There is benefit, risk and cost in all that we do, but when it comes to food, we expect that it will benefit our health, be available, safe to eat and affordable. But as climate change and demographic shifts through displacement and ageing gather momentum, the emphases on each of benefit, risk and cost will alter. That we are ecological beings whose health and wellbeing are ecosystem-dependent, must now be the underpinning framework for risk man- agement. Loss of natural environment and biodiversity represents reduced nutritional and health resilience, which will need to be factored in to risk assessment and management with climate change. This is proving a problematic risk communication challenge. Previously desirable food and food pattern recommendations will be tempered by substantial sustainability, availability, safety, affordability, equity and ethical considerations. Future workforces will need to ensure basic livelihoods (food, water, shelter, clothing, healthcare, education, communication, essen- tial transport, resource management and effective governance) and with risk minimisation. Cost appraisal will have less to do with monetisation and more to do with resource management in accordance with equity and ethi- cal principles. Communities could adopt Liveability Units (LU) for traceability and community-based transac- tions, as a currency for a more sustainable future, encouraging and enabling food and health system viability. Open source food and health systems, supported by LU matrix (bar code or QR) scanning with smartphones could be widely available for individual, household and community benefit, risk and cost management. The risk is remoteness from food’s origins and megadata commercialisation.
Background and Objectives: The aims of this study is to explore the acute effect of consuming dinner at differ- ent timing on postprandial glucose and hormone in patients with type 2 diabetes. Methods and Study Design: Eight patients (age 70.8±1.9 years, HbA1c 7.6±0.6 %, BMI 23.3±3.2, mean±SD) were randomly assigned in this crossover study. Patients consumed the test meals of dinner at 18:00 on the first day, and dinner at 21:00 or divid- ed dinner (vegetable and rice at 18:00 and vegetable and the main dish at 21:00) on the second or third day. Post- prandial glucose, insulin, glucagon, free fatty acid (FFA), active glucagon-like peptide-1 (GLP-1), and active glu- cose-dependent insulinotropic polypeptide (GIP) concentration after dinner were evaluated. Results: Both incre- mental area under the curve (IAUC) 2h for glucose and insulin were higher in dinner at 21:00 than those in dinner at 18:00 (IAUC glucose: 449±83 vs 216±43 mmol/L×min, p<0.01, IAUC insulin:772±104 vs 527±107 μU/mL×min, p<0.01, mean±SEM). However, in divided dinner both IAUC 4h for glucose and insulin tended to be lower than those of dinner at 21:00 (IAUC glucose: 269±76 mmol/L×min, p=0.070, IAUC insulin: 552±114 μU/mL×min, p=0.070). IAUC of active GLP-1 and active GIP demonstrated no difference among different dinner regimen. Conclusions: Consuming late-night-dinner (21:00) deteriorates postprandial glucose and insulin com- pared with those of early-evening-dinner (18:00) whereas consuming dinner dividedly ameliorates them.
Background and Objectives: To provide a questionnaire, with Shanghai medical interns as respondents, analyz- ing knowledge (K), attitude (A), and practice (P) in relation to clinical nutrition, and to explore factors that could affect KAP scores. Methods and Study Design: The cross- sectional study used 330 interns from Shanghai med- ical universities responding to general material data questionnaires and KAP questionnaires on clinical nutrition. Results: The mean KAP score was 210.26±25.9 (X±SD), and the score for each part of the KAP questionnaire was just within the threshold for qualified. Multivariate analysis showed that the factors influencing the propor- tion of excellent scores for K were preventive medicine major (OR=3.45, p<0.001), senior intern (OR=2.52, p=0.002), and tertiary intern hospital (OR=2.31, p=0.006). The only factor influencing the proportion of excellent scores for P was accessing nutritional information one to three times per week (OR=3.95, p=0.011). Nutrition course had no relation to any scores of K, A, P. Conclusions: The mean scores of overall KAP and the individual K, A, P were all categorized as qualified. The P score was the lowest and only influenced by how frequently in- formation was accessed. In summary, nutrition knowledge and regular practical training gained from intern hospi- tal could be a better way to enable senior interns to quickly and competently address patient nutrition problems at the commencement of their careers.
Background and Objectives: Multiple studies of the relative economic value of different nutritional support methods for patients with gastrointestinal cancer have provided inconsistent results. Methods and Study Design: The PUBMED and EMBASE databases were systematically searched through September 30, 2018to identify la- tent studies of the benefits of parenteral nutrition (PN), enteral nutrition (EN) or conventional intervention (CI) in gastrointestinal cancer patients. A fixed-effects model or random-effects model was applied depending on the heterogeneity of the studies. Statistical analysis was conducted using R software. A total of 728 studies were re- viewed, and 21 studies published from 1998 to 2018 were included in the final analysis. Results: The results showed that the hospitalization expenditure of the EN group was 3938 RMB less than that of the PN group. Simi- larly, the EN group had a shorter length of hospitalization than the PN and CI groups. The infection rate was low- er in the EN group (12%) than in the PN group (16%) and CI group (20%). Subgroup analysis showed that gas- trointestinal cancer patients who received oral nutritional supplements had the lowest infection rate (11%) after surgery. Conclusions: EN, especially oral nutritional supplements, has a positive economic impact on patients with gastrointestinal cancer, based on reductions in the post-operative infection rate, length of hospitalization, and hospitalization expenditure.
Background and Objectives: To develop and validate the prediction equations for lean body mass (LBM) and appendicular skeletal muscle mass (ASM) using body circumference measurements of community-dwelling adults older than 50 years old. Methods and Study Design: Four hundred and ninety-eight community-dwelling adults older than 50 years old were recruited for this study. Participants were randomly assigned to a development group (DG, n=332) and validation group (VG, n=166). Lean body mass and ASM were assessed using dual- energy x-ray absorptiometry along with the anthropometric parameters. The Pearson correlation coefficient was used to examine the associations between ASM, LBM and anthropometric parameters in the DG. Prediction equations for LBM and ASM were established from DG data using multiple regression analyses. Paired t-test and Bland-Altman test were used to validate the equations in the VG. Results: Forearm circumference had the high- est correlation with LBM and ASM. The developed prediction models were: LBM (kg) = 27.479 + 0.726 * weight (kg) - 3.383 * gender (male = 1, female = 2) - 0.672 * BMI + 0.514 * forearm circumference (cm) - 0.245 * hip circumference (cm)(r2=0.90); ASM (kg) = -4.287 + 0.202 * weight (kg) - 0.166 * hip circumference (cm) - 1.484 * gender (male = 1, female = 2) + 0.173 * calf circumference (cm) + 0.096 * height + 0.243 * forearm cir- cumference (cm)(r2=0.85). Conclusions: Prediction equations using only a measuring tape provide accurate, in- expensive, practical methods to assess LBM and ASM in Asians older than 50 years old.
Background and Objectives: Low sodium and high potassium intake is reported to be a risk of hypertension. However, it is uncertain whether these associations can be generalized to those without hypertension. This study is to evaluate the associations of systolic and diastolic blood pressure (SBP and DBP, respectively) with estimat- ed urinary sodium excretion (eUNaE), estimated urinary potassium excretion (eUKE) and their ratio (Na/K ratio) among hypertensive, normotensive, and hypotensive Chinese individuals. Methods and Study Design: A large institution-based cross-sectional study was conducted at the Third Xiangya Hospital, Changsha between August 2017 and November 2018. Spot urine samples were collected to test urinary sodium, potassium, and creatinine excretions for each participant. The Kawasaki formula was used to estimate 24-hour urinary sodium and potassi- um excretions. Results: A total of 26,363 eligible subjects were used to analyze the associations of blood pres- sure with eUNaE, eUKE, and their ratio. 27.3% (n=7,201) of participants were diagnosed with hypertension, 5.4% (n=1,427) were diagnosed with hypotension, and the remaining of 17,735 participants were normotensive. A significant increase in SBP and DBP was related to the Na/K ratio increase in hypertensive and normotensive subgroups (all ptrend<0.01), but the association was not significant for DBP among hypotensive individuals (ptrend=0.58). Stronger associations of SBP with the Na/K ratio were observed in older people (pinteraction<0.01) and females (pinteraction<0.0001), but the same trend was not observed for DBP (pinteraction=0.10 and 0.88, respectively). Conclusions: High potassium and low sodium intake were further confirmed to reduce blood pressure in hypo- tensive, normotensive, and hypertensive individuals.
Background and Objectives: Dairy has been shown to reduce the risk of obesity in many epidemiological stud- ies. However, few studies have been fully conducted in China in this respect. We aimed to investigate the asso- ciation between dairy consumption and prevalence of obesity in an adult Chinese population. Methods and Study Design: A cross-sectional study was performed in an adult population of 5598 in northeast China, aged ≥18. Intakes of dairy products were obtained by internet-based dietary questionnaire for the Chinese (IDQC). The associations between total and individual dairy consumption and prevalence of overall and abdominal obesity were examined by logistic regression. Sex stratification was performed. Results: A total of 3871 participants, in- cluding 1700 men and 2171 women, were eligible for analysis. Men who consumed ≥100 g/day of yogurt had lower risks of abdominal obesity (multivariate-adjusted OR=0.41; 95% CI: 0.24-0.70) than men who did not con- sume yogurt. Women who consumed ≥200 g/day of milk had lower risks of overall obesity (multivariate-adjusted OR=0.47; 95% CI: 0.24-0.91) than women who did not consume milk. Conclusions: Increased dairy consump- tion was associated with lower risk of obesity in adult population in northeast China. Further studies are needed to confirm these observational findings and explain the observed gender-specific difference.
Background and Objectives: Diabetes prevalence has been increasing overtime in Indonesia along with its complications and morbidities. Diabetes prevention program is still a challenge. Previous study concluded poor intrauterine nutritional status, low birth weight (LBW), and nutrition status early in life were risk factors for im- paired glucose tolerance (IGT) or type 2 diabetes mellitus in adulthood. This study aimed to evaluate the associa- tion between both LBW and intrauterine growth restriction (IUGR) with IGT in adolescents. Methods and Study Design: Total of 536 subjects from Tanjungsari Cohort Study were included in this study. Subjects were in their early adolescence age (12-14 years). Anthropometric data were collected and IGT was determined by using 2- hour postprandial plasma glucose level, then it was assessed based on their birth weight and intrauterine nutri- tional status. Results: Subjects with LBW history were shorter, had lower body weight and body mass index (p<0.05, respectively). The proportion of IGT is significantly higher among subject with LBW (RR 1.692 [1.079– 2.653]). There was no difference on proportion of IGT among subjects with IUGR compared with subjects who were not IUGR or born preterm (p=0.286). Multiple regression analysis showed the effect of LBW remain inde- pendent after adjusted with sex and socioeconomic variables (RR 1.650 [1.054–2.584]). Conclusions: Significant association was found between LBW and IGT in comparison to those who were born with normal birth weight. Hence, diabetes should be prevented as early as possible, even since in the pregnancy.
Background and Objectives: The purpose of the present study is to examine the socioeconomic correlates of adherence to minimum mineral intake recommended by the Chinese Dietary Guidelines during each trimester of pregnancy among Chinese women. Methods and Study Design: A total of 567 pregnant women with foetal age of 6 – 12 weeks were recruited from nine community health centres and three hospitals. Cross-sectional survey data were collected using structured interviews and questionnaires. Mineral intake was calculated from food con- sumption reported on 24-hour dietary reviews using the Chinese Food Composition Metrics. Logistic regression models were estimated to assess the relationship between sociodemographic factors and adherence to mineral in- take recommendations for each trimester. Results: Significant predictors of adherence to mineral intake recom- mendations include: (1) age (zinc: OR=1.09, p<0.05; copper: OR=1.11, p<0.05), having bachelor’s degree (cop- per: OR=2.23, p<0.05; phosphorus: OR=2.23, p<0.01), and household income ≥5,000RMB (potassium: OR=2.51, p<0.001; phosphorus: OR=1.91, p<0.05) during the first trimester, (2) being employed (zinc: OR=0.54, p<0.001; selenium: OR=0.53, p<0.05) and household income ≥5,000 RMB (zinc: OR=1.86, p<0.05) during the second tri- mester, and (3) husband/partner with associate degree or vocational school education (selenium: OR=3.26, p<0.01) and household income of 3,000–4,999 RMB (potassium: OR=1.71, p<0.05; zinc: OR=1.48, p<0.05) dur- ing the third trimester. Conclusions: To our knowledge, this is the first study that examines the relationship be- tween socioeconomic factors and mineral intake among Chinese pregnant women at three trimesters. Findings highlight the importance of considering individuals’ socioeconomic status to develop personalized interventions to prevent undernutrition among this population.
Background and Objectives: Gestational weight gain is known to impact maternal and child health outcomes. Energy intake and energy expenditure are major components of clinical nutrition in relation to weight gain during pregnancy. The study was to determine the association of physical activity and sitting time during pregnancy with gestational weight gain in Vietnamese women. Methods and Study Design: A multicentre prospective cohort study was conducted in Vietnam from 2015 to 2017. A total of 1873 women with a singleton pregnancy were included. Physical activity and sitting exposures dur- ing pregnancy were determined using an interviewer-administered validated questionnaire. Multiple regression analysis was performed to assess physical activity and sitting time in relation to gestational weight gain, adjusting for the confounding effects of maternal characteristics and total energy intake during pregnancy. Results: The mean weight gain was 12.9 (Standard deviation 4.1) kg throughout pregnancy. Pregnant women with prolonged sitting time gained an average of 0.6 kg more weight (p=0.016 for highest versus lowest tertiles). Conversely, women who were physically active, in terms of having higher tertiles of total physical activity, moderate-to-vigorous-intensity, house- hold/caregiving activities, and occupational physical activity, experienced significantly less gestational weight gain (p<0.05 for highest versus lowest tertiles). Conclusions: Inverse associations were found between gestational weight gain and physical activity (i.e. intensities and several domains), whereas gestational weight gain tended to increase with longer sitting time. Therefore, being physically active and less sedentary is important to regulate weight gain during pregnancy.
Background and Objectives: Chinese infants consuming four different commercially-available infant formulas were evaluated on gut comfort and stool consistency parameters. Methods and Study Design: Gut comfort char- acteristics were evaluated during a 7-day cross-sectional observational study in 409 healthy, term, exclusively formula-fed infants via questionnaires and fecal parameters. Results: The stool consistency and color scores were different between the infants consuming one of the four commercially-available infant formulas including diffe- rent fat sources, i.e. one milk fat-based (IF1), two structured vegetable fat blend-based (IF2 and IF4) and one palm oil-free vegetable fat blend-based (IF3). The scoring pattern showed more ‘soft-formed’ stools for IF1- consuming infants compared to infants consuming IF2, IF3 or IF4. In addition, a lower amount of green feces was observed in combination with an increase in golden-colored feces for IF1-consuming infants compared to the other groups. Furthermore, IF1-consuming infants reported less fussy/crying time during the night and less gut discomfort. Infants consuming milk fat-based IF1 showed significantly lower fatty acid soaps compared to palm- oil free IF3-fed infants. Conclusions: Infants consuming milk fat-based IF1 experienced less gut discomfort compared to infants consuming other commercially-available infant formula. Lower fecal fatty acid soap levels, fussy/crying time during the night and gut discomfort were observed. These findings contribute to the current un- derstanding of the association between lipid structure and gut comfort parameters. However, the suggested bene- fits noted cannot be fully linked to the effect of fat blend differences since formulas differ in ingredient-sourcing and processing. Future research should confirm the added benefit of milk fat-based infant formulas to improve gut comfort parameters.
The role of microbiomes in human biology and health are being extensively investigated, yet how the fungal community or mycobiome contributes to an integral microbiome is unclear and probably underestimated. We re- view the roles of fungi from the perspectives of their functionality in human biology, their cross-kingdom talk with other human microbial organisms, their dependence on diet and their involvement in human health and dis- eases. We hypothesize that members of the fungal community may interact as necessary symbionts with members of other human microbiome communities, and play a key role in human biology, yet to be fully understood. We propose further that “regulobiosis”, whereby fungi play a regulatory role in human ecobiology, is operative in humans as probably obtains in other forms of life. Fungally-dependent regulobiosis would characterise, at first, microbiomes which include, but are not limited to, bacteria, archaea, and viruses; then, their human host; and, next, provide ecological connectedness.
Background and Objectives: To evaluate the association between dietary diversity and all-cause mortality in older adults. Methods and Study Design: 17,949 community-based elderly participants aged ≥65 years in China were included in this cohort study. The baseline consumption frequencies of nine food groups (meat, vegetables, fish, eggs, fruits, legumes, milk, tea, and nuts) were recorded, and the dietary diversity score (0–9) was calculated. Survival status and death date were collected during follow-up. Cox proportional-hazards models were used to assess the association between dietary diversity and all-cause mortality. Results: We identified 8445 death events over 57,685 person-years of follow-up. Compared with participants in the lowest dietary diversity score group (score 0–1), higher dietary diversity scores were associated with lower mortality risk in univariate models. After adjusting for potential confounders, participants in the higher dietary diversity score group had a 9%–30% lower risk in all-cause mortality (p trend <0.001) compared with those in the lowest dietary diversity score group. The inverse relationship between dietary diversity score and all-cause mortality was also significant in four food groups (vegetables, fish, fruits, and nuts). Similar results were observed in sensitivity analyses. Conclusions: Our study showed that dietary diversity was inversely associated with all-cause mortality in the Chinese elderly, espe- cially in the oldest old and men. Therefore, increasing dietary diversity may reduce mortality rates in the older population, and tailored interventions for improving dietary diversity are required to benefit health and survival in them.
Background and Objectives: A previous pilot study revealed stunted children and obese adults in urbanized set- tled Tibetan communities. A survey with a representative population in selected communities was conducted to test the preliminary findings. Methods and Study Design: A cross-sectional study on the nutritional status in- volving 504 children (244 boys and 260 girls, 5-16 y) and 927 adults (422 men and 505 women, 18-90 y) was conducted in communities, with anthropometric parameters measured. The z-scores for height-for-age (HAZ) and BMI-for-age (BAZ) in children were calculated according to WHO 2007 reference. Results: The children showed a double burden of both under- and over-nutrition. The prevalence of under-nutrition in children was high – stunting (HAZ <-2) 10.7%, underweight (BAZ <-2) 9.5%, combined prevalence of stunting and underweight 19.4%. The rate of over-nutrition was also alarming – obesity 12.7% (BAZ >2). The mean value of HAZ (- 0.45±1.41) was lower than, whereas that of BAZ (0.05±1.76) was comparable to, the WHO reference. No signifi- cant differences were found in under- or over-nutrition between genders. Specifically, 8.9% of children demon- strated both short stature (HAZ <-1) and overweight (BAZ >1). By contrast, community adults showed almost a one-way direction tilted towards over-nutrition – overweight 61.4% (BMI ≥24 kg/m2), obesity 30.1% (BMI ≥28 kg/m2), and central obesity 62.0% (waist circumference, men ≥85 cm, women ≥80 cm). Women were marginally more likely to be obese than men (p=0.061). Conclusions: The co-existence of under- and over-nutrition in the community may have reflected the suboptimal early life nutrition and the obesogenic environment afterwards. Potential determinants need to be explored for future interventions.
Background and Objectives: An individual’s liking for food maybe associated with food consumption. This study investigates the association between food liking and dietary quality in Australian young adults. Methods and Study Design: Food liking and food frequency data were collected via an online Food Liking Questionnaire (FLQ) and Food Frequency Questionnaire (FFQ). Food liking scores were calculated for groupings of foods. FFQ Food intake data was used to calculate diet quality using a 13 item Dietary Guideline Index (DGI). The relation- ship between food liking and DGI was assessed using linear regression models and the difference was assessed using an independent sample t-test and One-way ANOVA. Results: Data were available from n=2,535 partici- pants (BMI=24 (SD 3.74), age=21.9 (SD 5.05) years, female=77.1%). Liking for grains, vegetables, fruits, dairy, plant-based protein, was weakly positively associated with diet quality. Liking for animal-based protein, fat and oil, sweet food, and salty food, was weakly negatively associated with diet quality. Liking for grains, vegetables, fruits, dairy, plant-based protein and healthy foods increased across increasing DGI tertiles, and liking for animal- based protein, fat and oil, sweet food, salty food and discretionary foods decreased across increasing DGI tertiles. Conclusions: The results were logical with increased liking for healthy or discretionary foods linked with in- creased consumption of those foods. The results reinforce the strategy to introduce a variety of healthy food groups early in life to initiate flavour-nutrient learning and increase liking for healthy foods.
Background and Objectives: The association between circulating vitamin D and liver cancer risk has been con- troversial on the basis of epidemiological studies. The aim of this study was to quantitatively evaluate this associ- ation with prospective studies. Methods and Study Design: A systematic literature search was implemented in PubMed and Scopus databases up to June 2019. Using a random-effects model, the multivariate-adjusted relative risks (RRs) with corresponding 95% confidence interval (CI) were pooled for the highest versus lowest category. Trend estimation was conducted with a two-stage dose-response meta-analysis. Results: Six independent pro- spective studies (992 liver cancer events and 60,811 participants) were included for data synthesis. The summary estimate showed that a higher circulating vitamin D was associated with lower risk of liver cancer (Summary RR=0.78; 95% CI: 0.63, 0.95; I2=53.6%, p=0.035). Dose-response analysis indicated that liver cancer was asso- ciated with 8% (95% CI: 0.89, 0.95) lower risk with a 10 nmol/L increment of circulating vitamin D concentra- tion. Conclusions: The present study provides substantial evidence that a higher concentration of circulating vit- amin D would have conferred protection against liver cancer.
Background and Objectives: To evaluate the synergistic and individual associations of leisure-time physical ac- tivity (LTPA) intensity and the frequency of milk intake in adulthood with newly diagnosed pathoglycemia. Pathoglycemia comprised impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM). Methods and Study Design: This cross-sectional study of 3977 adults was conducted in Mentougou District, Beijing, China. After excluding ineligible individuals or those with missing data, 2977 participants were included in the final analysis. Data on LTPA, milk intake, and other demographic characteristics were obtained through previously de- signed questionnaires. Newly diagnosed pathoglycemia was determined based on fasting plasma glucose (FPG) concentration. Results: Among all participants, 21.4% had newly diagnosed pathoglycemia, 9.9% engaged in moderate to vigorous leisure-time physical activity (MVLTPA), and 63.7% drank milk more than once weekly. Relative to those who engaged in low-intensity LTPA and drank milk less than once weekly, those who engaged in MVLTPA (OR: 0.584, 95%CI: 0.410-0.810) and drank milk more than once weekly (OR: 0.734, 95% CI: 0.614-0.878) had a lower risk of pathoglycemia; this association was greater when both variables interacted (OR: 0.446, 95% CI: 0.287-0.669). Conclusions: MVLTPA and enough frequency of milk intake synergistically de- creased the risk of pathoglycemia. A future interventional study including both factors should be performed.
Background and Objectives: To evaluate the reproducibility and construct validity of the Madras Diabetes Re- search Foundation FFQ (MDRF-FFQ) with biomarkers for its use in epidemiological settings in India. Methods and Study Design: The MDRF-FFQ was administered to 500 participants representing rural and urban areas of 10 Indian states, twice at an interval of 12 months. Reproducibility was assessed using intra cluster correlation coefficients (ICC). Construct validity of carbohydrate and fat intake was assessed using baseline serum lipids by regression analysis. Results: Reproducibility as measured by ICC was 0.50-0.77 for saturated fatty acids (SFA) and energy in urban and 0.61-0.72 for protein and SFA in rural areas. The ICC for food groups was 0.53-0.77 for whole grains, fruits and vegetables in urban and 0.50-0.89 for animal foods and whole grains in rural areas. After adjusting for potential confounders, carbohydrate intake was positively associated with serum triglycerides (TG) (β [SE]: +2.3 [0.72] mg/dL; p=0.002) and inversely with high density lipoprotein cholesterol (HDL) (β [SE]:-0.48 [0.12], p<0.001), while dietary fat and SFA (% Energy) were positively associated with HDL, low density lipo- protein (LDL) and total cholesterol and inversely with TG. Conclusions: The MDRF-FFQ can be considered as a reliable and valid tool to measure the long-term dietary exposure in respect of macronutrient intakes in Indian populations despite diverse dietary practices.
This critical review is intended to analyse the existing studies on the consumption patterns of sweetened con- densed milk in the diet of young Indonesian children and its potential nutritional health consequences. Consider- ing its limited nutritional value and high sugar content, sweetened condensed milk (SCM) should not be adminis- tered to young children (1-3 years old) with the goal of promoting their growth and development. However, such false practice has been reported in mostly urban studies among the underprivileged population. Conclusive scien- tific evidence is also still lacking regarding the health risks of long-term SCM consumption by young Indonesian children at early ages, as no study has focused on this specific topic. Nevertheless, inadequate understanding of SCM, its consumption patterns, and its long-term effects on health among young Indonesian children have been implicated in public confusion on the topic. Ongoing disparities that exist between regulation, industrial practices, and product advertisement have led to poor understanding in communities, which, to a considerable extent, has contributed to difficulties in segregating data on the consumption of SCM and its related products. Analogous to sugar-sweetened beverages, limited SCM consumption can be recommended when appropriately implemented with active monitoring and evaluation of product advertisements and product labeling, enforcement of regulations, and provision of effective customer education.
Background and Objectives: Thyroglobulin (Tg) is considered a sensitive indicator of iodine status for children and adults, but its usefulness for pregnant women is unknown. The aim of this study was attempting to explore the relationship between Tg and iodine status and the association between elevated Tg and thyroid diseases. Methods and Study Design: A total of 2163 pregnant women were recruited in this study. The ratio of urine io- dine concentration and urine creatinine concentration (UI/Cr) was measured in spot urine samples. Serum thyroid hormones and thyroglobulin were measured. Thyroid nodules and thyroid volume were diagnosed by ultrasound. Results: The geometric mean of serum Tg was significantly higher in the UI/Cr <100 μg/g group (10.94 [2.47] μg/L) and the UI/Cr >500 μg/g group (11.48 [2.35] μg/L) than in the 150–249 μg/g group (9.64 [2.32] μg/L). The generalized linear model analysis showed that Serum log(10) Tg concentration was much higher in the UI/Cr <100 μg/g group (β=0.052, p=0.026) than in the 150–249 μg/g group. Multivariate logistic regression models demonstrated that elevated Tg may be a risk factor for both goiter (OR=8.30) and thyroid nodules (OR=2.73). Conclusions: Pregnant women with UI/Cr <100 μg/g have a higher Tg, and those with elevated Tg concentra- tions have a higher risk of thyroid nodules and goiter. Tg can be a functional biomarker of iodine deficient, thy- roid nodules and goiter.
Background and Objectives: Acute acalculous cholecystitis (AAC) often occurs in critically ill patients, espe- cially in those that have experienced trauma, surgery, shock, and prolonged fasting. Early enteral nutrition has been shown to significantly reduce morbidity and mortality compared to other nutritional support strategies. The purpose of this study was to evaluate the effect of early enteral nutrition on the incidence of AAC among trauma patients. Methods and Study Design: Multi-strategy nutritional protocol was implemented in the intensive care unit (ICU) in 2016 for early enteral nutrition and proper nutritional support. The traumatized critically-ill patients without volitional intake who were admitted to ICU between 2015 and 2017 were included. Basic characteristics, duration of fasting, and the incidence of percutaneous cholecystostomy (PC) due to AAC were analyzed accord- ing to the year. Results: Enteral nutrition was indicated in 552 trauma patients (28.2%). The mean duration of fasting was shortened from 6.5 days in 2015 to 5.4 days in 2017 (p=0.202). The incidence of PC was significantly decreased from 2015 to 2017 [6/171 (3.5%) vs. 6/204 (2.9%) vs. 0/177 (0%), p=0.023]. The provision of central parenteral nutrition (p=0.001) and fasting over 7 days (p=0.014) proved to be a risk factor of AAC. Conclusions: This study showed that the incidence of PC due to AAC was decreased significantly after the implementation of a nutritional protocol among traumatized critically ill patients. Early enteral nutrition may be effective in reducing the AAC among trauma patients who are at high risk of AAC.
Background and Objectives: This study aimed to assess the influence of prolonged preoperative fasting on prognosis in elective surgery. Methods and Study Design: A retrospective, controlled study involving patients admitted to our surgical intensive care unit who underwent a gastrointestinal operation under general anesthesia. Patients were divided into regular preoperative fasting time (n=57) and prolonged preoperative fasting time (n=73) groups. Clinical data were collected including patients’ demographics, intraoperative and postoperative operation time, volume of blood loss, intensive care unit stay, hospital stay, postoperative complications and other factors. Results: Patients in the regular preoperative fasting time group had less duration of mechanical ventilation sup- port after surgery [245 (177, 450) min vs 315 (210, 812) min (p=0.021)] and the postoperative myocardial inju- ries (myocardial injury 2 cases vs 11 cases, p=0.038) and reoperation percentages (reoperation 0 cases vs 7 cases, p=0.044) were lower compared to the prolonged preoperative fasting time group. In addition, patients in the regu- lar preoperative fasting time group presented with a significantly shorter period of postoperative fasting time [6.0 (5.0, 8.0) vs 8.0 (6.0, 13.0), p=0.005]. Conclusions: Prolonged preoperative fasting time led to unfavorable out- comes after gastrointestinal operations. Thus, reducing preoperative fasting time is likely to accelerate postopera- tive recovery in gastrointestinal surgery patients.
Background and Objectives: We performed this study to evaluate serum iron and ferritin concentrations, serum total iron-binding capacity (TIBC), and proportion of overall iron deficiency among patients with non–dialysis- dependent chronic kidney disease (ND-CKD). Methods and Study Design: A hospital-based cross-sectional ob- servational study was conducted on 175 adult patients with stage 3–5 chronic kidney disease (CKD) by using 51 healthy age–sex-matched Vietnamese adults as the control group. We next examined the prevalence of anemia and determined the serum iron and ferritin concentrations and TIBC. Anemia in CKD was defined as hemoglobin levels <13 g/dL in men and <12 g/dL in women. Transferrin saturation (TSAT, %) was calculated as (serum iron x 100)/TIBC. Functional iron deficiency was defined as serum ferritin >100 ng/mL and TSAT <20%, and abso- lute iron deficiency was defined as serum ferritin <100 ng/mL and TSAT <20%. Overall iron deficiency was de- fined as the presence of either absolute or functional iron deficiency. Results: Anemia prevalence in our study was approximately 88.6% with a mean hemoglobin concentration of 9.71±2.26 g/dL. The median serum TIBC was lower in the CKD group (50.4 μmol/L) than in the control group (66.0 μmol/L; p<0.001). The proportion of overall iron deficiency was 44.0%. TIBC had a diagnostic value for overall iron deficiency (area under the ROC curve=0.81; p<0.001). Conclusions: Anemia and iron deficiency are common in Vietnamese patients with ND- CKD. TIBC had diagnostic value for overall iron deficiency.
Background and Objectives: The severity of neurologic impairment is significantly associated with gastrointes- tinal (GI) hemorrhage. Therefore, the aim of this study was to compare the effect of two nutritional interventions in acute ischemic stroke patients with GI hemorrhage. Methods and Study Design: We retrospectively studied consecutive ischemic stroke patients with GI hemorrhage from January 2014 to December 2018. They were strat- ified into two programs of nutritional therapy after GI hemorrhage: moderate feeding (more than 70% optimal ca- loric uptake, 50-100 mL/h) and trophic feeding (16-25% of the target energy expenditure, 25 kcal/kg per day, 10- 30 mL/h) with supplemental parenteral nutrition. Results: The group receiving moderate feeding included 30 pa- tients, and the group receiving trophic feeding and supplemental parenteral nutrition included 32 patients. There was no statistically significant difference between the two groups in the baseline characteristics of the patients. Mortality, Glasgow Coma Scale (GCS) score at discharge, and Glasgow Outcome Scale (GOS) score 3 months after discharge were compared between the two groups. In the moderate feeding group, the overall mortality was significantly lower than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). Conscious state and neurological severity were assessed by the GCS score before discharge, and the score was higher in the moderate feeding group than in the other group (p<0.05). The GOS score 3 months after discharge was higher in the moderate feeding group than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). These three items showed that moderate feeding led to a better prognosis: lower occurrence of mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge. Conclusions: This study showed that moderate feeding had a much more profound effect on the outcomes than trophic feeding and supplemental par- enteral nutrition, as it was associated with lower mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge.
Background and Objectives: This prospective, randomized, controlled study aimed to evaluate the effects of flaxseed supplementation on functional constipation and quality of life in adult men and women in China. Meth- ods and Study Design: 90 subjects with functional constipation diagnosed by the Rome IV criteria were enrolled. Subjects were randomly assigned to receive either 50 g/day flaxseed flour with meals (n=60) or 15 mL/day of a lactulose solution on an empty stomach (n=30) every morning for 4 weeks. Wexner constipation scores, stool consistency according to the Bristol Stool Form Scale, and bowel habits (frequency of bowel movements/week, the time spent on defecation) were the primary outcomes. The change in Patient Assessment of Constipation Quality of Life score was the secondary outcome. Results: After 4 weeks, the bowel habits in both groups were significantly improved. The median Wexner constipation score decreased from 14 to 6.5 in the flaxseed group (p<0.001) and from 15 to 9 in the lactulose group (p<0.001). The median defecation frequency per week in- creased significantly (2 to 7 for flaxseed and 2 to 6 for lactulose, p<0.001 for both groups). The Patient Assess- ment of Constipation Quality of Life score decreased significantly (−1.34 and −0.66 for flaxseed and lactulose, respectively; p<0.001 for both groups). Conclusions: Flaxseed flour is somewhat more effective at increasing defecation frequency than lactulose, improving bowel movements and promoting life quality of subjects with chronic functional constipation in the Chinese population.