Pandemics have shaped humanity over and over again, but the coronavirus outbreak of 2019-2020 is in a world at the tipping point of catastrophic climate change. Its origins and distinction derive from over-population with in- equity and an industrial revolution since the 17th century which has exploited fossil fuels as a globalised energy source, a period now described as the anthropocene. Asymptotic ecosystem loss and dysfunction, for people whose being is socioecological, makes ultimate survival tenuous. Microbial forms of life jump species when habitats are destroyed, or their host misused. Our innate immunity depends on our general health and fitness- so- cial, mental, physical, and nutritional, in step with nature and its rhythms through walking in it, enjoying sunlight and sleep. Biodiversity and the associated benefit of food variety, after being breast-fed, is the key descriptor of a healthful, sustainable, accessible, and acceptable way of eating. How this pattern might contribute to our resili- ence in the face of a highly transmissible and biologically evasive virus is becoming clear. It may also be possible to compliment usefully preventive vaccination and therapeutic healthcare and rehabilitation through a greater un- derstanding of our nutritional biology.
To investigate the effect of accelerated rehabilitation combined with enteral nutri- tion on surgically treated lung cancer patients. Methods and Study Design: In total, 150 lung cancer patients treated in our hospital from January 2017 to January 2018 were retrospectively analysed. Sixty-six patients were randomly divided into a control group with conventional nutrition (Con group) and an accelerated rehabilitation combined with enteral nutrition group (EN group). Postoperative drainage; total hospitalization time; total hospi- talization expenses; and albumin, haemoglobin and total lymphocyte counts (TLC) before and after treatment were compared. Results: The serum albumin, prealbumin and haemoglobin in both groups were decreased after operation and were significantly higher in the EN group (p<0.05) than in the Con group. The TLC decreased in both groups after operation and were significantly higher in the EN group than in the con group. The postopera- tive drainage volume, total hospitalization time and total hospitalization expenses were significantly lower in the EN group than in the Con group (p<0.05). Conclusions: The effect of accelerated rehabilitation combined with enteral nutrition in lung cancer surgery patients is clear. Surgery leads to stress, which enhances catabolism and reduces the synthesis of carbohydrates, protein, and fat, increasing patients’ nutritional risk. Nutritional support combined with fast-track minimally invasive thoracic surgery for at-risk lung cancer patients who undergo pre- operative nutritional screening and assessment can reduce postoperative complications and hospitalization time and improve nutritional indicators, immunity, respiratory function recovery and clinical outcomes, leading to so- cioeconomic benefits.
The optimal energy intake for early nutrition therapy in critically ill patients is un- known, especially in Chinese patients with a lower BMI. This study investigated the relationship between energy intake and clinical outcomes in this patient population. Methods and Study Design: A retrospective study was carried out at a tertiary hospital. Critically ill patients were recruited and divided into 3 tertiles according to the ratio of actual/target energy intake during the first week of hospitalization in the intensive care unit (ICU) (tertile I, <33.4%; tertile II, 33.4%–66.7%; and tertile III, >66.7%). 60-day mortality and other clinical outcomes were compared. To adjust for potentially confounding factors, multivariate and sensitivity analyses were performed exclusively in patients who stayed in the ICU for ≥7 days. Results: A total of 325 patients with a mean BMI of 22.5±4.7 kg/m2 were recruited. 60-day mortality was similar between the 3 tertiles. In the unadjusted analysis, tertile III had a longer length of stay in the ICU and at the hospital, longer duration of mechanical ventilation, and higher rate of ICU-associated infections, but only the latter showed a significant difference between the 3 tertiles in the multivariate and sensitivity analyses. Logistic regression analysis showed that energy groups was an inde- pendent risk factor for ICU-associated infections. Conclusions: Energy intake in early nutrition therapy influ- ences risk of ICU-associated infections in Chinese critically ill patients with lower BMI. Furthermore, patients with near-target energy intake have more frequent ICU-associated infections.
The health benefits of red furu in young, healthy volunteers had not been ade- quately investigated. The aim of this study was to determine the effect of a single meal containing red furu on se- rum vitamin B-12 (B-12), homocysteine and other cardiometabolic risk factors compared with that of tofu. Methods and Study Design: Twenty-three healthy volunteers from Zhejiang University, China, were randomly assigned to two groups of consumption, either red furu (n=11, 5 women and 6 men) or tofu (n=12, 6 women and 6 men). Volunteers consumed one breakfast meal composed of either 50 g of red furu (intervention group) or 50 g of tofu (non-active comparison group) with two slices of bread. Fasting blood was collected at 0 h, 24 h, and 72 h. Standard methods were used to measure the volunteers’ biochemical parameters. Results: The consumption of 50 g of red furu a day did not significantly affect serum B-12 and showed a non-significant trend to reduce serum homocysteine. In the red furu group, but not in tofu group, serum concentrations of B-12 and folate were nega- tively associated with homocysteine, and B-12 was positively associated with folate. Conclusions: A breakfast meal with 50 g of red furu containing 0.096 μg of B-12 did not increase serum B-12 in healthy volunteers. These results suggested that one meal containing B-12 could be sufficient to reduce serum Hcy.
The aim of the study was to explore the association between dietary patterns and lipid levels in Henan rural area. Methods and Study Design: Fasting blood samples, information on dietary intakes (with food frequency questionnaires) and other data were collected from the Henan Rural Cohort Study. Principal component analysis was used to identify the dietary patterns. Binary logistic regression and restricted cubic spline regression models were performed to obtain odds ratios (ORs) and 95% confidence intervals (95%CI). The study recruited 38,983 available participants aged from 18 to 79 from rural areas in Henan province. Results: The study showed that, three patterns were identified by higher factor loadings: namely the “meat” (high intakes of red meat, white meat and fish), “grain-egg-nut complex” (high intakes of nuts, milk, eggs, grains and beans), and “vegetables- staple food-fruits” pattern (high intakes of vegetables, staple food and fruits). “Grain-egg-nut complex” pattern was significantly positively related to the risk of dyslipidemia (OR: 1.10; 95% CI: 1.05–1.16, p<0.05). The multivaria- ble-adjusted ORs across tertiles of each dietary pattern were significantly associated with each component of dyslipidemia indexes. Conclusions: Grain-egg-nut complex dietary pattern was positively associated with dyslipidemia. All three dietary patterns were associated with blood lipid profiles aberrations.
Many studies have investigated the association between dietary iron intake and death due to cardiovascular disease (CVD), but the results were inconsistent. We performed a dose–response me- ta-analysis to quantitatively assess the risk of CVD mortality with dietary intake of iron (total iron, heme iron, and non-heme iron). Methods and Study Design: PubMed and Embase databases were searched for articles published up to February 21, 2019. Prospective cohort studies were included if reporting relative risks (RRs) and 95% confidence intervals (CIs) for risk of CVD mortality associated with dietary iron intake. Restricted cubic splines were used to model the dose–response association. Results: We included eight articles (19 studies includ- ing 720,427 participants [46,045 deaths due to CVD]) in the meta-analysis. When comparing the highest versus lowest level of dietary heme iron intake, the pooled RR for CVD mortality was 1.19 (95% CI, 1.01–1.39). With a 1-mg/day increase in dietary heme iron intake, the pooled RR for death due to CVD, stroke, coronary heart dis- ease, and myocardial infarction were 1.25 (95% CI, 1.17–1.33), 1.17 (1.04–1.32), 1.25 (0.70–2.22), and 1.17 (0.55–2.50) respectively. The association between dietary iron intake and CVD mortality was linear (pnonlineari- ty>0.05). Conclusions: Higher dietary intake of heme iron was associated with a greater risk of CVD mortality. Reducing consumption of heme iron may help to prevent premature death due to CVD.
Previous study has reported phosphorus intake is associated prostate cancer (PCa), but the association between phosphorus intake and serum prostate specific antigen (PSA) levels hasn't been re- ported in non-history of PCa population. Therefore, we performed a secondary data analysis based on existing da- ta from the public Nutrition Examination Survey (NHANES) (2003-2010) database. Methods and Study Design: Totally 6403 participants were selected from NHANES (2003-2010) database. The interested independent and dependent variables were considered as dietary phosphorus intake and PSA level, respectively. Covariates includ- ed demographic data, dietary data, physical examination data, and comorbidities. Weighted linear regression and generalized additive models were used to addressing the linear and non-linear link of phosphorus intake to PSA level. Results: Linear association between phosphorus intake and PSA was not detected [β=0.016 (95% Confi- dence Interval (CI) -0.012, 0.045)]. But we found an existing nonlinearity. By the recursive algorithm, the inflec- tion point was 1151 mg. On the left side of the inflection point, we did not find the correlation between dietary phosphorus intake (per 100 change) and PSA level [β=-0.04 (95% CI -0.11, 0.02), p=0.2155], while dietary phos- phorus intake (per 100 change) positively associated with PSA [β=0.05 (95% CI 0.01, 0.09) p=0.0293] on the right side of inflection point. Conclusions: There is a non-linear correlation between dietary phosphorus intake and PSA. Dietary phosphorus intake was positively associated with increased PSA when dietary phosphorus in- take is beyond 1151 mg after adjusting other covariates. Over 1151 mg per day dietary phosphorus intake may be the risk factor for PSA increasing.
Using a linear programming approach, an optimized food-based recommendations (FBRs) had been formulated for Minangkabau women of reproductive age with dyslipidemia in Indonesia. This study aimed to assess the effectiveness of the promotion of the FBRs for improving dietary practices and nutrient intakes. Methods and Study Design: A community-based, clustered-randomized trial was conducted among Minangkabau women of reproductive age (20–44 years) with dyslipidemia. The subjects were assigned either in- to the FBR group (n=48), or the non-FBR group (n=54). Baseline and end-line dietary data were assessed through interviews using a one-week semiquantitative food frequency questionnaire (SQ-FFQ) and two replicate 24-hour dietary recalls. The changes in dietary practice and nutrient intakes were analysed using ANCOVA test. Results: Significant changes were observed (p<0.005) in the consumption of the promoted food items and subgroups (sea fish, soy protein, dark green leafy vegetables, and potatoes). Significant changes were also observed in nutrient intake, especially energy intake from carbohydrates and unsaturated fatty acids (total PUFA, MUFA, n-3 and n-6 fatty acids), as well as the dietary P/S ratio and fiber intake. Conclusions: With current dietary practices, intakes of some typical problem nutrients such as n-6, zinc, iron, and fiber still could not achieve 100% of the RNIs, while the intake of SFA still exceeded the recommended intake. Further approaches are needed to expand the population food basket and promote behavioral change to address established cultural food habits, including re- ducing the use of cooking oil in food preparation and increasing vegetable consumption.
Mental health disorders amongst pregnant and postpartum women are an increas- ing public health concern. Our aim was to determine the association between fruit and vegetable intake and psy- chological distress in a nationally representative sample of Australian pregnant and breastfeeding women. Meth- ods and Study Design: This study used cross-sectional data collected by the Australian Bureau of Statistics in the 2014 to 2015 Australian National Health Survey. Participants included 166 pregnant and 207 breastfeeding women >18 years old. Number of serves of fruit and vegetables usually consumed each day was reported. The Kessler Psychological Distress Scale (K10) measured levels of global non-specific psychological distress. The as- sociation between fruit and vegetable intake and psychological distress was investigated using linear regression adjusted for available known covariates (age, education, physical activity). Results: Mean±SD fruit intake was greater in pregnant compared to breastfeeding women (2.0±1.0 versus 1.7±1.0, p<0.05). The mean K10 score for both the pregnant and breastfeeding women was in the 10-15 ‘little or no psychological distress” range. In preg- nant women, combined fruit and vegetable intake was inversely associated with psychological distress in the fully adjusted model (β=-0.37, 95% CI -0.72, -0.02). There was no association between fruit and vegetable intake and psychological distress in breastfeeding women. Conclusions: A higher intake of combined fruit and vegetables was found to be associated with less psychological distress in pregnant women. Further research, including lon- gitudinal and intervention studies, are required to determine causality between fruit and vegetable intake and psy- chological distress in this population group.
The efficacy of nutrient interventions to prevent/reverse stunting is considered to be restricted to early life. Whether such interventions are equally effective in later childhood is not clear. The pre- sent study evaluated the effect of a food-based high-quality protein and micronutrient intervention on the linear growth of Indian primary school children. Methods and Study Design: A secondary analysis of a one-year milk- protein and micronutrient fortified food product intervention (protein-energy ratio: 12.8%) on the height of 550 children aged 6-10 years, of poor-socioeconomic background, was carried out. Height and weight increments were compared between groups of each year of age using multiple linear regression. Comparisons in prevalence of stunting and underweight between these groups was also made. Results: The overall mean height increment at the end of 1-year was 6.10±1.07 cm, the highest being for 6-year olds (6.38±0.84 cm). The mean height incre- ments in 6, 7 and 8-year-olds were significantly higher (all p<0.05) than the expected median growth. Height-for- age score increased across all age-groups (by 0.14±0.18) and was significantly higher in 6-year olds compared to the rest. Stunting reduced by 12% in 6- year olds in comparison to the older age-groups. No significant associa- tion was observed between height gain and gender. The increased BMI-for-age scores were significantly lower for the 6-year olds compared to older children. Conclusions: Food supplements containing high-quality protein (like milk) along with micronutrients, can continue to influence height of children even in primary school, alt- hough the most effect is seen in younger children.
This study evaluated the association of the Mediterranean Diet Quality Index (KIDMED index) with neck circumference, obesity, and abdominal obesity in a national sample of Turkish chil- dren aged 6–9 years. It was hypothesized that the Mediterranean diet has beneficial effects on BMI and waist and neck circumferences in children. Methods and Study Design: The study sample consisted of 900 children aged 6–9 years recruited from seven primary schools in Ünye District in Ordu, Turkey. Anthropometric data were col- lected. The KIDMED score was used to assess the children’s adherence to the Mediterranean diet. Results: Com- pared with girls, a higher percentage of boys were obese (27.9% vs 22.2%), and the KIDMED score differed be- tween boys (4.89±2.0) and girls (5.27±2.48; p<0.05). Only 18.7% of children had optimal KIDMED scores, and 35.7% had poor KIDMED scores. Compared with boys and girls with medium and optimal KIDMED scores, boys and girls with poor KIDMED scores had higher body weight, height, BMI, and waist and neck circumfer- ences (p<0.05). KIDMED scores of overweight boys and girls were higher than those of obese boys and girls (p<0.05). An inverse correlation was found between KIDMED scores and body weight, BMI, and waist and neck circumferences. Conclusions: The Mediterranean dietary pattern is significantly associated with improved an- thropometric measurements in children. These results demonstrate that providing a diet similar to the Mediterra- nean diet can prevent obesity and related disorders in children.
Type 2 diabetes (T2D) caused by the complex interplay of both genetic and environmental factors, is a serious public health issue. Compelling evidence from epidemiological studies has highlighted that an unhealthy lifestyle, such as obesity, physical inactivity and poor diet are significant drivers of the epidemic of T2D. Meanwhile, re- cent genome-wide association studies (GWAS) have identified a large number of T2D and glycemic traits loci. Emerging data emphasize the critical role that gene-environment interactions have played in the development of T2D. Identifying the genetic, environmental factors and their complex interplays may help elucidate the biologi- cal pathways of T2D, identify the high-risk groups and characterize heterogeneity in intervention programs. This review summarized the studies investigating gene-environment interactions of T2D.
Although Dietary Guidelines for Chinese Residents offers advice for breakfast in China, current breakfast consumption habits are unclear. The aim of this study was to describe the frequency of breakfast consumption among adults and explore its associations with daily food consumption and daily nutrient intake. Methods and Study Design: A stratified cluster sampling technique was employed in this cross-sectional study. Demographic characteristics, breakfast consumption, and daily food and nutrient intake were investigated. Results: Dietary data were collected for 3251 adult residents through interviews. We determined that residents with an annual income of <CN¥10000 were the group with the highest rate of breakfast consumption. Among adults living at home, those who were retired had the highest proportion of breakfast eaters (92.1%), whereas among adults not living at home, commercial services and production personnel had the highest proportion of breakfast eaters (83.8%). Residents who never ate breakfast had a lower daily intake of rice, dark-colored vegeta- bles, pork, poultry, and fish and shrimp and a higher daily intake of bean products and instant foods (p<0.05). Residents who never ate breakfast had a higher daily intake of energy, fat, and carbohydrates, and a lower intake of protein, retinol, vitamins A and C, carotene, Ca, P, K, Mg, Zn, Se, and Mn (p<0.05). Conclusions: Breakfast skipping may influence the daily intake of nutrients. A simple and important public health message should be de- livered to target populations.
Dietary diversity is an indicator of diet quality. Dietary diversity has been suggest- ed to result in good nutrient intake, but it can affect dietary cost. We examined whether dietary diversity corre- lates with nutrient intake and monetary diet cost. Methods and Study Design: We used data for 3985 individuals (age range: 20–64 years) from the 2014 Japan National Health and Nutrition Survey (NHNS). Dietary diversity was assessed using the food variety score (FVS; the number of foods) and dietary diversity score (DDS; the num- ber of food groups, range: 1–14). Mean energy and nutrient intake from NHNS, and diet cost from the National Retail Price Survey were compared among FVS quartiles using the Kruskal-Wallis test, and between 2 groups with median DDS using the Mann-Whitney U test. Results: Mean (SD) FVS and DDS per day were 22.3 (7.2) and 9.8 (2.0), respectively. For most nutrients, intake per 4184 kJ was relatively high when FVS was high (p<0.001); however, carbohydrate intake was relatively high in the low-FVS group (p<0.001). For all nutrients with significant differences, intake was higher in the group with high DDS (≥10). Monetary diet cost was higher in the high-FVS and DDS groups compared with the low groups (p<0.001). Conclusions: Intake of a variety of food and food groups resulted in higher intake of various nutrients as well as higher monetary diet cost. Addition- ally, care should be taken to avoid excessive intake of nutrients such as sodium and SFA that may result from di- verse diets.
This study aimed to explore the changes of gut bacteria in bladder cancer patients. Methods and Study Design: Newly diagnosed bladder cancer patients were recruited. All participants completed a questionnaire about personal behavior and diet. Pyrosequencing of the total genomic DNA extracted from human feces was carried out by Illumina HiSeq 2000. The copy number of target DNA for bacteria was determined by real-time quantitative PCR assay. Fecal short chain fatty acids contents were measured by gas chromatography (GC) analysis. The concentrations of lipopolysaccharide and D-lactic acid in serum were determined by enzyme-linked immunosorbent assay kits. Results: Fruit intake was significantly lower than in healthy controls. The numbers of Clostridium cluster XI and Prevotella in bladder cancer patients decreased. The numbers of domain bacteria and Prevotella were significantly and positively associated with fruit intake (r=0.002, p<0.05 for domain bacteria; r=0.004, p<0.05 for Prevotella). The concentration of butyric acid decreased significantly in bladder cancer patients, and the quantities of fecal butyric acid were significantly and positively associated with fruit intake (r=0.610, p<0.01). The concentrations of lipopolysaccharide and D-lactic acid, two sensitive markers of gut permeability, were greater in bladder cancer patients. Conclusions: Dysbiosis of gut microbiota, decreased butyric acid concen- trations and impaired intestinal structural integrity were found in bladder cancer patients, which might be associated with inadequate fruit intake.
Koreans tend to have high sodium intake in restaurants. This study assessed the effect of the sodium reduction project in restaurants in Daegu Metropolitan City. Methods and Study Design: A total of 156 sodium reduction menu items offered by 90 restaurants were categorized into 11 food groups to compare sodium content and salinity before and after the project. In total, 162 owners and staff members of the restaurants, as well as 727 of their customers, were surveyed on their perceptions of and satisfaction with the sodium reduction project. Results: Average salinity of the menu items was significantly reduced from 0.70% prior to the project to 0.49% after the project (p<0.001), and average sodium content was also significantly reduced from 1,470 mg to 980 mg (p<0.001). The food groups with the highest sodium reduction rate were soups (46.0%) and grilled dishes (39.5%), with an average sodium reduction rate of 36.1%. The restaurant owners’ average satisfaction score with the project was 39.6 points (out of 50). Customers responded that the sodium reduction menus were moderate (62.4%) and bland (27.9%), and the taste was good (48.9%) and excellent (25.0%). Approximately 52.0% and 18.6% of customers were satisfied and very satisfied, respectively, with the sodium reduction menu. Conclusions: Overall, the sodium reduction project in restaurants in Daegu had a positive effect because it successfully reduced the sodium content of food while also boosting the satisfaction of the restaurant owners and staff and their customers with the project.
Fortifying commercial table salt with iodine is the principal strategy used globally to prevent dietary iodine deficiency. However, the costs of providing fortified salt to remote communities may re- sult in it not being locally available or too expensive for many households. This study shows that barriers to con- suming adequately iodized salt remain significant for remote rural households in Papua New Guinea (PNG). Methods and Study Design: Using data from a rural household survey conducted in four areas of PNG in 2018, two issues are examined. First, we contrast the characteristics of households that reported consuming or not con- suming iodized table salt, respectively. Second, the adequacy of the iodine content of samples of table salt con- sumed was assessed in the laboratory. Results: Nine percent of the 1,026 survey households reported not con- suming iodized table salt. These households tend to live in remote communities, are among the poorest house- holds, have received no formal education, and have experienced recent food insecurity. Second, 17 percent of the 778 salt samples tested had inadequate iodine. The brand of salt most commonly consumed had the highest share of samples with inadequate iodine levels. Conclusions: Particularly in remote communities, ensuring that indi- viduals consume sufficient iodine will require going beyond salt iodization to use other approaches to iodine sup- plementation. To ensure that the iodine intake of those using commercial table salt is adequate, closer monitoring of the iodine content in table salt produced or imported into PNG and enforcement of salt iodization regulations is required.
Notable inter-individual differences in cholesterol-lowering effects following oat- meal consumption have been previously reported. Genetic variations may among the reasons for the heterogene- ous response to lipid modulations. And to determine whether SNP of cytochrome P450 family 7 subfamily A member 1 gene rs3808607 and isoforms of apolipoprotein E are associated with the inter-individual variations in cholesterol-lowering effects of oatmeal consumption, we did this study. Methods and Study Design: Data in this study were extracted from a parallel, controlled trial, in which 62 medication-naive hypercholesterolemic patients provided with staple food substitute of either 80 g/d oatmeal (n=31) or 80 g/d refined white rice (n=31) for 45 days. Fasting blood samples were collected at baseline and endpoint of the study for lipid profiling, glycemic test- ing, and genotyping. Results: Totally, 56 of 62 participants completed the study and were thus included. Geno- type–diet interactions were observed between oatmeal consumption and SNP in the cytochrome P450 family 7 subfamily A member 1 gene rs3808607 in regulating LDL cholesterol (p=0.04); rs3808607-TT homozygotes ex- hibited significantly higher responsiveness to oatmeal (reduction in LDL cholesterol) than G allele carriers (GG/GT) (p=0.02). However, obvious genotype–diet interactions were not observed between oatmeal consump- tion and apolipoprotein E isoforms in cholesterol and glycemic modulation (p>0.05). Conclusions: SNP in cyto- chrome P450 family 7 subfamily A member 1 gene rs3808607 was associated with the extent of LDL cholesterol reduction following oatmeal consumption. Trials with larger sample sizes are required to confirm the findings.
Dysphagia is a common clinical symptoms among older adults. The incidence of dysphagia is high, and it can easily cause complications such as aspiration, aspiration pneumonia, and malnutri- tion; affect clinical outcomes; and even become life-threatening. Nutrition for patients with dysphagia is consid- ered the first problem to address in dysphagia intervention. Currently, China has no standard for food classifica- tion and nutrition management for patients with dysphagia. Methods and Study Design: The Dysphagia Reha- bilitation Specialty Committee of Chinese Association of Rehabilitation Medicine and the Elderly Nutrition Committee of Chinese Nutrition Society organized and led Chinese experts in related fields to publish the “Chi- nese Expert Consensus on Dysphagia and Nutrition Management 2019.” The goals of the publication were two- fold: (1) to establish and improve Chinese dietary standards for dysphagia, and (2) to promote the development of special food industries for dysphagia. Results: This report systematically explains the content of nutrition man- agement for patients with dysphagia and can serve as a reference for medical and food industry in related fields.
Nutritional screening has been recommended for hospitalized patients. The goal of this study was to compare the screening value of Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Uni- versal Screening Tool (MUST), and Malnutrition Screening Tool (MST) in inpatients with laryngeal cancer, and to identify which is the most accurate. Methods and Study Design: An observational cross-sectional study of 197 laryngeal cancer patients admitted for surgery was conducted using continuous sampling. NRS-2002, MUST, and MST were used to screen the nutritional risk of patients after admission and before discharge. Diagnostic in- formation and the length-of-hospital stay (LOS) data were extracted from the hospital HIS system. Results: The detection rates of NRS-2002, MUST, and MST in admission or discharge patients were 14.7%/27.9%, 22.3%/26.9%, and 4.6%/11.2%, respectively. Using NRS-2002 as the reference, high sensitivity (82.8%) and a Kappa coefficient (k=0.584) were achieved using MUST in admission patients, while MST presented the lowest sensitivity (17.3%) and Kappa coefficient (k=0.208). MST maintained low sensitivity (25.5%) and Kappa coeffi- cient (k=0.243) in discharge patients. NRS-2002 ≥3 was an independent risk factor for longer LOS in patients with laryngeal cancer (odds ratio (OR)=5.59, 95% confidence interval (CI)=1.86–16.81, p=0.002). The MUST and MST scores did not predict long LOS. Conclusions: Compared with NRS-2002, MUST is superior to MST in sensitivity, specificity, and Kappa coefficient. NRS-2002 better identified patients at risk for longer LOS, but a consistent conclusion was not reached with MUST and MST. Further validation in larger samples is needed.
We investigated the effects of a carbohydrate-whey protein solution on aged pa- tients undergoing hip fracture surgery. Methods and Study Design: Forty patients were randomly assigned to the carbohydrate-whey protein (CHP) group or the control group (CTL). In the CHP group, a mixed solution of CHP was orally administered to patients before surgery: 400 mL was administered on the day before surgery, and 200 mL was administered 3 h before surgery. The size of the liquid dark area in the gastric antrum was measured by ultrasound, and the bleeding volume during surgery was assayed. The incidence of nausea, vomiting, thirst, hunger, and days of hospitalization and the levels of blood glucose, C-reactive protein (CRP) and serum albumin were assessed. Results: There was no obvious liquid dark space in the gastric antrum. CHP administration im- proved postoperative thirst and hunger and resulted in increased albumin levels and decreased CRP concentra- tions and blood glucose fluctuations. Conclusions: Oral CHP before hip fracture surgery reduces the incidence of postoperative thirst and hunger and improves recovery in the aged.
Enteral nutrition (EN) plays a vital role in promoting the recovery of patients after surgery. This study aims to clarify the effects of total protein enteral nutrition (TPEN) and short peptide enteral nutrition (SPEN) on the recovery of patients after radical gastrectomy. Methods and Study Design: Patients un- derwent radical gastrectomy were randomly divided into a TPEN (n=60) or SPEN group (n=60). These two kinds of EN were fed 24 hours after radical gastrectomy with increasing dose from 10 kcal/kg to maximal 25 kcal/kg on postoperative day (POD) 5 and with the maximal dose in following days. Supplemental parenteral nutrition was given for replenishing energy deficits. The tube feeding was discontinued when oral intake increased to sixty per- cent of the target requirements. The postoperative recovery was evaluated on POD 1 and POD 7. Results: On POD 7, the serum prealbumin (transthyretin) was higher in the TPEN than the SPEN group (p<0.001). The pa- tients in the TPEN group had a higher incidence of abdominal distension (p=0.043), but had a lower incidence of diarrhea (p=0.016) compared to the SPEN group. The anal exhaust time of patients in the TPEN group was post- poned (p=0.020), but the postoperative hospitalization time (p=0.005) and total hospitalization time (p=0.027) were shortened compared to the SPEN group. No significant differences were observed between the two groups in any other indicators. Conclusions: SPEN is suitable for early and TPEN for later stage recovery after radical gastrectomy.
This study aimed to evaluate whether B vitamins supplementation would improve dyslipidemia, alleviate inflammatory state of patients with stable coronary artery disease (SCAD). Methods and Study Design: We conducted a randomized, double-blind, 12-week, placebo-controlled trial involving adults with SCAD, and who were randomly divided into B vitamins group (folic acid and VB-6) and control group (pla- cebo tablet). Blood tests had also been performed at baseline and endpoint. Results: After 12 weeks of interven- tion, B vitamins supplementation significantly improved the concentration of serum TG, TC and HDL-C (p<0.05). Changes of serum homocysteine in B vitamins treatment were significantly different compared to placebo by the multivariate-adjusted analysis (3.02±2.35 vs 1.55±1.58 p<0.001). Meanwhile, the levels of IL-1β and IL-10, sig- nificant difference were observed between two groups after adjustment for confounding factors. Conclusions: Supplementation with B vitamins significantly improves lipid metabolism, alleviate inflammation and serum ho- mocysteine concentration in patients with SCAD.
Several studies have shown that glutamine (Gln) may play an important role in en- ergy metabolism, inflammatory reactions, and immune processes in patients with severe acute pancreatitis (SAP). Nevertheless, the results of individual randomized controlled trials (RCTs) on Gln nutrition support for SAP are contradictory. This systematic review and meta-analysis evaluated the clinical benefit of Gln-supported early en- teral nutrition (G+EEN) in patients with SAP. Methods and Study Design: Cochrane Library, PubMed, Embase, CNKI, Wan Fang, and Chinese Biomedical Literature Database were searched for relevant studies published be- fore December 2018. RCTs of G+EEN versus standard early enteral nutrition (EEN) for SAP were selected, with both started within 48 h of admission. Results: Seven clinical RCTs including a total of 433 patients (EEN group: 218 patients; G+EEN group: 215 patients) were included. Compared with EEN, G+EEN increased serum albumin (standard mean difference [SMD]=0.74; 95% confidence interval [CI], 0.33–1.15; p<0.01), reduced serum hyper- sensitive C-reactive protein (SMD=−1.62; 95% CI, −1.98 to −1.26; p<0.01) and risks of mortality risk (risk ra- tio=0.38; 95% CI, 0.16–0.90; p=0.03) and multiple organ dysfunction syndrome (MODS)(risk ratio=0.37; 95% CI, 0.15–0.94; p<0.01), and shortened length of hospital stay (SMD=−1.19; 95% CI, −1.88 to 0.49; p<0.01); moreover, it did not significantly increase the incidence of infection-related complications, operative interven- tions, or APACHE II scores. Conclusions: G+EEN is beneficial in SAP management.
Even though the nutritional status of patients following organ transplant has a sig- nificant effect on outcomes, the energy intake of transplant patients hospitalized in the intensive care department is not well reported. The present study aims to examine the medical nutritional therapy of transplant patients in a large transplant center. Methods and Study Design: Data were collected retrospectively. All patients after peri- operative transplant surgery or with late complications after organ transplants were included. The study included 78 patients who underwent liver (n=36), kidney (n=21), lung (n=14), pancreas (n=3) or both pancreas and kidney (n=4) transplants in 2017. Energy requirements were predicted using the Faisy-Fagon predictive equations calcu- lated daily for 14 days. Energy intake was assessed, and daily energy balance was calculated. Complications and mortality were noted. Results: The mean energy intake was 1150 kcal/day. Most patients were in a negative en- ergy balance (NEB; range –5735 to 3437 kcal/day). A greater NEB was associated with longer length of ventila- tion (LOV) and length of stay (LOS). The observed mortality rate was 42.3%. The correlation between energy balance (14 days) and LOS was r=–0.549; for LOV, it was r=–0.569. Patients who underwent lung transplant had the highest negative energy balance and the highest mortality (p<0.01). Conclusions: Most of the transplant pa- tients were underfed, and there was a significant correlation between energy balance and mortality (r=–0.324). Optimal energy intake should be assessed prospectively.
Aspiration pneumonia is a major cause of death in patients on nasogastric tube (NGT) feeding. This study aimed to evaluate the oropharyngeal dysphagia and stratify risk of pneumonia in pa- tients undergoing NGT feeding. Methods and Study Design: The study included patients on NGT feeding who underwent UGI endoscopy at Tri-Service General Hospital, Taiwan. Endoscopy was performed to examine the pharyngolaryngeal region. The severity of oropharyngeal dysphagia was evaluated according to the visualized amount and location of pooling of secretions in the pharyngolaryngeal region; 60 patients showed absent or min- imal amount of secretions (control group), 14 patients showed moderate-to-large amounts of secretions filling the pyriform sinus (pharyngeal group), and 27 patients showed secretions entering the laryngeal vestibule (laryngeal group). Demographic data and occurrence of pneumonia were analyzed. Results: The incidence of pneumonia was highest in the pharyngeal group (4.2±3.6 episodes/person-years), followed by the laryngeal (2.6±2.2 epi- sodes/person-years) and control groups (1.7±3.8 episodes/person-years) (p=0.042). Multivariable regression showed significantly higher risk of pneumonia in the pharyngeal (adjusted odds ratio=2.7, 95% CI, 2.4-2.8, p<0.001) and laryngeal (adjusted odds ratio=2.0, 95% CI, 1.7-2.4, p<0.001) groups. The cumulative incidence rate of pneumonia was significantly higher in the laryngeal and pharyngeal groups than in the control group (log rank test, p<0.001). Conclusions: Endoscopic pharyngolaryngeal observation can evaluate the oropharyngeal dysphagia. Visual evidence of oropharyngeal dysphagia increase the risk of pneumonia in patients on NGT feed- ing.