Background and Objectives: Malnutrition and energy metabolism disorders are characterized by a low respira- tory quotient in patients with liver failure and often lead to poor prognosis. Therefore, early nutrition interven- tions are crucial for patients with liver failure to ameliorate abnormal metabolic status and malnutrition. This study explored the effect of an individualized nutrition intervention on the respiratory quotient of patients with liver failure. Methods and Study Design: An individualized 2-week nutrition intervention was conducted on pa- tients with nutritional risk caused by liver failure according to patient resting energy expenditure. Patients were separated into two groups for further analysis according to whether their energy intake reached 1.2 times their resting energy expenditure. Results: Fifty-two patients with nutritional risk caused by liver failure were enrolled. Their average respiratory quotient was 0.79 (0.76–0.84) at the baseline. Patients with an energy intake of ≥1.2 times their resting energy expenditure had a higher respiratory quotient and lower scores on the model for end- stage liver disease and Child–Pugh test than those with an energy intake of <1.2 times their resting energy ex- penditure at weeks 1 and 2 after the intervention. Moreover, no significant differences were observed between the two groups at the baseline. Respiratory quotient was negatively correlated with the model for end-stage liver dis- ease and Child–Pugh scores. Conclusions: Individualized nutrition interventions with an energy intake ≥1.2 times the patient’s resting energy expenditure can effectively improve the respiratory quotient and reduce disease severity in patients with nutritional risk caused by liver failure.
Background and Objectives: This study investigated major dietary patterns and their relationship to obesity among urbanized Tibetan pastoralists. Methods and Study Design: Using a cross-sectional design, this study as- sessed 782 urbanized Tibetan pastoralists aged 18-84 y. A food frequency questionnaire and anthropometric measurements were conducted in 2018. Principal component analysis was used to identify dietary patterns. Lo- gistic regression was applied to compare the risks for overweight (BMI ≥24 kg/m2), obesity (BMI ≥28 kg/m2), and central obesity (waist circumference ≥80 cm for women and ≥85 cm for men) across quintiles of dietary pat- tern scores after controlling for gender, age, education, medical insurance, smoking status, alcohol consumption and physical activity. Results: This study identified three major dietary patterns: an urban pattern characterized by high intake of vegetables, tubers/roots, and refined carbohydrates; a western pattern characterized by sugary drinks, snacks, and desserts; and a pastoral pattern characterized by tsamba (roasted Tibetan barley), Tibetan cheese, and buttered/milk tea. Subjects in the highest quintile of urban pattern scores were more likely to be overweight (OR=2.58, 95% CI 1.48-4.49) (p-for-trend=0.001), obese (2.94, 1.57-5.49) (p-for-trend=0.001), and centrally obese (1.94, 1.12-3.36) (p-for-trend=0.019) compared to those in the lowest quintile with confounders controlled. The western dietary pattern was positively associated with overweight (p-for-trend=0.037). No clear association was observed for the pastoral dietary pattern. Conclusions: Urban and western dietary patterns inde- pendently predict the likelihood of being overweight. Improved nutrition education may contribute to healthier eating behaviors, thus reducing or preventing obesity.
Background and Objectives: It is well known that dietary factors affect the development of cardiovascular dis- ease. We evaluated the associations between carbohydrate intake and cardiovascular disease risk factors using da- ta from the China Health and Nutrition Survey, 2009. Methods and Study Design: A total of 6,648 Chinese adults aged 18-60 were divided into five groups based on carbohydrate intake (% of energy). Mixed-effect linear regression models were used to estimate the risk factors in relation to carbohydrate intake, and mixed-effect lo- gistic regression models were used to assess the risk of cardiovascular disease. Results: When age was adjusted, carbohydrate intake was negatively correlated with total cholesterol and triglycerides in men and total cholesterol and low-density lipoprotein cholesterol in women. However, there were positive associations of carbohydrate in- take with waist circumference, body mass index, and blood pressure in women. After additional adjustment for urbanicity index, income, physical activity, education, alcohol and smoking, and dietary intake, the 5th quintile of carbohydrate intake reduced the risk for high low-density lipoprotein cholesterol in women (OR=0.73, 95% CI: 0.53, 0.99) compared with the 1st quintile. However, the top quintile of carbohydrate intake increased the risk for impaired glucose tolerance in men (OR=2.08, 95% CI: 1.04, 4.16) compared with the lowest quintile after adjust- ing for all confounders. Conclusions: Higher-carbohydrate diets may associate with risk factors for cardiovascu- lar disease. Moderate carbohydrate intake is recommended for daily consumption. These results suggest that im- proving dietary patterns may be an important approach to the prevention of cardiovascular disease in Chinese adults.
Background and Objectives: We aimed to determine the association between Hemoglobin (Hb) and ferritin with blood pressure (BP) and risk of hypertension (HTN) among elderly South African adults in four time points over a period of 10 years. Methods and Study Design: We used the data source from the Sharpeville Project conducted among the elderly in Sharpeville, South Africa (SA). A total of 275 subjects from the 2004 data source were included. Among these, data were available for 251, 114, and 81 subjects in 2007, 2012, and 2014 respec- tively. Confounding factors included age, BMI, sodium intake, high-sensitivity C-reactive protein (hs-CRP), and serum total cholesterol. Linear and logistic regressions were used to investigate the Hb and ferritin associations with BP and HTN risk. Results: Mean age in 2004, 2007, 2012, and 2014 was 72.8±8.66, 75.8±7.28, 80.2±9.54, and 83.2±8.98 respectively. In the unadjusted model, systolic BP (SBP) and diastolic BP (DBP), after 132.2 and 83.6 mmHg, increased by 0.57 and 0.72 mmHg respectively for each increment increase in Hb. In the adjusted model, slope coefficients remained statistically significant. Adjusted OR (95% CI) for the highest quartile of Hb (Q4) compared to the first quartile (Q1) in 2004 (p<0.001) and 2007 (p=0.017) were 2.81(2.12-4.83) and 2.58 (1.18-5.65) respectively. Those in Q4 of ferritin had OR (95% CI) of 1.85(1.32-3.73) in 2004 (p<0.001) and 2.20 (1.24-4.04) in 2007 (p<0.001) compared to Q1. Conclusions: Consistencies between the results from both varia- bles suggest that some part of these positive associations could be iron dependent. Caution should be taken about unmonitored iron supplements consumption among older adults particularly those with elevated BP or on antihy- pertensive medications.
Background and Objectives: Vitamin D deficiency during pregnancy has been associated with many adverse pregnancy and birth outcomes. Low serum 25-hydroxyvitamin D (25OHD) levels (<30 nmol/L) increases the risk of nutritional rickets. This study aimed to investigate the concentration of cord serum 25OHD in a birth cohort in Guangzhou, China and determine whether maternal lifestyle factors had any effect on these levels. Methods and Study Design: A total of 854 pregnant women giving birth between Dec 2016 and Dec 2017 were recruited to this study. Basic information was obtained from the clinical database. A voluntary retrospective pregnancy life- style questionnaire was completed by 388 participants. The concentration of serum 25OHD, calcium, phosphorus, and alkaline phosphatase (ALP) were measured in umbilical cord blood. Results: The mean (SD) of cord serum 25OHD was 44.7 (16.7) nmol/L. The prevalence of cord 25OHD <30 nmol/L was 22.2% and 70.4% had levels <50 nmol/L. The prevalence of vitamin D deficiency is higher in infants born in winter months (31% <30 nmol/L and 76% <50 nmol/L), compared to those born in the summer (12% <30 nmol/L and 64% <50 nmol/L). Infants born to women taking a vitamin D containing supplement had approximately 10 nmol/L higher levels of 25OHD than those who did not supplement their diets. Conclusions: Summer born infants have higher serum 25OHD levels at birth, but there are still infants being born with vitamin D deficiency. Vitamin D containing supplement use during pregnancy was effective in raising cord serum vitamin D levels.
Background and Objectives: Cow milk allergy is the most common food allergic disease in young infants and vitamin D has a critical role in regulating intestinal inflammation. Methods and Study Design: To determine roles of vitamin D in cow milk allergy, fifty-six young infants with cow milk allergy were enrolled. The serum 25-hydroxyvitamin D (25OHD), total and specific IgE, circulating regulatory T lymphocytes, and blood eosino- phil counts were determined. Results: The serum 25OHD in cow milk allergy and age-matched infants were sim- ilar (68.3±38.9 nmol/L versus 72.9±33.1 nmol/L, p>0.05), 71% Cow milk allergy infants (40/56) had serum 25OHD lower than 75 nmol/L compared to 66% (37/56) in the controls. The cow milk allergy infants with 25OHD lower than 75 nmol/L had persistent blood eosinophilia and delayed resolution of symptoms after cow milk elimination compared to those with 25OHD above 75 nmol/L (odd ratio 3.7, 95% CI 1.1-12.6, p<0.05). The serum 25OHD inversely correlated with blood eosinophil counts after cow milk elimination (r=-0.37, p<0.01). Cow milk allergy infants with 25OHD lower than 50 nmol/L (vitamin D deficiency, n = 22) were in general at younger age (1.6±0.6 months) compared to infants with insufficient (50-75 nmol/L) or normal (≥75 nmol/L) group (4.3±1.2 and 4.6±0.9 months, respectively, p<0.001). Conclusions: Low serum vitamin D associates with persistent blood eosinophilia and symptoms in young cow milk allergy infants.
Background and Objectives: A recent dietary survey in 5 big cities in China provided information on various milk options consumed by 1-3 years old children. To investigate the nutritional role of these milks (young-child formula (YCF), cow’s milk, others), simulation analyses based on this survey were performed. Methods and Study Design: We studied daily intakes of calcium, iron, zinc, vitamins A, B-1, B-2, C and E and compared these to the Chinese DRIs. In Scenario 1, consumption of cow’s milk, kid’s milk and/or soy milk was replaced with matching amounts of YCF (n=66 children). In Scenario 2, where 348 children exclusively consumed YCF, YCF was replaced with matching amounts of cow’s milk. Results: Scenario 1 revealed significant increases in total dietary intakes of iron, vitamins A, B-1, C and E upon substitution of the various milks with YCF. The pro- portions of children not meeting the Estimated Average Requirement (EAR) for these nutrients dropped from 29, 26, 61, 53 and 54 % to 12, 11, 50, 27 and 24%, respectively. In Scenario 2, the hypothetical substitution of YCF by cow’s milk increased the proportions of children not meeting the EAR for these nutrients, calcium and zinc from 11, 6, 49, 15, 28, 42, and 8 to 45, 24, 78, 69, 59, 44, and 20, respectively. Execution of Scenario 2 in sub- groups of 1-2- and 2-3 years old children revealed similar results. Conclusions: YCF may help to reduce the risk of insufficient intake of several key micronutrients for toddlers, independent of age.
Background and Objectives: This study explored the appropriate classification of pre-pregnancy body mass in- dex (BMI) in women of childbearing age in Beijing, China. Methods and Study Design: Women with singleton pregnancies at more than 28 gestational weeks were retrospectively reviewed. Based on the pre-pregnancy BMI (kg/m2), these patients were divided into 7 groups: <18.5, ≥18.5–22.9, ≥23–23.9, ≥24–24.9, ≥25–27.9, ≥28–29.9, and ≥30. Pregnancy adverse outcomes, including gestational hypertension with or without preeclampsia, gesta- tional diabetes mellitus, initial cesarean section, postpartum hemorrhage, macrosomia, large-for-gestational age infant and so on were recorded. Binary logistic regression analysis was used to calculate the uncorrected and cor- rected odds ratios and 95% confidence intervals, with the ≥18.5–22.9 group serving as a reference. Results: A to- tal of 11,136 pregnant women were analyzed. Incidences of above mentioned six adverse outcomes were greater in women with higher pre-pregnancy BMI. The risks of the abovementioned six adverse outcomes were increased significantly among the ≥23–23.9, ≥24–24.9, ≥25–27.9 groups and substantially higher in the ≥28–29.9, ≥30 groups after correction. <18.5 group showed an increased risk of small-for-gestational age infants. Conclusions: For women of childbearing age in Beijing, China, the optimal pre-pregnancy BMI range was ≥18.5–22.9 kg/m2, with the cutoff value for overweight status being ≥23.0 kg/m2 and the cutoff value for obesity being ≥28.0 kg/m2.
Background and Objectives: Iron deficiency (ID) is the most common micronutrient deficiency worldwide and usually leads to impaired neurodevelopment. Appropriate introduction of complementary foods is mandatory for all infants to prevent iron insufficiency. We aimed to demonstrate feeding behaviors in relation to infant iron sta- tus and also identify potential concomitant nutrient inadequacies. Methods and Study Design: A cross-sectional descriptive study of infants 6-12 months old was performed at the Well Baby Clinic at Thammasat University Hospital, Pathumthani. Demographic data, feeding practices and nutritional status were obtained. Dietary intake was evaluated using general and food frequency questionnaires. Blood samples for complete blood count and iron studies were investigated. Results: We enrolled 206 infants (mean age 8.552.1 months). Prevalence of ID and iron deficiency anemia (IDA) was 34.0% and 25.7%, respectively. In multivariable ordinal continuation ratio lo- gistic regression analysis for risk of iron depletion severity among the 3 groups (normal, ID and IDA infants), we found a stepwise increase in odds ratios for iron depletion with lower family income, longer duration of breast- feeding, delayed introduction of meat, and lower dietary iron intake. IDA infants had significantly lower intakes of energy, protein, fat and various micronutrients, compared to those with normal iron status. Conclusions: In- fants with ID may have low intakes of other nutrients due to reduced complementary food intake. Nutritional ed- ucation for appropriate feeding practices should be provided to prevent ID and other possible micronutrient defi- ciencies.
Background and Objectives: Chinese women in rural areas who are currently ≥55 years old have experienced extreme undernutrition during their childbearing age. Their specific experiences provided us with a natural quasi- experimental field for assessing the effects of consuming eggs to obtain nutrients during the childbearing period on preventing nonfatal coronary events (NCE) during the postmenopausal period in the framework of life course epidemiology. Methods and Study Design: A population-based matched case–control design for NCE was con- ducted in Yiyuan County, Shandong Province, China. In this study, 462 women with NCE (cases; onset age ≥55 years) were included from the Active Surveillance System for Chronic Diseases, and 462 age-matched women without NCE and stroke (controls) from the same village were included. Conditional logistic model analysis was used to determine the association between egg intake and NCE during the postmenopausal period in 3 specific life-periods, namely age 18 to 49 years (childbearing period), age 50 years to NCE onset (perimenopausal and postmenopausal period), and age 18 years to NCE onset (total period). Results: We found that ≥12 eggs vs. 0 egg intake per month under extreme undernutrition status during childbearing period exhibited a strong preventive ef- fect against NCE during the postmenopausal period (OR=0.588, 95% CI=0.358-0.964). The window of protective effect was in the age 28 to 49 years, suggesting a critical period model of life course epidemiology. Conclusions: Egg intake under extreme undernutrition status during the childbearing period plays a critical role in preventing NCE during the postmenopausal period.
Background and Objectives: The extent to which health and survival inequality between indigenous and nonin- digenous older Taiwanese is associated with diet is uncertain. Methods and Study Design: Participants from the Elderly Nutrition and Health Survey in Taiwan (1999–2000) formed this cohort. Dietary information was collect- ed by 24-hr recall and simplified food frequency questionnaire. Dietary quality was assessed by dietary diversity score (DDS, 0-6). Annual medical service utilization and expenditure were derived from National Health Insur- ance claims until 2006. Survivorship was ascertained from the National Death Registry until 2008. Cox propor- tional-hazards models were used to determine the association between aboriginality and mortality in conjunction with dietary diversity. Results: Indigenes (n=156) compared with nonindigenes (n=1182) significantly differed in socio-demography, behaviors and chronic disease prevalences. For up to 8 years, indigenes had a higher mortality rate (46.2% vs 33.6%, p=0.003). Indigenes’ nutrient intakes were less for polyunsaturated fat, dietary fiber, vita- mins and minerals (but more sodium); food intakes more for meat, with less cooking oil, dairy products and fruits; and a lower DDS, (3.61 vs 4.54). They had a 41% higher mortality risk (HR: 1.41, 95% CI: 1.09-1.81, p=0.008). Control for demographic variables did not change the findings. However, the increase in HR was substantially at- tenuated by the inclusion of DDS (HR: 1.15, 95% CI: 0.88-1.49, p=0.316). There was no significant interaction between aboriginality and DDS on mortality (p=0.673). Conclusions: Older indigenous Taiwanese have a higher mortality risk than their majority counterparts. Irrespective of aboriginality, the more diverse diet is associated with a lower risk of mortality.
Background and Objectives: To assess the efficacy and safety of auscultation-assisted bedside postpyloric feed- ing tube (ABPFT) placement in early enteral nutritional support for critically ill patients. Methods and Study Design: A prospective observational study was conducted and 92 critically ill patients who met the inclusion cri- teria undergoing ABPFT placement after the intravenous injection of 10 mg of metoclopramide were included. Abdominal X-ray was performed to confirm the location of the catheter tip. End points investigated were the suc- cess rate of tube placement, rate of jejunal tube placement, duration of the procedure, length of insertion, and number of attempts. Operational-related adverse events or complications were also documented and evaluated. Results: The total success rate of postpyloric feeding tube implantation was 97.8% (90/92), among which, 89.1% (82/92) of the tubes were placed proximal to the jejunum. The first-attempt success rate was 91.3% (84/92) and the mean attempt per individual patient was 1.11±0.38 times. The mean operation time was 28.6±17.7 minutes, and the mean insertion length of tube was 106±9.6 cm. A total of 27 adverse events occurred in 19.6% (18/92) patients and there was no serious adverse events or complications during the study period. Conclusions: Assis- tance by auscultation can significantly improve the success rate of nasal feeding tube placement. This simple, safe and fast approach is feasible for the application among health practitioners in the intensive care unit.
Background and Objectives: Results regarding associations between specific-food and prognosis of colorectal cancer (CRC) are limited and inconsistent, and few studies have examined this issue in Asian population. This study examined the association between diet and prognosis of CRC, and developed a diet quality score for prog- nosis of CRC. Methods and Study Design: 352 participants who provided completed dietary information were recruited during 2004 to 2014, and there are 154 death case documented with 10-year follow-up. Cox regression models were used to examine associations between food groups and survival rate, and to develop the diet quality score for prognosis of CRC. Results: Intake of whole grain, fruit and coffee consumption habitus were associated with higher survival rate (HR 0.56 [95% CI 0.35, 0.89] for whole grain; HR 0.62 [95% CI 0.40, 0.97] for fruit; HR 0.46 [95% CI 0.24, 0.87] for coffee), whereas intake of red meat and frequency of grilled food were associat- ed with lower survival rate (HR 1.68 [95% CI 1.08, 2.61] for red meat; HR 1.78 [95% CI 1.05, 3.02] for grilled food). The overall diet quality based on these nutritional factors was negatively associated with survival rate (HR 1.60 [95% CI 1.07, 2.39] with adjustment for age, sex, BMI, smoking, drinking, energy intake, UICC stage, chemotherapy, postoperative adjuvant radiotherapy, tumor size, carcinoembryonic antigen and carbohydrate anti- gen 19-9 levels. Conclusions: Whole grain, fruit, red meat, coffee consumption habitus and frequency of grilled food were significantly associated with survival rate in Chinese population. The diet quality score may be useful for Chinese healthcare providers to advise patients on the optimal diet.
Background and Objectives: The aim of the present study was to evaluate the relationship between retinol and risk of diabetic retinopathy in Chinese adults. Methods and Study Design: Eighty-six subjects with type 2 dia- betes mellitus (T2DM) and 40 healthy subjects (healthy comparison group, HCG) were recruited in Beijing Luhe Hospital. Of the 86 T2DM subjects, 43 subjects were diagnosed with diabetic retinopathy (DRG), and 43 subjects had no retinopathy (DNRG). Results: Dietary intake of retinol (p<0.001) and retinol equivalent (p<0.05) was significantly higher but serum retinol and (p<0.001) retinol binding protein 4 (RBP4) (p<0.05) were significantly lower in DNRG compared with HCG. Dietary intake of retinol (p<0.05) and retinol equivalent (p<0.05) was sig- nificantly lower, and serum retinol and (p<0.01) retinol binding protein 4 (RBP4) (p<0.01) were significantly higher in DRG compared with DNRG. In T2DM subjects, per 100 μg/day higher dietary retinol intake was asso- ciated with 17% lower risk of diabetic retinopathy (odds ratio (OR), 0.83; 95% CI, 0.70 to 0.98; p=0.032), and af- ter adjusting for potential confounding factors, the OR was 0.82 (95% CI, 0.69 to 0.99; p=0.036); per 100 μg/day higher in dietary retinol equivalent intake was associated with 12% lower risk of diabetic retinopathy (OR, 0.88; 95% CI, 0.79 to 0.97; p=0.010), and after adjusting for potential confounding factors, the OR was 0.88 (95% CI, 0.79 to 0.98; p=0.025). Conclusions: Higher dietary intake of retinol or retinol equivalent is associated with low- er risk of diabetic retinopathy.
Background and Objectives: The studies investigated the association between serum 25-hydroxyvitamin D (25(OH)D) concentrations and cardiorespiratory fitness (CRF) are few, and the results are controversial. We aim to evaluate the association of serum 25(OH)D concentrations with CRF in adults, and assess whether the associa- tions vary with ageing. Methods and Study Design: The study included 78 middle-aged (30-64 years) and 83 elderly (65-79 years) Japanese men. Hand grip strength and leg extension power were measured using hand grip and leg dynamometers, respectively. CRF was measured via a maximal graded exercise test and quantified as the peak oxygen uptake (VO2peak). Fasting serum 25(OH)D concentrations were determined by enzyme-linked im- munosorbant assay. Results: Serum 25(OH)D concentrations were positively related to hand grip strength (r=0.331, p<0.001), leg extension power (r=0.353, p<0.001), CRF (r=0.285, p<0.001) in all adults after adjust- ment for age. Significant interaction between 25(OH)D and age on CRF was observed (p<0.05). Age-related re- duction of CRF was prevented in high 25(OH)D group (p<0.05). In the elderly, subjects in high 25(OH)D group had higher CRF compared with those in low group (p<0.05). Conclusions: We found that serum 25(OH)D con- centrations significantly related with leg extension power, hand grip strength and CRF after adjustment for age. The relationship of vitamin D and CRF was affected by ageing. Higher serum 25(OH)D concentrations are a key predictor for CRF in the elderly, but not in middle-aged men.
Background and Objectives: The purpose of our study was to estimate the national prevalence of metabolic syndrome, its individual components and its changes in the past decade. Methods and Study Design: Two na- tional-representative cross-sectional surveys: the China National Nutrition and Health Survey 2002 (CNNHS 2002) and the Chinese National Nutrition and Health Surveillance 2010–2012 (CNNHS 2010–2012). A total of 48,235 and 104,098 participants aged 18 years or older who had completed data on physical examination, blood lipids, and fasting glucose tests from CNNHS 2002 and CNNHS 2010–2012, respectively, were included in cur- rent study. Results: The prevalence of metabolic syndrome in Chinese adults increased from 9.5% (95% confi- dent interval [CI]: 9.2%–9.7%) in 2002 to 18.7% (18.3%–19.1%) in 2010–2012, corresponding to an estimated 83.6 million adults in 2002 and 189 million adults in 2010–2012 living with metabolic syndrome in China. The increment was more than doubled among young, rural residents and those from poor households. Abdominal obe- sity, hyperglycemia, high triglycerides, low HDL-C, and elevated blood pressure were found in 18.9% (18.5%– 19.3%), 6.4% (6.2%–6.7%), 13.8% (13.5%–14.2%), 19.3% (18.9%–19.7%), and 34.0% (33.5%–34.5%) of adults in 2002, respectively, which was 25.8% (25.3%–26.2%), 16.2% (15.8%–16.5%), 23.7% (23.3%–24.2%), 32.6% (32.0%–33.1%), and 34.4% (33.9%–34.9%), respectively, in 2010–2012. Conclusions: Based on two nationally representative surveys, our results indicated that the prevalence of metabolic syndrome is widespread and increas- ing in China.
Background and Objectives: An individual’s liking of food may be associated with Body Mass Index (BMI) due to its subsequent impact on food consumption. This study investigates the association between food liking and BMI in young adults from Australia and Thailand. Methods and Study Design: Food liking data were col- lected via a validated online Food Liking Questionnaire (FLQ). Food liking scores were calculated for overall lik- ing of groupings of foods: grains, vegetables, fruits, dairy, animal protein, plant-based protein, fat and oil, sweet food, salty food, and alcohol. The relationship between food liking and BMI (calculated from self-reported height and weight) was assessed using linear regression models including country and gender, and mean differences were assessed using independent sample t-test. Results: Data were available from n=4,173 participants (BMI=22.25 (SD 4.18), age=20.6 (SD 4.22) years, female=71.6%, Thai=52.5%). There were significant differ- ences of food liking between countries for all of food groups (p<0.01) except for animal-based protein and plant- based protein liking. BMI was positively, but weakly, associated with liking of animal-based protein (β=0.20 [0.12, 0.28], p<0.001), and alcohol (β=0.08 [0.02, 0.13], p<0.01) and negatively associated with plant-based pro- tein (β=-0.09 [-0.18, -0.01], p<0.05). There was significant difference of food liking between weight status for all of food groups. Conclusions: This study supports only minor associations between food liking and BMI, but cul- tural and gender variation in liking was evident.
Background and Objectives: Rising obesity in Southeast Asia, one consequence of economic growth, has been linked to a rising consumption of energy from added sugars. This symposium, organized by ILSI Southeast Asia, explored regional issues related to dietary sugars and health and identified ways in which these issues could be addressed by regional regulatory agencies, food producers, and the consumer. Methods and Study Design: Pa- pers on the following topics were presented: 1) current scientific evidence on the effects of sugars and non-caloric sweeteners on body weight, health, and eating behaviors; 2) innovations by food producers to reduce sugar con- sumption in the region; 3) regional dietary surveillance of sugar consumption and suggestions for consumer guid- ance. A panel discussion explored effective approaches to promote healthy eating in the region. Results: Exces- sive consumption of energy in the form of added sugars can have adverse consequences on diet quality, lipid pro- files, and health. There is a need for better surveillance of total and added sugars intakes in selected Southeast Asian countries. Among feasible alternatives to corn sweeteners (high fructose corn syrup) and cane sugar are indigenous sweeteners with low glycemic index (e.g., coconut sap sugar). Their health benefits should be exam- ined and regional sugar consumption tracked in detail. Product reformulation to develop palatable lower calorie alternatives that are accepted by consumers continues to be a challenge for industry and regulatory agencies. Conclusions: Public-private collaborations to develop healthy products and effective communication strategies can facilitate consumer acceptance and adoption of healthier foods.
Background and Objectives: The association between skeletal muscle status and gastric cancer (GC) prognosis remains unclear. Here, we investigated the impact of the skeletal muscle index (SMI) on overall survival (OS) in GC patients after radical gastrectomy. Methods and Study Design: We divided 178 patients into four groups: adult men, adult women, elderly men and elderly women. The SMI, calculated using CT images, of patients was graded using cutoff values of group-specific tertiles. Age, body mass index, SMI grade, Charlson comorbidity in- dex, surgical method (total vs distal gastrectomy), tumor stage, and histological type and differentiation were in- cluded in Cox regression models to assess the primary outcome parameter of OS. A new prognostic score for 3- year OS was established by combining the SMI grade and tumor stage, and receiver operating characteristic (ROC) curve analyses were used to determine its predictive reliability. Results: For groups with high, medium, and low SMI grades, the 3-year OS rates were 94.04, 79.08 and 59.09% and 86.09, 70.11 and 49.11% (p˂0.001) in patients undergoing distal and total gastrectomy, respectively. In the multivariate analysis, low SMI (hazard ra- tio (HR) 1.82, 95% confidence interval (CI) 1.14-2.9), advanced stage (HR 2.89, 95% CI 1.43-5.83), and total gastrectomy (HR 1.69, 95% CI 0.95-3.01) were independent risk factors for OS (p˂0.010). The areas under the ROC curves for the prognostic score were 0.77 (range 0.61-0.93) and 0.76 (range 0.65-0.86) in patients undergo- ing distal and total gastrectomy, respectively. Conclusions: The preoperative SMI was an independent prognostic factor for long-term survival in GC patients after radical gastrectomy.
Background and Objectives: To evaluate the effect of oral nutritional supplementation (ONS) on the post- discharge nutritional status and quality of life (QoL) of gastrointestinal cancer patients after surgery. Methods and Study Design: A multi-center study was conducted on gastrointestinal cancer patients who received surgical treatment from 2013–2015. All patients were screened using the Nutrition Risk Screening 2002 (NRS 2002) to assess nutritional risk. Patients with nutritional risk were randomized into two groups: patients in the study group (n=55) were given dietary guidance and ONS, control group (n=59) received only dietary guidance. Anthropo- metric measurements, nutrition-related laboratory tests, and gastrointestinal function scores were also collected and analyzed using Student’s t test and analysis of variance (ANOVA). In addition, the EQ-5D was used to eval- uate patients’ QoL. Results: Compared with baseline measurements, the body weight of patients in the study group increased by 1.35±0.53 kg and 1.35±0.73 kg at 60 and 90 days, which were significantly higher than those in the control group (-1.01±0.54 kg, and -1.60±0.81 kg at 60 and 90 days). The results from ANOVA showed that only weight and BMI differed significantly between the study and control groups and also between different measurement times (p<0.01). No differences were found for the other indicators or QoL between the study groups. Conclusions: ONS may improve the weight and BMI of surgically treated gastrointestinal cancer patients post- discharge. However, these effects had little impact on patients’ QoL.
Background and Objectives: Older adults are at increased risk of micronutrient deficiency, disrupting the bal- ance of oxidation/antioxidation system and leading to serious health burdens. This study aimed to investigate the effect of micronutrient pack on micronutrient status and oxidative/antioxidative biomarkers in institutional older adults. Methods and Study Design: Subjects aged 65-100 years were randomly assigned to either intervention group or control group (n=49 each), providing a package of micronutrient pack or placebo daily for three months. The concentrations of micronutrients, malondialdehyde (MDA), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were detected both at baseline and at the end of the study. Results: The changes in concentra- tions of serum folate (21.1±1.6 vs 0.6±0.5 nmol/L), vitamin B-1 (3.4±0.4 vs -0.2±0.3 nmol/L), vitamin B-2 (11.5±3.3 vs 2.3±1.4 nmol/L), vitamin B-12 (128.8±34.8 vs 13.3±16.0 pmol/L), 25-hydroxyvitamin D (17.8±1.3 vs -0.8±0.5 ng/mL) and plasma zinc (0.6±1.8 vs -9.6±1.9 μmol/L) over 3-months were significantly increased in the intervention group compared with the control group (all p<0.05). While the prevalence of folate, vitamin B-12 and vitamin D deficiencies were significantly decreased after 3-months intervention (all p<0.05). Moreover, changes in serum MDA level (-1.5±0.2 vs 0.2±0.3 nmol/mL) were remarkably reduced, and the activities of se- rum GSH-Px (1.3±0.3 vs 0.3±0.2 ng/mL) and plasma SOD (14.3±2.4 vs -2.1±2.4 U/mL) were increased in the in- tervention group than those of in the control group (all p<0.01). Conclusions: The micronutrient pack among in- stitutional older adults was well-accepted with good compliance and tolerance. The 3-month intervention may improve micronutrient status and enhance antioxidative capacities.
Background and Objectives: Swallowing difficulty and diabetes mellitus are common in the elderly. However, texture-modified foods suitable for blood sugar control are scarce. This study was aimed to identify texture, gly- cemic indices (GIs) and postprandial responses of original and high-fiber Riceberry rice puddings. Methods and Study Design: International Dysphagia Diet Standard Initiative (IDDSI)’s methods were used to determine tex- ture. In vitro digestion was performed for estimating glycemic indices. A randomized cross-over controlled trial was conducted in twelve healthy volunteers. Original pudding, high-fiber pudding and white bread containing 40 g carbohydrate each were assigned in random sequence with twelve-day wash-out intervals. Plasma glucose con- centrations were measured at 0, 15, 30, 60, 90, 120, 150, and 180 min after food intake. Individual GIs of pud- dings were calculated. Results: Original and high-fiber puddings were classified as IDDSI level 3 (liquidized) and 4 (pureed), respectively. The in vitro estimated GIs were 51 for original and 48 for high-fiber puddings. Clin- ical trial showed rapid kinetics (peaked at 30 min) but lower postprandial responses of both puddings, compared to white bread (peaked at 60 min). The adjusted GIs for original and high-fiber puddings were not significantly different (at 41±7.60 and 36±6.40, respectively). Conclusions: Addition of fiber to the original pudding changed physical properties but not significantly reduced the GI. Original and high-fiber Riceberry rice puddings could be low-GI dysphagia diets, which may be useful for step-wise swallowing practice from IDDSI level 3 to 4 for those who also required blood sugar control.
Background and Objectives: Obesity and diet contribute to the development of hypercholesterolemia; therefore, controlling blood lipid concentration through diet is essential. To understand the role of diet in controlling blood lipid concentration, we evaluated the food and nutrient intakes, anthropometry, and blood lipid concentrations of adults with dyslipidemia with or without lipid-lowering drug use. Methods and Study Design: For this cross- sectional study, three-year data were obtained from the 6th–7th Korean National Health and Nutrition Examina- tion Survey (2015–2017). Patients with dyslipidemia were categorized as users (1,734) or nonusers (856) of lipid- lowering drugs. Results: Age, education level, marital status, self-reported health status, hypertension, diabetes, and alcohol intake were significantly different between users and nonusers (p<0.05). Multiple logistic regression analysis revealed a significant association between hypertension and diabetes and blood cholesterol status among users. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol were significantly lower in users than in nonusers. During the study period, intake of saturated fatty acids increased significantly among users and nonusers, and intakes of vitamins A and C decreased significantly with potential detrimental health effects. How- ever, intakes of n-3 fatty acids and dietary fiber significantly increased in users and nonusers with potential health benefits. Intakes of vegetables and fish significantly increased in users. No associations were observed between intakes of nuts, fruits, or vegetables and blood cholesterol status. Conclusions: Changes in personal behaviors of dyslipidemic patients need reinforcement for effective blood lipid management, particularly for optimal food in- take patterns, whether lipid-lowering drug users or nonusers.
Background and Objectives: Current best practice for postoperative feeding in surgical patients is well estab- lished, however implementation of evidence-based practice comes with many challenges. A common barrier is surgeon adherence to guidelines and the reasons behind this are not well understood. Pelvic exenteration surgery is a complex surgery and postoperative feeding methods in this patient cohort vary significantly from patient to patient. The aim of this study was to identify barriers and enablers for surgeons to implement evidence based feeding methods after pelvic exenteration surgery and provide practical strategies for non-surgeon healthcare workers to improve compliance. Methods and Study Design: A qualitative study was conducted by performing semi-structured interviews with 12 Consultant Surgeons at hospitals in Australia and New Zealand with dedicated pelvic exenteration services. Deductive and inductive thematic analysis was performed in line with the Theoreti- cal Domains Framework and Behaviour Change Wheel model to identify relevant domains, themes and interven- tion functions. Results: Culture was identified as an overarching theme that influenced postoperative feeding practices, surgeon behaviours and sub-themes. Identified sub-themes included motivation, relationships and ex- pectations, environment and ‘moving forward’. Motivations to use different types of feeding routes postopera- tively varied across hospitals. Relationships, surgeons’ expectations and the environment all influenced the way in which patients were fed postoperatively. Practical strategies were identified to assist non-surgeon healthcare workers achieve positive change moving forward with postoperative feeding. Conclusions: Practical strategies to promote enablers and reduce barriers are required to bring about positive change and align practice with the evi- dence.
Background and Objectives: The precise association between palm oil consumption and lipid-related cardio- vascular disease risk remains unclear. A systematic review was thus performed to assess whether palm oil con- sumption has a negative effect on plasma lipid-related cardiovascular disease marker levels. Methods and Study Design: In June 2018, the electronic bibliographic databases PubMed, EMBASE (Ovid), the Cochrane Library (Ovid) and the Chinese National Knowledge Infrastructure were searched and a total of 11 eligible dietary inter- vention articles involving 961 volunteers were selected. Both random and fixed effect models were used to calcu- late pooled weighted mean differences (WMD). Results: A total of 11 articles involving 547 participants met the inclusion criteria. The pooled analysis revealed that palm oil increased the concentration of High-density lipopro- tein cholesterol (WMD: 0.15 mmol/L; p<0.00001). Palm oil consumption had no significant effects on blood total cholesterol (WMD: -0.01 mmol/L; p=0.82) and LDL-c (WMD: -0.05mmol/L; p=0.10) and triglyceride concentra- tions (WMD: 0.00 mmol/L; p=0.96), relative to the effects of unsaturated fatty acid consumption. Subgroup anal- yses revealed that palm oil has a beneficial effect on High-density lipoprotein cholesterol levels when more than 30% of total dietary energy was constituted by fat. Conclusions: This review revealed that palm oil does not in- duce increases in cardiovascular disease risk risk-related biomarkers relative to unsaturated fatty acids. Further- more, larger-scale samples of human dietary intervention trials are required to increase the accuracy of meta- analyses.