APJCN

Background and Objectives: This narrative review aims to provide recent understanding of the implications of maternal diet on fatty acid composition of breast milk, with focus on the docosahexaenoic acid (22:6n-3 (DHA) and arachidonic acid 20:4n-6 (AA) contents, for fetal growth and development.  Breast milk n6/n3 polyunsaturated fatty acids (PUFA) ratio will also be highlighted in relations to maternal lipid intake. Methods and Study Design: PubMed and Google Scholar were searched for relevant publications in English focusing on but not limited to the use of the key words stated below. Results: Studies since the 1950s of different population groups worldwide affirmed the recognition that breastmilk fatty acid compositions are highly sensitive to maternal diet.  Colostrum is richer in long-chain PUFA (LC-PUFA) metabolites of both linoleic and linolenic acids than mature milk.  Among these LC-PUFA, both DHA and AA are incorporated preferentially and rapidly within the cerebral cortex and the retina during the last trimester of pregnancy and postnatal 18 months.  Maternal supply of DHA and AA include maternal fatty acid stores, endogenous synthesis or directly from diet.  Decreasing fish intake concomitant with increased intake of meat and vegetable oil leading to decreased intake of DHA and EPA, and an increase in AA intake, have resulted in an imbalanced n-6/n-3 PUFA ratio in breastmilk. Conclusions: A balanced intake of PUFAs during pregnancy and lactation is recommended for fetal and childhood growth and development.

Background and Objectives: Nutritional status is presumed essential for healthy longevity. The city of Rugao in Jiangsu province recognized as a long-lived area on the coastal plain of China, with a higher proportion of centenarians than Chinese elsewhere or in the world at large. The nutritional status and related factors of centenarians in Rugao, along with muscle mass and activities of daily living (ADL) have been documented with a view to improved nutritional and health approaches to healthy ageing. Methods and Study Design: A cross-sectional study was conducted in Rugao from April 2020 to December 2020. 116 local centenarians agreed to participate in the study. Nutritional status was evaluated by the Mini Nutritional Assessment Short Form (MNA-SF), and ADL was assessed by the Barthel Index (BI). Anthropometric data (e.g., calf circumference) and body composition data (e.g., skeletal muscle mass) were collected as muscle mass variables. Results: The age of centenarians ranged from 100 to 109 years. According to MNA-SF assessment, only 6 (5.2%) of 116 centenarians were malnourished, and 57 (49.1%) were at risk of malnutrition. Binary logistic regression results indicated that prealbumin, albumin, bean product consumption, and current exercise status were independent determinants of centenarians’ nutritional status. Centenarians with poor nutritional status tended to have worse muscle mass and BI scores. Conclusions: Nearly half of the centenarians maintained normal nutritional status, insofar as muscle mass condition and function were concerned. Frequent bean product consumption and routine exercise were conducive to healthier centenarian nutritional status.

Background and Objectives: Previous studies have explored the relationship between lipid accumulation product (LAP) and hypertension or hyperuricemia. However, the association between LAP and hypertension with hyperuricemia (HWH) is inconclusive. Therefore, we aimed to evaluate the association between LAP and HWH. Methods and Study Design: A total of 7897 participants aged 18 to 75 years from the 2009 wave of the China Health and Nutrition Survey were included in this study. General linear regression models were built to assess the association of LAP with systolic blood pressure (SBP), diastolic blood pressure (DBP), and uric acid (UA) concentrations. Logistic regression models were used to estimate the association between LAP and HWH risk, restricted cubic splines (RCS) were used to analyze the dose-response relationship between them. Results: The prevalence of HWH was significantly higher in men (7.63%) than in women (1.99%) (c²=142; p<0.001). After adjustment for potential confounders, LAP scores were positively correlated with SBP, DBP, and UA concentrations in both genders (all p-trend <0.01). Compared with participants in the lowest quartile of LAP, those in the highest quartile had a higher risk of HWH [OR (95% CI)=12.2 (7.22-20.5) for men, OR (95% CI)=14.5 (3.50-60.2) for women]. The RCS results suggested a nonlinear relationship between the continuous change of LAP and HWH risk after adjustment for confounding factors in each gender (p for nonlinearity <0.001). Conclusions: Our findings suggest that higher LAP scores was strongly associated with greater HWH risk in Chinese adults.

Background and Objectives: Perception of body weight often affects dietary intake and biological nutrient concentrations. However, the association during pregnancy has not been clarified. This study examined the association of the perceived pre-pregnancy body weight with nutrient intake and circulating nutrient concentrations during pregnancy. Methods and Study Design: The cross-sectional study was conducted at a university hospital in Tokyo, Japan, from 2010 to 2014. Nutrient intake was assessed using a diet history questionnaire. The circulating concentrations of some nutrients were measured. The participants were divided into the following groups based on the perceived pre-pregnancy body weight: thin group (TG, n=174), average group (AG, n=357), and fat group (FG, n=220). Analysis of covariance was performed to compare the nutritional status among the groups. Results: Women in the AG had significantly higher energy-adjusted intake of important nutrients such as eicosapentaenoic acid, docosahexaenoic acid, total dietary fiber, calcium, iron, and folate compared with women in the TG or FG. Among women with pre-pregnancy normal body mass index (BMI), intakes of nutrients such as potassium, calcium, magnesium, and vitamin B₁ and the serum 25-hydroxyvitamin D and β-carotene concentrations were significantly lower in the FG than in TG or AG. Among women with pre-pregnancy underweight, no significant differences were found in the nutritional status between the groups. Conclusions: Pregnant Japanese women who overestimate their pre-pregnancy body weight despite having a normal BMI may need to have their nutritional status carefully assessed as a high-risk population for several nutrient deficiencies.

Background and Objectives: Regular breakfast consumption is widely considered an important component of healthy dietary habits. In this study, we assessed differences in nutrient/food intake between breakfast consumers and skippers. We also investigated behavioural factors related with breakfast skipping utilizing data collected from both children and their guardians. Methods and Study Design: This cross-sectional study was conducted in 14 public primary schools in Japan. Two questionnaires were distributed: a behavioural questionnaire and a brief-type, self-administered diet history questionnaire. In total, 1816 child (10-12 y/o)-guardian dyads were included in the analysis. Intakes of nutrients and foods were compared between breakfast consumers and skippers by the t-test. The relationship between breakfast skipping and behavioural factors was investigated by logistic regression analysis by child sex. Results: The proportion of breakfast skippers in the children was 9.8%. Daily intakes of nutrients/foods were better in the breakfast consumers. Later bedtime, lower nutrition knowledge level, and frequent incomplete consumption of home meals was significantly or marginally associated with breakfast skipping. Guardians’ breakfast skipping was also associated with children’s breakfast skipping. Some relationships between behavioural factors and breakfast skipping differed between boys and girls. Conclusions: Breakfast consumers had a more nutritious meal quality. To increase breakfast consumption, morning time schedules may need to be rearranged to avoid time pressure. Nutritional knowledge and dietary behaviour appear relevant. Guardians played a major role in coping with breakfast avoidance, in part as role models.

Background and Objectives: South Asia hosts the largest proportion of undernourished children in the world. Hidden hunger and undernutrition continue to be a major global health concern in the region. A systematic review looking at factors and drivers for hidden hunger and child undernutrition was undertaken. Methods and Study Design: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Five computerized databases were searched: CINAHL, EMBASE, PubMed, PsycINFO and Scopus, in addition to various grey literature sources. Results: A total of 3601 articles were retrieved from databases and 25 studies from grey literature, 98 studies met our inclusion criteria. Included studies were assessed for quality by validated tools. A Meta-ethnographic narrative approach was used to analyse the findings. The most commonly reported factors for child undernutrition were maternal education, poor dietary diversity and rural residence. Conclusions: Based on findings we propose a model to mainstream context specific nutrition behavioural change along with nutrition specific and sensitive interventions aimed at targeting gender, social and cultural factors and norms.  Findings from the review add to the extant literature of child undernutrition to inform policy and program.

Background and Objectives: Health-related quality of life (HRQoL) is a multidimensional concept that indicated an individual’s holistic health, whereby the urban-poor community are susceptible to low HRQoL due to their high vulnerability. This study aimed to determine factors that predicted the HRQoL among the urban-poor school-aged children. Methods and Study Design: This is a cross-sectional study and a total of 408 primary school-aged children (male: 72.3%; female: 27.7%), with a mean age of 9.68±1.48 years, were recruited from 10 urban-poor flats through cluster sampling at the central region of Malaysia. Their anthropometry, nutrition knowledge, attitude and practice, physical activity, dietary practices, and HRQoL were assessed. Results: A quarter (24.5%) of the urban-poor children were either overweight or obese in the present study. The HRQoL total score among the urban-poor children was 65.0±18.5. The result of multiple linear regression analysis shown that higher nutrition attitude (B=0.34, p=0.001) and practices (B=0.39, p=0.001), higher physical activity (B=3.73, p=0.004), higher lunch intake (B=1.35, p<0.001), lower supper intake (B=-1.35, p<0.001), and lower fast-food intake (B=-1.61, -1.17, p<0.001) are the significant predictors of better HRQoL among the urban-poor children (R²=0.32, F(8,399)=23.72, p<0.001). Conclusions: Future studies should focus on these predictors to formulate interventions that could enhance the HRQoL among the Malaysian urban-poor children.

Background and Objectives: Vitamin A is vital for the growth and health of children. This study aimed to estimate the current vitamin A status and the prevalence of vitamin A deficiency (VAD) among preschool children and explore the correlation between serum vitamin A concentration and changes in hematological parameters. Methods and Study Design: The study included 697 children aged 1-6 years, presenting for routine checkups at the Department of Pediatrics, Peking University Shougang Hospital, Beijing, from April 2017 to December 2020. We obtained the complete laboratory test data of 630 children. Results: The mean serum vitamin A concentration among preschool children was 0.29±0.08 mg/L, with a median of 0.29 mg/L. The proportion of children with VAD and marginal VAD (MVAD) was 9.84% and 43.49%, respectively. The highest prevalence of VAD and MVAD was in the 3- to 4-year age group. Compared with the normal vitamin A serum concentration group, other groups had lower mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and higher red blood cell distribution width. The mean serum vitamin A concentration among anemic children was significantly lower (0.27±0.07 mg/L) than among those children who were not anemic (p<0.05). Conclusions: VAD constitutes a public health problem in northern China. The prevalence of VAD is highest, and the serum vitamin A concentration was the lowest among preschool children aged 3-4 years. Vitamin A serum concentration was associated with red blood cell indices. We should attach more importance to those children aged 3-4 years.

Background and Objectives: To investigate the iatrogenic risk factors for hypophosphatemia in intensive care unit (ICU) patients. Methods and Study Design: A total of 120 patients were enrolled and further divided into 4 groups, namely normal, mild, moderate or severe, according to the degree of hypophosphatemia. A number of related factors were analyzed and compared among the 4 groups, including the treatment method and outcomes. Univariate and multivariate regression analyses were employed to identify and confirm the risk factors associated with the occurrence of hypophosphatemia. Results: The results revealed that the acute physiology and chronic health evaluation II (APACHEII), Sequential Organ Failure Assessment (SOFA), modified NUTrition Risk in Critically ill (NUTRIC) scores as well as the length of patient stays in ICUs exhibited a gradually increasing trend of aggravation of hypophosphatemia. Univariate regression analysis identified the use of dehydrating drugs to be closely associated with the occurrence of hypophosphatemia, which was further confirmed by a multivariate regression analysis. Conclusions: The use of dehydrating drugs led to hypophosphatemia; therefore blood phosphorus concentrations should be closely monitored during treatment of ICU patients.

Background and Objectives: Studies have suggested that vitamin D deficiency is associated with impaired cardiac autonomic nerve function. This study explores the correlation between serum vitamin D and cardiac autonomic neuropathy (CAN) in prediabetes and reveals the protective effect of vitamin D against CAN. Methods and Study Design: In total, 113 patients with prediabetes and definite CAN and 180 with prediabetes but without CAN were enrolled on the basis of their standard cardiovascular autonomic reflex test results. Chemiluminescence was used to measure 25(OH)D, the patients with CAN were divided into four groups, and the heart rate variability (HRV) of the study groups were compared. Results: Relative to the 50≤25(OH)D<75-nmol/L group, the 25≤25(OH)D<50-nmol/L and 25(OH)D<25-nmol/L groups exhibited significant differences in the time and frequency domains of HRV (p< 0.05). Furthermore, we discovered that 25(OH)D is positively correlated with standard deviation of normal-to-normal RR intervals (SDNN) (β=0.566, p<0.05) and negatively correlated with low-to-high frequency ratio (LF/HF) (β =−0.199, p<0.05). A logistic regression reveals that CAN in prediabetes is significantly correlated with the 25(OH)D concentrations of <25 nmol/L (OR, 2.380 [1.208–4.691]; p<0.05) and 25≤25(OH)D<50 nmol/L (OR, 1.875 [1.064–3.751]; p<0.05). Conclusions: Serum 25(OH)D is significantly correlated with CAN in prediabetes, especially in the 25(OH)D <25-nmol/L group. Therefore, vitamin D deficiency may be related to the occurrence of CAN in prediabetes, and appropriate supplementation may provide protection against CAN.

Background and Objectives: In daily life, the intake of dietary nutrients is mixed. However, evidence for the association between mixed dietary B vitamin intake and insulin resistance is limited. In this study, we estimated the joint effect of intake of various dietary B vitamins on insulin resistance. Methods and Study Design: This cross-sectional study used data from the National Health and Nutrition Examination Survey 2011-2018. We included 1,628 middle-aged and 1,058 older adults without diabetes. Multivariable logistic regression and Bayesian kernel machine regression models were constructed. Results: In the multivariable logistic regression, when all B vitamins were included in the model, the ORs (95% CIs) of insulin resistance were 3.06 (1.00-9.37) and 0.42 (0.19-0.93) for the highest quartile of vitamin B-1 and B-12 intake in the middle-aged group when the lowest quartile was the reference. In the older group, no significant association was observed. In the Bayesian kernel machine regression analysis, a negative trend was noted between mixed B vitamin intake and insulin resistance in both examined groups. The univariate exposure-response function indicated that vitamin B-12 intake was negatively associated with insulin resistance in the middle-aged group, and that vitamin B-6 and dietary folate equivalent intakes were negatively associated with insulin resistance in older group. The bivariate exposure-response function indicated a potential interaction effect between dietary intake of vitamin B-12 and those of vitamin B-1, B-2, niacin, and dietary folate equivalent on insulin resistance in older people. Conclusions: Our results suggest that mixed dietary B vitamin intake tends to decrease the OR of insulin resistance both in middle-aged and older people.

Perioperative nutritional support reduces the healthcare burden of pediatric malnutrition and its risk. Strategic preventive, diagnostic and therapeutic nutritional management guidelines are now available for their optimization.  The global needs for pediatric surgery are vast, amounting to millions of children and adolescents, with a corresponding workforce requirement, especially in less socioeconomically developed regions, and where malnutrition is endemic. Acute and elective surgery from neonate to adolescent, for congenital to infective, neoplastic and traumatic conditions, are involved. To identify, highlight and critique current perioperative pediatric nutrition guidelines with regard to availability, utility, affordability and accuracy. Advantages and limitations of nutritional methodologies are taken into account in an algorithmic approach to perioperative decision-making to optimise outcomes. Routine documentation, monitoring and surveillance of pediatric nutritional status as a contributor to surgical risk management should increase its benefits, and reduce costs.

Background and Objectives: There is emerging scientific evidence of the health benefits of traditional food plants at both molecular and folk remedy levels; however, epidemiological observations are limited. The Amami island region of Japan has a variety of unique traditions conserved till today, where a cohort study was conducted in 2005. The objective of this study was to investigate the associations between the intake of common and local vegetables and the risk of mortality and cancer incidence in Amami. Methods and Study Design: Participants were enrolled from the general population of Amami as part of the Japan Multi-institutional Collaborative Cohort (J-MICC) Study. In total, 5,015 participants (2,053 men and 2,962 women) aged 35-69 years were enrolled in this study. They were followed up to obtain information on movement, death, and cancer incidence. The hazard ratios (HRs) and 95% CIs were estimated using the Cox proportional hazard model after adjusting for potential confounding factors. Results: A significant inverse association was observed between cabbage intake and the HRs for overall mortality (p for trend=0.046) and lung cancer incidence (p=0.016). Intake of handama and togan as local vegetables was associated with decreased HRs for overall mortality (p=0.019 and 0.036, respectively). Conclusions: While the molecular and biochemical reasoning and residual confounding factors behind this association remain unclear, the findings of this study suggest that the dietary lifestyle in Amami has a positive impact on the residents, which can significantly decrease mortality risk.

Background and Objectives: Family meals favor adolescent dietary quality and mental health. The aim of this study was to explores the relationships between parental behavior during family meals, and the subjective diet-related quality of life (SDQOL) of Japanese adolescents. Methods and Study Design: Participants comprised 664 second-year junior high school students aged 13-14 years from Kumamoto Prefecture, Japan. Survey items included sex, age, family structure, parental behavior during mealtimes (frequency of warnings/listening to children), frequency of family meals (number of meals taken together), and SDQOL. Participants were divided into two groups (low and high) based on the median SDQOL score. Logistic regression analysis was performed to examine the relationships among parental behavior during meals, frequency of family meals, and SDQOL. The dependent variable was SDQOL; independent variables were parental mealtime behavior and family meal frequency. Results: The high-SDQOL group comprised 150 boys (45.3%) and 167 girls (51.1%). Compared to those who ate with family 0–5.5 times per week, those who did so 7–9.5 (OR: 2.56, 95% CI: [1.64-4.00]) or 11.5–14.0 (OR: 2.87, 95% CI: [1.83-4.50]) times per week had a better SDQOL. Those whose parents listened during meals on four or more days per week, compared with three days or less, had a better SDQOL (OR: 4.06, 95% CI: [2.76-5.98]). Conclusions: Eating together more than seven times a week and having parents listen to them during meals are associated with better adolescent SDQOL.

Chlorogenic acid (CGA) is widely present in plant foods and has attracted much attention due to biological activities such as those which are antioxidant, anti-inflammatory, antibacterial, and antiviral. It plays a role in regulating glucose and lipid metabolism, improving insulin resistance, and reducing the risk of type 2 diabetes and cardiovascular diseases. The estimated dietary intake of CGA is 5 to 1000 mg/d. Based on the data from population intervention studies, daily oral doses of CGA at 13.5mg to 1200 mg can reduce fasting blood glucose (FBG), improve glucose tolerance, enable weight loss /prevent weight gain, and improve blood pressure in hypertensive patients. Daily intake of 200 mg or more may reduce FBG, with a dose-effect relationship in the range 13.5-500 mg/d. Therefore, a specific proposed level (SPL) of CGA to improve FBG could be ≥200 mg/d. Data insufficiency does not allow formulation of a tolerable upper intake level (TUIL) for CGA.

Background and Objectives: It is often difficult to assess the nutritional requirements of severely injured patients. In this study, we aimed to determine whether various nutritional assessment formulas are accurate at assessing the nutritional requirements of trauma patients. Methods and Study Design: We recruited trauma patients who were admitted to a trauma centre in 2018 and were identified as being at high risk for malnutrition. Energy expenditure was calculated using commonly used prediction equations, and the results were compared to resting energy expenditures measured using indirect calorimetry. Results: Sixty-nine patients (78.9% men; mean age, 53.6 years) collectively underwent 95 indirect calorimetry assessments. The average resting energy expenditure was 1761.8±483.8 kcal/day, and the average respiratory quotient was 0.8±0.2. The correlations between the measured resting energy expenditures and nutritional requirements estimated by each formula were significant but weak (i.e., r-values <0.8). The Penn State formula had the highest r-value (0.742; 95% confidence interval [CI], 0.6359–0.8210), followed by the Faisy formula (0.730; 95% CI, 0.620–0.812). Conclusions: The formula-predicted nutritional requirements did not adequately correlate with the resting energy expenditures measured by indirect calorimetry. Therefore, we recommend using indirect calorimetry to assess the nutritional requirements of severely injured patients.

Background and Objectives: Bioelectrical-impedance analysis (BIA) is frequently used to estimate dry weight in hemodialysis (HD) patients. However, the clinical prognostic significance of BIA indicators is unclear. As a nutritional index, low phase angle (PA) might be an independent risk factor for predicting death in multiple chronic diseases. We performed this study to find relative influence factors of PA and other clinical prognostic significance. Methods and Study Design: The study involved 87 HD patients, 33 of whom were diabetic and 54 of whom were not. We measured body composition index, body water index and nutritional indicators and collected biochemical criteria. Then, we statistically analyzed the associations of these indices. After 1 year of follow-up, we recorded death, heart failure, hospitalization, cerebrovascular and cardiovascular events and other clinical outcomes. Results: We found a significant difference between the two groups in visceral-fat area, extracellular water/total body water (ECW/TBW) ratio and PA value. Two factors were negatively associated with PA: ECW/TBW ratio and HCO3− before HD. At 1 year, we noted that PA was associated with events such as heart failure or hospitalization. By further stratification and multivariate analysis adjusting for age, sex and months of dialysis, we found that low PA was an independent predictor of heart failure for diabetic HD patients. Conclusions: PA value was lower in Diabetic nephropathy (DN) HD patients, than that in non-DN HD patients. PA was mainly negatively associated with ECW/TBW ratio. It is a useful index for predicting heart failure in diabetic HD patients.

Background and Objectives: This study aimed to investigate independent risk factors for intra-abdominal infection and to construct a nomogram to identify colorectal patients at a high risk of intra-abdominal infection. Methods and Study Design: Clinical data of patients undergoing radical resection of colorectal cancer from January 2019 to December 2021 were retrospectively included in this study. Patients were divided into two groups according to postoperative intra-abdominal infection. Clinicopathological indicators, intraoperative conditions, and postoperative complications were compared between the two groups, logistic regression was used to look for independent risk factors for intra-abdominal infection, and a nomogram was constructed based on independent risk factors. Results: 402 colorectal cancer patients were enrolled in this study, and 46 patients (11.4%) developed intra-abdominal infections after surgery. The independent risk factors for intra-abdominal infection were preoperative albumin, lymphocyte-white cell ratio (LWR) <0.17, low subcutaneous fat mass, and low skeletal muscle mass. The nomogram model for intra-abdominal infection was able to reliably quantify the risk of intra-abdominal infection with strong optimism-adjusted discrimination (concordance index=0.931). Furthermore, decision curve analysis showed that the nomogram was clinically useful and had a better discriminative ability to recognize patients at high risk than the risk factors alone. Conclusions: In conclusion, we found that preoperative albumin, LWR <0.17, low subcutaneous fat mass, and low skeletal muscle mass were significantly correlated with intra-abdominal infection. Our nomogram was a simple and practical instrument to quantify the individual risk of intra-abdominal infection.

Background and Objectives: Nutritional status greatly impacts the clinical outcome of the patients receiving lung transplantation. The objective of this study was to evaluate the effect of nutritional status on the clinical outcome in lung transplant recipients. Methods and Study Design: A single-center retrospective study was conducted including 73 patients received lung transplantation from December 2015 to April 2022 in the Affiliated Henan Provincial People’s Hospital of Zhengzhou University. Data were collected from the hospital information system. The records of BMI, malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria, hemoglobin and plasma albumin before operation were accessed. The primary outcome assessed was survival or mortality represented by Kaplan-Meier survival curves; the log-rank test and multivariate Cox proportional hazards regression were used to evaluate the influence of each factor on survival. Results: Kaplan-Meier survival analysis showed that malnutrition, hemoglobin and plasma albumin were predictors of survival in lung transplantation (Log Rank p<0.05). Multivariate Cox regression showed that pre-operative hemoglobin <130 g/L (HR 2.532, p=0.036) and plasma albumin <35 g/L (HR 2.723, p=0.016) were associated with the decreased survival rate. Conclusions: Preoperative anemia and hypoalbuminemia increase the mortality risk of the lung transplantation patients. Pre-operative nutrition support, therefore, is likely to be critical for improving clinical outcome in patients undergoing lung transplantation.

Background and Objectives: Evidence showed that intermittent fasting may have beneficial effects on metabolic syndrome. However, the results are controversial and indefinite. This study intends to investigate and assess the effects of intermittent fasting (IF) on cardiometabolic risk factors in patients with metabolic syndrome. Methods and Study Design: We searched PubMed, Web of Science, Embase, and Cochrane Library databases up to July 31, 2022. Primary outcomes included body mass index, fat mass, fat free mass, body weight, blood pressure, the homeostasis model assessment of insulin resistance (IR), fasting blood glucose, fasting insulin, and lipid profiles. Results: Of 4997 retrieved records, 6 met the inclusion criteria. The meta-analysis showed that IF can significantly reduce BMI (mean difference=-1.56 kg/m2, 95% CI: -2.62 to -0.51), fat mass (mean difference=-1.35%, 95% CI: -2.03 to -0.67), fat free mass (mean difference=-0.63%, 95% CI: -1.22 to -0.04), body weight (mean difference=-2.49 kg, 95% CI: -3.11 to -1.88), waist circumference (mean difference=-3.06 cm, 95% CI: -4.21 to -1.92), and HOMA-IR (mean difference=-0.62, 95% CI: -0.84 to -0.40) compared with non-fasting. However, no statistical difference was found in the SBP, DBP, TC, TG, LDL-C, HDL-C, fasting blood glucose, and fasting insulin comparing fasting and non-fasting group. Subgroup analyses suggested that study duration and sample size may be the source of heterogeneity for LDL-C. Sensitivity analysis indicated that our results are reliable and robust. Conclusions: IF could be used for patients with metabolic syndrome. Further studies with a larger sample size are needed to verify the effectiveness and safety of IF in patients with metabolic syndrome.

Background and Objectives: To identify the main dietary patterns of adults and investigate the cross-sectional associations of these dietary patterns with prediabetes and undiagnosed or diagnosed diabetes mellitus (DM) in Qingdao, China. Methods and Study Design: This study included 4,457 participants who were administered the semi-quantitative food frequency questionnaire (FFQ). Dietary patterns were identified through principal component analysis (PCA). Logistic regression analysis was performed to determine the associations of each pattern with the risks of prediabetes and undiagnosed or diagnosed DM. Results: PCA revealed two major dietary patterns. The Fruits–Vegetables and Poultry–Seafood patterns were not significantly associated with the risk of prediabetes in either crude or adjusted models (all p>0.05). The highest quartile of the Fruits–Vegetables pattern was significantly associated with decreased risks of undiagnosed DM (crude: OR=0.55, 95% CI: 0.41–0.72; Model 1: OR=0.61, 95% CI: 0.46–0.81; Model 2: OR=0.57, 95% CI: 0.42–0.77; Model 3: OR=0.56, 95% CI: 0.41–0.76) and diagnosed DM (crude: OR=0.51, 95% Cl: 0.34–0.75; Model 1: OR=0.59, 95% CI: 0.39–0.88; Model 2: OR=0.60, 95% CI: 0.39–0.93; Model 3: OR=0.59, 95% CI: 0.38–0.91) compared with the lowest quartile in crude and adjusted models. The Poultry–Seafood pattern was not significantly associated with the risk of undiagnosed or diagnosed DM in crude or adjusted models (all p>0.05). Conclusions: The Fruits–Vegetables pattern was associated with a decreased risk of undiagnosed or diagnosed DM.