Nutrition was invented in the early 19th century as a biochemical science that reduces foods into significant chemical constituents. Ever since then, the teaching and practice of nutrition has been based on this conceptual framework, or paradigm. The examples given here are dietary guidelines and other food guides. The first guides issued up to the middle of the last century were designed to help prevent nutrient deficiencies, promote growth, and ensure plentiful diets. These recommended foods then thought to contain adequate proteins, fats, carbohydrates, vitamins, minerals and trace elements, as well as dietary energy. At a time of accelerating industrial production of food, they were generally effective. Within the second half of the century, guides were developed and changed to counter the rapid rise in heart disease in the USA, the UK, and other high-income countries. These recommended less foods of all types high in fat, saturated fat, cholesterol and sodium, more ‘complex carbohydrates’, and fruit and vegetables rich in microconstituents. They probably had some limited effect. In this century and now, dominant guides have been changed again in attempts to counter what has become pandemic obesity and diabetes. These recommend less food high in saturated fat, sugar and sodium, with less emphasis on total fat and more on sugar. They are not effective. All these guides are derived from and governed by the biochemical paradigm of nutrition science. This was once useful, but now should be discarded as obsolete except for addressing deficiencies. Here, a new paradigm is proposed.
Background and Objectives: Overconsumption of drinks containing fructose increases the risk for hyperuricemia and gout. Comparative analysis evaluating the indicators of serum uric acid (SUA) load caused by natural food-derived fructose and pure fructose in sweeteners is lacking. We aimed to uncover the effect of fructose from apple and honey and pure fructose powder on the SUA concentration of healthy young Chinese individuals. Methods and Study Design: Two randomized crossover trials were performed. The participants were randomly assigned to consume apple or honey (test food) or pure fructose powder (reference food); one week later, the groups’ dietary intervention was switched. Blood samples were collected at 0, 30, 60, and 120 min after meal to measure the SUA and blood glucose concentrations. Results: At 30 and 60 min, the SUA concentration in participants consuming apple or honey was lower than in those consuming fructose powder. At 120 min, the SUA concentration of participants consuming apple returned to baseline. The areas under the curve (AUC) within 2 h (2h-AUCs) of SUA exhibited the trend of fructose >honey >apple. The 2h-AUC ratio between test food and reference food was determined using the uric acid index to assess the efficiency of food-derived fructose in increasing the SUA concentration. The uric acid index of honey was higher than that of apple. Men had higher postprandial SUA concentration than women. Conclusions: Food-derived fructose caused a lighter load on uric acid metabolism than pure fructose. Uric acid index can be useful for distinguishing fructose-containing foods.
Background and Objectives: The present study aimed to investigate the hypothesis that dietary amino acid intakes are associated with the risk of sarcopenia through a community-based observational study. Methods and Study Design: A total of 1,140 participants (72.7±6.3 y) were recruited from an annual health check-up program in Qingdao, China. Skeletal muscle mass, muscle mass functions and biochemical parameters were measured by standard methods. Dietary intake was assessed by 3-day, 24-hour food records. The odds ratios (ORs) and 95% confidence intervals (CIs) of sarcopenic risk across quartiles of amino acid intakes were calculated using a multivariable-adjusted logistic regression model. Generalized linear models were used to assess the associations between dietary amino acid intakes and muscle mass functions. Results: The prevalence of sarcopenia was 4.1%. Compared with the lowest category intake, the highest category of branched chain amino acids (BCAAs) (OR=0.11; 95% CI: 0.01, 0.90; p for trend=0.119), isoleucine (OR=0.11; 95% CI: 0.01, 0.89; p for trend=0.122) and tryptophan (OR=0.10; 95% CI: 0.01, 0.87; p for trend=0.176) was negatively correlated with sarcopenic risk with adjustment for potential confounding factors. Generalized linear model analysis showed that gait speed was positively correlated with dietary intakes of lysine, threonine, leucine, valine, tryptophan, BCAAs and aromatic amino acids (p<0.05). Conclusions: Higher intakes of BCAAs were associated with a lower risk of sarcopenia, which might beneficially protect against sarcopenia and improve physical function of the elderly.
Background and Objectives: To assess the general and nutritional health of children with attention deficit/hyperactivity disorder (ADHD). Methods and Study Design: The National Multicenter Sleep Research Database for 23791 school-age children in grades 1-6 from 9 cities in China was accessed. Children with a specialist diagnosis of ADHD or not (non-ADHD) in 2005 were studied. National anthropometric growth standards for children aged 2-18 years classified children as underweight, wasted, stunted (short stature presumed nutritional), or overweight/obesity. Independent variables were preterm birth, sleep quality and prior disease and ADHD was the dependent variable. Binary logistic regression models were developed along with interaction analyses for associated disorder or disease on overweight/obesity, and stunted. Results: Some 18731 records were analyzed for 808 children with ADHD. The comparative prevalences for ADHD with non-ADHD children were stunted 9.8% vs 5.9% (p<0.001) and overweight/ obesity (32.6% vs 29.6%, p=0.002) respectively. ADHD boys were more often underweight (7.5% vs 5.3%, p=0.027), but not in girls. ADHD likelihood Odds Ratios, ORs (with 95%CI) were for premature birth 1.838, (1.393-2.423), allergic diseases 1.915 (1.526-2.399), otitis media 1.54 (1.118-2.146), tonsillar or adenoid hypertrophy1.662 (1.348-2.050), gastroesophageal reflux 3.008(1.792-1.792-5.049), and sleep disorder 2.201(1.847-2.623) were ADHD risk factors. Only poor sleep quality and ADHD exhibited an interaction for stunted with OR=0.409 (0.233-0.719). Conclusions: Compromised and complex nutritional health in ADHD children challenges clinical nutrition with a range of health problems, albeit coherent with the needed nutritional emphasis in the ‘first 1000 days’.
Background and Objectives: Energy provided by macronutrients plays a key role in healthy aging. This study therefore explored the association between macronutrients and cognitive function in elderly populations in rural areas of Qingdao, China. Methods and Study Design: This study included 1,504 participants over the age of 65 recruited from Licha Town, Qingdao City, China. Dietary intake was measured using the Food Frequency Questionnaire, and cognitive function was assessed using the Mini-Mental State Examination. Logistic regression models were used to evaluate the association between dietary macronutrient intake and cognitive function. In addition, restricted cubic bars were applied to determine the dose–response relationship between macronutrient ratios and cognitive performance. Results: A total of 877 adults over the age of 65 were included. After adjusting the weighted multiple variables, significant positive associations were revealed between protein and moderate carbohydrate intake and cognitive ability, but a negative association between fat intake and cognitive performance was identified. After calculating the daily energy supply ratio, similar associations were revealed between fat and protein intake and cognitive function. Furthermore, the ratio of proteins to carbohydrates had a U-shaped relationship with cognitive function (pnonlinearity=0.674), whereas the ratio of proteins to fats was L-shaped with lower cognitive function (pnonlinearity<0.001). Compared with the lowest quartile of the ratio of protein to fat intake, the weighted adjusted OR (95% CI) of the highest quartile was 0.509 (0.314, 0.827) for low cognitive performance. Conclusions: With an adequate carbohydrate supply, appropriately increasing dietary protein intake and reducing fat intake might benefit the cognitive function of elders in rural areas.
Background and Objectives: Malnutrition is potentially preventable in older people, but with varied reported prevalence. We assessed its prevalence, assessment methods, and risk factors in older Thai people. Methods and Study Design: Studies published from January 1, 2000, to September 30, 2020 were searched in Medline, EMBASE, Google Scholar, and local databases. A random-effects model was used to calculate pooled prevalence with subgroups analysis (setting of the patient, region). Forest plots displayed sensitivity and specificity for all nutritional screening tools validated against Mini Nutritional Assessment (MNA) with tests for heterogeneity. Publication bias was tested by funnel plot and Egger’s test. Results: 71 studies (total 23,788 subjects) were included where mean age was 65.5 to 78.3 years. The pooled prevalences of malnutrition were 10.4%, 6.1%, and 5.7% by body mass index (BMI), MNA, and MNA-Short Form (MNA-SF), respectively. At-risk of malnutrition prevalence was 42.6% using the MNA and 37.8% using the MNA-SF. The pooled prevalence of malnutrition by BMI <18.5 kg/m2 was 10.4% (95% CI 8.7-12.4). The pooled prevalence of malnutrition based on MNA was 6.1% (95% CI 3.8-9.4). It was highest among hospitalized patients and lowest in community-dwelling elders by both measures. Factors associated with malnutrition were female sex, advanced age, low education, living alone, living in rural areas, comorbidities, eating problems, and geriatric conditions. Conclusions: The pooled prevalence of elder malnutrition was 6-10%, depending on assessment method and study setting. Hospitalized older people were at increased risk of malnutrition. It might be ameliorated through community directed food systems.
Background and Objectives: South Asians are known to have excess adiposity at a lower body mass index, with truncal fat accumulation. Whether this confers higher risk to develop severe COVID-19 is not known. This study evaluated body mass index, body fat mass and waist circumference as risk factors for COVID-19 severity and its progression, in South Asian adults. Methods and Study Design: Details of COVID-19 patients (19-90 years) were obtained prospectively, along with weight, height, waist circumference and body fat mass assessed by bioelectrical impedance analysis. Binomial logistic and Poisson regression were performed to test associations between waist circumference, body fat mass and body mass index to evaluate the adjusted OR or relative risk for disease severity at admission and length of stay. Results: After adjusting for age, sex, height and co-morbidities, body mass index >23 kg/m2 (adjusted OR 2.758, 95% CI 1.025, 7.427), waist circumference (adjusted OR 1.047, 95% CI 1.002, 1.093) and body fat mass (adjusted OR 1.111, 95% CI 1.013, 1.219) were associated with a significant risk for disease severity at admission, while only waist circumference (adjusted relative risk 1.004, 95% CI 1.001, 1.008), and body fat mass (adjusted relative risk 1.011, 95% CI 1.003, 1.018), were associated with a significantly longer length of stay. Conclusions: Body mass index, at a lower cut-off of >23 kg/m2, is a significant risk factor for COVID-19 disease severity in the group of patients studied. The waist circumference and body fat mass are also good indicators for both severity at admission and length of stay.
Background and Objectives: Cow’s milk allergy (CMA) is the most common food allergy in young children. Previous studies have reported that single-nucleotide polymorphisms (SNPs) are associated with CMA. The extent to which SNPs contribute to the occurrence of CMA is unknown. The purpose of this study was to investigate the independent relevance of genetic predisposition to CMA in Chinese children. Methods and Study Design: 200 infants with CMA and 799 healthy controls aged 0–12 months were included. Five previously identified genetic variants (rs17616434, rs2069772, rs1800896, rs855791 and rs20541) were genotyped. Logistic regression was used to analyze the genetic associations or their interactions with a family history of allergy on CMA. Results: Among the five SNPs, only IL10 rs1800896 was significantly associated with CMA (odds ratio (OR) 1.60, p=0.042). Each 1-risk allele increase in the genetic risk score (GRS) was suggestively associated with an 11% higher risk of CMA (1.11: 0.99–1.27, p=0.069) and a 45% increased risk of CMA in the GRS high-risk group compared to the GRS low-risk group (1.45: 1.02–2.06, p=0.037). Furthermore, parental allergy also increased the risk of CMA among children (1.87: 1.46–2.39, p<0.001). Importantly, parental allergy exacerbated the genetic effect on the risk of CMA. Conclusions: The rs1800896 variant in the IL-10 gene is associated with CMA in Chinese children. In addition, the GRS had an interaction with parental history of allergy, implying that genetic risk for CMA was exacerbated among those with parental history of allergy.
The aim of this review is to provide an overview of the present association between Intermittent Fasting (IF), the Gut Microbiota (GM), and the adipocyte with respect to Metabolic Health (MH). A search was carried out through Dialnet, Scielo, Web of Science, Redalyc and PubMed, using keywords such as: “intermittent fasting”, “time-restricted feeding”, “gut microbiota” and “Metabolic Health”. Intermittent fasting (IF) regimens promote weight loss, therefore contributing to improved metabolic health. IF beneficially participates in the modulation of the intestinal microbiome, allowing a continuous interaction with nutrients to be digested and shaping the intestinal immune responses during the development of cardiovascular disease, blood pressure and diabetes mellitus through metabolic activities.
Background and Objectives: It has been proven that skeletal muscle index (SMI) and muscle attenuation (MA) are correlated with outcomes in liver cirrhosis. However, whether there are sex differences in these factors remains unknown. We aimed to analyze the predictive ability of SMI and MA for the prognosis of cirrhotic patients of different sexes and promote computed tomography (CT) use in body composition assessment. Methods and Study Design: CT images taken at the 3rd lumbar vertebra from 223 patients were quantified for body composition. A Cox regression model was used to assess associations between mortality and body composition. Time-dependent receiver operating characteristic curves were calculated to evaluate the predictive ability of SMI and MA for the 1-, 3- and 5- year mortality of cirrhotic patients. Results: The majority of patients with liver cirrhosis were male (64.6%), and there was a weak linear correlation between SMI and MA in males (r=0.33, p<0.001). In the sex stratified multivariate Cox regression analysis, SMI in males (HR=0.95; 95% CI, 0.91-0.98; p=0.002) and MA in females (HR=0.91; 95% CI, 0.87-0.96; p<0.001) were independently associated with mortality. The areas under the curve (AUCs) of SMI (AUC=0.718) and MA (AUC=0.705) were similar in the 5-year mortality prediction of males, while in females, MA (AUC=0.797) had a stronger predictive ability than SMI (AUC=0.541). Conclusions: SMI in males and MA in females are independent prognostic factors for liver cirrhosis. For females, MA may be a more sensitive indicator of mortality prediction than SMI, while in males, they are equivalent.
Background and Objectives: To evaluate the significance of diaphragm thickness (DT) in assessing the nutritional status and predicting the length of hospital stay (LOS) of patients with COVID-19. Methods and Study Design: The data of 212 patients with severe and critical COVID-19 in Wuhan, China, were retrospectively analyzed. Computed tomography (CT)-obtained DT was measured in cross-sectional images of the mediastinal window at the level of the outlet of the celiac trunk at admission and at 2 weeks, then the rate of change in DT(RCDT) at 2 weeks was calculated. Nutritional risk and malnutrition were evaluated at admission. Results: A total of 91 patients were involved in the study. The mean DT was 3.06±0.58 mm (3.15±0.63 mm in male and 2.93±0.50 mm in female). DT was significantly negatively correlated with malnutrition based on Global Leadership Initiative on Malnutrition (GLIM) criteria (r=−0.324, p=0.002), Nutritional Risk Screening 2002 (NRS-2002) score (r=−0.364, p=0.000) and the Malnutrition Universal Screening Tool (MUST) score (r=−0.326, p=0.002) at admission. For the prediction of LOS ≥4 weeks in patients with COVID-19, the area under the ROC curve (AUC) of the RCDT at 2 weeks was 0.772, while the AUCs of DT, NRS-2002, MUST and Nutrition Risk in Critically Ill scores at admission were 0.751, 0.676, 0.638 and 0.699 respectively. According to the model of multiple linear regression analysis, the DT at admission (β=−0.377, p=0.000), RCDT at 2 weeks (β =−0.323, p=0.001), and mechanical ventilation (β=0.192, p=0.031) were independent risk factors contributed to LOS. Conclusions: CT-obtained DT can be used as a dynamic assessment tool for evaluating the nutritional status of patients in isolation wards for COVID-19.
Background and Objectives: The aim is to investigate the association between nutritional status and clinical picture of pulmonary tuberculosis (PTB). Methods and Study Design: A total of 613 pulmonary tuberculosis patients in Weifang city, Shandong province, China were included. Clinical and nutritional history, anthropometry, nutritionally relevant indicators including serum total protein and albumin, hemoglobin and lymphocyte count were measured. Adjustments were made for confounders in multivariable logistic models where tuberculosis activity (clinical symptoms and signs, sputum–smear tests or chest computerized tomography (CT)) was the dependent variable. Results: Hypoalbuminemia (OR=2.61; 95% CI, 1.69–4.03), anemia (OR=1.62; 95% CI, 1.04–2.51) and lymphocytopenia (OR=1.92; 95% CI, 1.21–3.05) were associated with a higher TB score (a clinical severity measure for pulmonary tuberculosis based on typical signs and symptoms); hypoalbuminemia (OR=1.75; 95% CI, 1.08–2.84) and anemia (OR=1.87; 95% CI, 1.14–3.08) were associated with a positive sputum smear; anemia (OR=3.58; 95% CI, 1.85–6.94) was associated with cavitation in CT. Conclusions: Hypoalbuminemia, anemia and lymphocytopenia were positively associated with the severity of clinical manifestation of PTB. Nutritional status may be a marker for the severity of the clinical manifestations of PTB.
Background and Objectives: To evaluate the effectiveness of insulin addition to the total nutrition admixture (TNA) for glycemic control among patients with gastric cancer (GC) receiving supplementary parenteral nutrition (SPN) after gastrectomy. Methods and Study Design: A retrospective cohort study was conducted among 208 noncritical ill patients who underwent gastrectomy for GC from 2017 to 2019 at a tertiary teaching hospital in Lanzhou, China. All the included patients received individualized SPN and enteral nutrition treatment after gastrectomy. The patients were randomly divided into insulin and noninsulin groups based on the TNA composition. Blood glucose (BG) measurements, glycemic fluctuation, and hypoglycemia incidence during SPN were compared between the two groups. The postoperative comprehensive complications index (CI) and infections were compared according to insulin regimen and postoperative glycemic status. Results: The mean BG was significantly lower and fluctuated less in the insulin group than in the noninsulin group (p<0.05). One unit of insulin per 6 g of parenteral nutrition glucose addition to TNA did not increase hypoglycemia incidence (p>0.05). Comparing CI and the infection rate, no significance was observed between the insulin and noninsulin groups, but a higher postoperative CI was observed in patients with hyperglycemia than in euglycemic patients (p<0.05). Conclusions: Appropriate insulin addition to TNA has an overall positive effect on glycemic management in patients with noncritical GC who received SPN after gastrectomy. Postoperative glycemic status was associated with the incidence of relevant complications. Further research is needed for conclusive recommendations.
Background and Objectives: The variation in glycemic responses to white rice caused by the circadian rhythm has been widely investigated but remain controversial. This study investigated diurnal differences in the effect of rice meals on glycemic responses, insulin responses, satiety, and acute cognitive function. Methods and Study Design: A total of 20 healthy participants in Group 1 and 14 in Group 2 were served identical servings of cooked white rice containing 50 g of available carbohydrates at 8:00 a.m. (rice at breakfast), 12:30 p.m. (rice at lunch), and 5:00 p.m. (rice at early supper) in a randomized order. Postprandial blood glucose, insulin, satiety, and cognitive performance tests were conducted for each test meal. Results: The rice at an early supper elicited significantly milder glycemic responses than did the rice at lunch and resulted in a lower insulin sensitivity than did rice at breakfast. No difference was observed among the test meals in terms of hunger and prospective food intake. Diurnal acute cognitive performance did not differ considerably among the meals. A correlation analysis indicated that low variability in glycemic responses was positively associated with superior cognitive performance. Conclusions: A high–glycemic index white rice supper at 5:00 p.m. may facilitate daily glycemic management.
Background and Objectives: Inflammatory cytokines and metabolic abnormalities are common in patients with tuberculosis. Observational studies have indicated that probiotics modulate inflammatory cytokines and metabolites; however, clinical evidence of the effect of probiotics on patients with tuberculosis is lacking. This study investigated the effects of Lactobacillus casei on inflammatory cytokines and metabolites during tuberculosis treatment. Methods and Study Design: A randomized controlled trial was conducted. A total of 47 inpatients were included and randomly assigned to receive standard antituberculosis therapy only (control group) or that treatment together with 1 × 1010 colony-forming units per day of Lactobacillus casei (low-dose group) or 2 × 1010 colony-forming units per day of Lactobacillus casei (high-dose group) for 4 weeks of intensive treatment during hospitalization. Plasma samples were analyzed for inflammatory cytokines and metabolomics with ELISA kits and ultrahigh performance liquid chromatography quadrupole time-of-flight mass spectrometry. Results: Daily Lactobacillus casei supplementation of up to 2 × 1010 colony-forming units significantly lowered the concentrations of tumor necrosis factor-α, interleukin-6, interleukin-10, and interleukin-12 (p=0.007, p=0.042, p=0.002, p<0.001, respectively) in patients with tuberculosis. Compared with the control and low-dose groups, the plasma metabolites of phosphatidylserine, maresin 1, phosphatidylcholine, L-saccharopine, and pyridoxamine were significantly upregulated, and N-acetylmethionine, L-tryptophan, phosphatidylethanolamine, and phenylalanine were downregulated in the high-dose group. Strong correlations were observed between metabolites and inflammatory cytokines. Conclusions: Lactobacillus casei supplementation during the intensive phase of tuberculosis treatment can significantly modulate inflammatory cytokines and metabolites. Decreased inflammatory cytokines may be related to metabolite changes.
Background and Objectives: This study aimed to evaluate the effects of enteral immunonutrition (EIN) on the nutritional status of patients during the perioperative period of digestive system surgery. Methods and Study Design: The clinical data of 102 patients who underwent gastrointestinal surgery between August 2017 and February 2021 were retrospectively analyzed. According to the nutritional support regimen, the patients were divided into an enteral nutrition (EN) group (50 patients) and an EIN group (52 patients). Results: The times (in hours) to return of the first bowel sound, first postoperative flatus, and first bowel movement, as well as the length of postoperative hospital stay were shorter in the EIN group than in the EN group (p<0.05). The concentrations of hemoglobin, prealbumin, albumin, and transferrin, as well as the concentrations of immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), complement C3, and complement C4 were higher in the EIN group than in the EN group at 1 and 7 days after surgery (p<0.05). The concentrations of endotoxins, D-lactic acid, and diamine oxidase were lower in the EIN group than in the EN group (p<0.05). The tolerance to enteral feeding was better in the EIN group than in the EN group (p<0.05). The incidence of complications was lower in the EIN group (5.77%) than in the EN group (10.0%) (p>0.05). Conclusions: EIN can promote gastrointestinal function recovery, improve the nutritional status, enhance the humoral immune function, regulate intestinal flora balance, improve intestinal permeability, prevent enteral feeding intolerance, and reduce complications in patients undergoing surgery for digestive system diseases.