0.001, respectively). However, MCP-1 and MDA levels were not affected. Consumption of rice porridge did not lead to significant changes in these measures. Conclusions: Daily consumption of 70 grams oat porridge containing 3 grams β-glucan for 4 weeks may help reduce markers of inflammation and oxidation in hypercholesterolemic adults. Therefore, oat may be an appropriate dietary recommendation for individuals with hypercholesterolemia.
Background and Objectives: The association between black-colored foods (black foods) such as black beans, known for their high antioxidant capacity, and the prevention of metabolic diseases has been explored, but not in a large population. Therefore, this study examined relationships between the consumption of black foods and metabolic syndrome in Korean adults. Methods and Study Design: Data from 9,499 40-65-year old subjects (3,675 men and 5,824 women) from the 2010-2015 Korea National Health and Nutrition Examination Survey were used in the analysis. Black food consumption was estimated using 24-h dietary recall data, and analyses were performed according to black food consumer and non-consumer groups. Results: The average total con- sumption of black foods was higher in women than men. The total black food consumer group in women had a 24% reduced risk of abdominal obesity than the non-consumer group (p=0.007). Furthermore, waist circumfer- ence decreased significantly with an increase in total black food consumption in women. High consumption of to- tal black foods and black beans reduced the risk of abdominal obesity by 26% (p for trend=0.012) and 29% (p for trend=0.003) compared with no consumption. No risk factors for metabolic syndrome were associated with black food consumption in men. Conclusions: In conclusion, black foods, including black beans, may have beneficial effects on metabolic syndrome components, especially abdominal obesity.