Efficacy of malnutrition screening tools in China for
elderly outpatients
Author:Junren Kang, Hailong Li, Xiaodong Shi, Enling Ma,Jun Song, Wei Chen
Keywords:Elderly outpatients, malnutrition, Nutritional Risk Screening 2002 (NRS2002), Nutrition Screening Initiative Checklist (NSI), Malnutrition Screening Tool (MST)
Abstract:Background and Objectives: Malnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients. Methods and Study Design: This study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of <18.5 kg/m2as a reference. Results: The mean (range) age of the patients was 69.6±6.8 (60–100) years. Overall, 4.3% had BMI <18.5 kg/m2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p<0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively. Conclusions: NRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.
Asia Pac J Clin Nutr. 2021;30(1):1-6.doi: 10.6133/apjcn.202103_30(1).0001
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Association of folate, vitamin B-12 and vitamin B-6
intake with diabetes and prediabetes in adults aged 20 years and older
Author:Genquan Jin, Jingjing Wang, Xiubo Jiang
Keywords:diabetes, dietary folate, dietary vitamin B-12, dietary vitamin B-6, dose-response
Abstract:Background and Objectives: This study aimed to assess the association of folate, vitamin B-12 and vitamin B-6 from diet and supplements with diabetes and prediabetes in U.S. adults. Methods and Study Design: We used
data from the National Health and Nutrition Examination Survey (NHANES) 2007–2016 to conduct this crosssectional study. Diabetes and prediabetes status were based on self‐report, medication use, fasting plasma glucose
levels (FPG), haemoglobin A1c (HbA1c) levels and the two hours plasma glucose (PG) value during a 75-g oral glucose tolerance test (OGTT). Logistic regression models and restricted cubic spline models were used to evaluate the associations between dietary folate, vitamin B-12, vitamin B-6 and diabetes. Results: After adjustment for the potential confounders, compared with the lowest quartile, the ORs (odds ratios) with 95%CIs (confidence intervals) of diabetes for the highest quartile intakes of folate and vitamin B-6 were 0.65 (0.47–0.90) and 0.61 (0.42–0.89), the OR with 95% CI of diabetes for the third quartile of dietary vitamin B-12 was 0.76 (0.60–0.97). Further excluded participants with diabetes history, the ORs with 95% CI of newly diagnosed diabetes were 0.60 (0.39–0.94), 0.84 (0.58–1.23), and 0.65 (0.43–0.98) for the third quartile of dietary folate, vitamin B-12 and vitamin B-6, respectively. A linear inverse relationship was found between vitamin B12 and diabetes, and a nonlinear inverse relationship was found between dietary folate, dietary vitamin B6 and diabetes. Conclusions: Our study suggested that folate, vitamin B-12 and vitamin B-6 intake were inversely associated with the risk of diabetes in US adults.
Asia Pac J Clin Nutr. 2021;30(1):75-86.doi: 10.6133/apjcn.202103_30(1).0010
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Dietary n-3 and n-6 fatty acid intakes and NAFLD:
A cross-sectional study in the United States
Author:Jiajia Cui, Lianghui Li, Lisheng Ren, Jianping Sun, Huimin Zhao, Yongye Sun
Keywords:nonalcoholic fatty liver disease, dietary n-3 polyunsaturated fatty acids, dietary n-6 polyunsaturated fatty acids, dose-response
Abstract:Background and Objectives: PUFAs play critical roles in the development of nonalcoholic fatty liver disease (NAFLD). This study examined the associations between dietary n-3 and n-6 PUFA intake and NAFLD risk in a
US population. Methods and Study Design: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2014 was used in this cross-sectional study. Data on dietary n-3 and n-6 PUFAs were extracted
through two 24-h dietary recall interviews, and the dietary n-3 and n-6 PUFA intakes were adjusted by weight. NAFLD was defined based on the US fatty liver index (FLI) value ≥30. Multivariable logistic regression models and restricted cubic spline models were applied to investigate the associations between dietary n-3 and n-6 PUFA intakes and NAFLD risk. Results: Dietary n-3 and n-6 PUFA intakes were inversely associated with NAFLD risk. The multivariable-adjusted OR (95% CI) of NAFLD for the highest versus lowest quartile of dietary n-3 and n-6 PUFA intakes was 0.24 (0.17–0.35) and 0.18 (0.13–0.26), respectively. In stratified analyses by sex and age, the negative associations between dietary n-3 and n-6 PUFA intakes and NAFLD risk were significant in men, women, and individuals younger and older than 45 years. Dose–response analyses indicated that NAFLD risk was associated with dietary n-3 and n-6 PUFA intakes in a nonlinear manner. Conclusions: Dietary n-3 and n-6 PUFA intakes were inversely associated with NAFLD risk in US adults.
Asia Pac J Clin Nutr. 2021;30(1):87-98.doi: 10.6133/apjcn.202103_30(1).0011
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Iodine nutrition status and thyroid function of women at different phases of gestation in an iodine sufficient rural area
Author:Yanling Wang, Zhongliang Zhang, Faqing Chen, Xiaon Zhu,Wei Sun, Yongqin Cao
Keywords:pregnant women, iodine status, thyroid hormones, urinary iodine
Abstract:Background and Objectives: This study was undertaken to evaluate the status of iodine nutrition and thyroid function of women at different phases of gestation in an iodine sufficient rural area. Methods and Study Design:
215 pregnant women in different trimesters were consecutively enrolled in iodine sufficient rural areas of Yongjing county of Gansu province, China. The blood samples and random urine samples were collected from
them, and serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxin (FT4), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and urinary iodine were measured. Results: Median Urinary Iodine (MUI) of three groups of pregnant women (first, second and third trimester) were 190 μg/L, 153 μg/L and 145 μg/L respectively. With the increase of gestational age, the level of FT3 decreased. And the FT3 level in the first trimester was higher than those in the second and third trimester. There was a U-shaped
curve seen between the TSH levels and the gestational age. The medians of TgAb and TPOAb appeared the lowest in the first trimester．Significant difference was seen in TgAb and TPOAb levels of the three groups of pregnant women. The incidence of thyroid function disorder was 1.86%, including subclinical hypothyroidism accounted for 1.40% and hypothyroidism accounted for 0.47%. The incidence of thyroid function disorder mainly
appeared in the early pregnancy. Abnormal FT3, TSH, positive TgAb and TPOAb were mainly seen during early pregnancy. Conclusions: The levels of serum TSH and thyroid hormones fluctuate at the different phases of pregnancy. With the increase of gestational age, the incidence of iodine deficiency also increased. Abnormal thyroid hormones, TSH, positive TgAb and TPOAb were mainly existed in the early pregnancy.
Asia Pac J Clin Nutr. 2021;30(1):99-103.doi: 10.6133/apjcn.202103_30(1).0012
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Exploring the effects of formula feeding on infant
immune development in China: A prospective cohort study
Author:Xiao-Chen Yin, Li-Jia Xiao, Chuan-Zhu Yi, Zi-Min Li, Zhi Huang , Yue-Chan Zhou
, Yu-Ming Hu
Keywords:formula feeding, breastfeeding, immune development, diarrhea rate, respiratory infection rate
Abstract:Background and Objectives: The worldwide exclusive breastfeeding rate is suboptimal and this study aims to evaluate effects on infant immune development of formula feeding. Methods and Study Design: A prospective
study including 221 infants fed with breast milk or formula was conducted. At 3-month and 9-month, the concentrations of total immunoglobulin (Ig)G, IgM, IgA, IgG1, IgG2, interleukin (IL)-4, interferon-gamma (IFN-γ) and
tumor necrosis factor-alpha (TNF-α) were measured by using enzyme-linked immunosorbent assay (ELISA). Natural killer (NK) cell activity and lymphocyte transformation testing were conducted. Furthermore, the occurrence of infantile diarrhea, respiratory infections and allergic diseases were questioned. Results: The levels of total IgG (Z=-3.21, p=0.001), IgG1 (Z=-2.12, p=0.034), IFN-γ (t=-2.09, p=0.039) and NK cell activity (t=-2.14, p=0.034) were significant higher in formula-fed infants compared to breast-fed after 3 months. At 9-month, the levels of total IgG (Z=-4.34, p<0.001), IgA (Z=-2.05, p=0.041) and TNF-α (t=-2.10, p=0.037) of formula-fed infants were higher, but the lymphocyte stimulation index (t=2.76, p=0.007) was lower than breast-fed infants. While, no significant differences were found in the incidences of diarrhea and respiratory tract infection (p>0.05).Conclusions: This investigation suggested that formula- and breast-feeding have different contributions to infant immune development, but the formula feeding would not cause significantly increase of diarrhea and respiratory infections.
Asia Pac J Clin Nutr. 2021;30(1):104-112.doi: 10.6133/apjcn.202103_30(1).0013
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Ketogenic diet and growth in Chinese infants with
refractory epilepsy
Author:Yongfang Liu, Juan Wang, Zhongmin Gao, Lijuan Xu, Lin Kong
Keywords:ketogenic dietary treatment, children, anaemia, haemoglobin, blood lipids
Abstract:Background and Objectives: This study evaluated the impact of 12 months of ketogenic dietary treatment (KDT) on growth in Chinese infants with refractory epilepsy. Methods and Study Design: The KDT group included patients who were divided into groups A (age 6-12 months), B (12-24 months) and C (24-36 months). The normal group included infants aged approximately 6-12 months, 12-24 months and 24-36 months who were classified into groups A1, B1 and C1, respectively. Data on height, weight, aspartate transaminase (AST), alanine transaminase (ALT), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), zinc, iron, calcium, magnesium, and haemoglobin (Hb) were extracted from the medical records. Then, we compared the impacts of 12 months of KDT on growth. Results: Forty-one patients were included in the KDT group, and 90 infants were included in the normal group. The overall prevalence of underweight (WAZ <-2 SD), stunting (HAZ <-2 SD), wasting (BAZ <-2 SD), and overweight/obesity (BAZ ≥2 SD) were relatively lower in the A and B groups. The prevalence of anaemia in group A was significantlyhigher than that in group A1. No significant differences were observed in the KDT groups with regard to HDL, LDL, AST, ALT, iron, calcium, magnesium, or zinc. A greater than 50% reduction in weekly seizure frequency was evident in 100% of group A, 78.6% of group B and 77.8% of group C. Conclusions: The results revealed that patients less than 2 years old who received KDT maintained appropriate growth at the 12-month follow-up.
Asia Pac J Clin Nutr. 2021;30(1):113-121.doi: 10.6133/apjcn.202103_30(1).0014
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Increased meat consumption is associated with reduced tuberculosis treatment failure rate: A cohort study
Author:Yidan Hu, Mingde Ni, Qiang Wen, Jing Cai, Bo Zhang, Shanliang Zhao, Qiuzhen Wang, Aiguo Ma
Keywords:tuberculosis (TB), meat, diet, food frequency questionnaire, China
Abstract:Background and Objectives: Information regarding the relationship between dietary meat intake and tuberculosis treatment outcomes among patients with tuberculosis is still limited. The aim of the present study was to investigate the relationship between meat consumption and tuberculosis treatment outcomes in patients with pulmonary tuberculosis. Methods and Study Design: A pulmonary tuberculosis cohort study including 2,261 patients with pulmonary tuberculosis was conducted in Linyi, Shandong Province, China from 2009 to 2013. Dietary data were collected using a semi-quantitative food frequency questionnaire. Treatment outcomes were assessed using a combination of sputum smear microscopy and chest computerized tomography. Results: In a multiple adjusted model, the higher quartile of total meat (OR=0.59, 95% CI, 0.38–0.91) was associated with a decreased failure rate of pulmonary tuberculosis treatment. In addition, higher consumption of chicken (OR=0.62; 95% CI, 0.44–0.87) and pork (OR=0.54; 95% CI, 0.31–0.95) was associated with a lower failure rate of tuberculosis treatment. Conclusions: Increased dietary intake of total meat, pork, and chicken are associated with a decreased failure rate of pulmonary tuberculosis treatment. A higher dietary meat intake may be beneficial in pulmonary tuberculosis treatment.
Asia Pac J Clin Nutr. 2021;30(1):122-129.doi: 10.6133/apjcn.202103_30(1).0015
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The correlation between chili pepper consumption and gastric cancer risk: A meta-analysis
Author:Lei Luo, Jing Yan, Xiaohong Wang, Zhiguang Sun
Keywords:chili pepper, capsaicin, gastric cancer, dose response, meta-analysis
Abstract:Background and Objectives: The correlation between chili pepper intake and gastric cancer (GC) risk has been controversial. We conducted a meta-analysis of 16 studies to provide updated evidence for this uncertainty.
Methods and Study Design: Medline, and China National Knowledge Infrastructure (CNKI) databases were searched to obtain all qualified literature related to pepper consumption and GC incidence before June 2020.
Random effects models were adopted to integrate the relative risk of individual studies. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the literature of each included study. Dose response meta-analysis was implemented through the one-stage robust error meta-regression (REMR) approach. Results: 16 studies (8337 cases) were included in quantitative meta-analysis. The pooled odds ratio (OR) of GC for the highest versus the lowest category of chili consumption were 1.51 (95% confidence interval [CI]=1.02-2.00) for all countries, 2.05 (95% CI=1.15-2.95) for Mexican, 2.03 (95% CI =0.71-3.34) for Colombian, 1.92 (95% CI=1.21-2.64) for Asian and 0.48 (95% CI=0.24-0.72) for other countries. Dose-response meta-analysis showed that there was a positive linear correlation between the risk of GC and the daily frequency of chili consumption. Conclusions: Significantly increased consumption of chili pepper or capsaicin has the potential to increase the risk of gastric
cancer, however, inconsistencies still exist in subgroup analysis between different regions.
Asia Pac J Clin Nutr. 2021;30(1):130-139.doi: 10.6133/apjcn.202103_30(1).0016
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Fish consumption, long-chain omega-3 fatty acids intake and risk of stroke: An updated systematic review and meta-analysis
Author:Chen Chen, Hui Huang, Qiu-qin Dai, Jing Ren, Hong-hua Cai, Wen-jia Hu, Xiu-juan Zhang, Wang-tao Zhong, Xiang-yong Li
Keywords:fish, long-chain omega-3 fatty acids, stroke, meta-analysis
Abstract:Background and Objectives: Although fish consumption or omega-3 intake is associated with cardio- cerebrovascular disease including stroke, their correlation is still controversial. Therefore, this meta-analysis is to identify the relationship between the risk of stroke and fish consumption or omega-3 intake. Methods and Study Design: We searched the PubMed, EMBASE and Cochrane Library databases as of May 2019. Multivariateadjusted risk ratios (RRs) with 95% confidence interval (CI) for stroke in different level intake of fish or Longchain omega-3 polyunsaturated fatty acids (LC ω3-PUFAs) were pooled using a random-effects meta-analysis. A
dose-response analysis was conducted with the 2-stage generalized least-squares trend program. Results: Our meta-analysis identified a total of 17 prospective cohort studies including 14986 strokes events in 672711 individuals. Meta-analysis revealed that the higher fish consumption was significantly associated with lower risk of stroke (RR=0.871, 95% CI: 0.779-0.975, p=0.016), especially with ischemic stroke (RR=0.808, 95% CI: 0.696-0.937, p=0.005). Meantime, the combined RR of total stroke was 0.859 (95% CI: 0.769-0.959, p=0.007) for the highest versus lowest intake of LC ω3-PUFAs, and stratification analysis showed that higher LC ω3-PUFAs intake was associated with reduced stroke risk in women (RR=0.793, 95% CI: 0.706-0.891, p=0.000) but not in men. In addition, the dose-response analysis showed fish consumption with 1000g per month and LC ω3-PUFAs
intake with 0.5g per month was associated with 17.3% (RR=0.927, 95% CI: 0.83-0.98) and 14% (RR=0.86, 95% CI: 0.78-0.95) lower risk of stroke, respectively. Conclusions: Both fish consumption and LC ω3-PUFAs intake
were negatively associated with the risk of stroke, especially in women, which suggest that increased intake of fishery products and LC ω3-PUFAs may benefit primary prevention of stroke.
Asia Pac J Clin Nutr. 2021;30(1):140-152.doi: 10.6133/apjcn.202103_30(1).0017
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Gynecological cancer and omega-3 fatty acid intakes: meta-analysis
Author:Tung Hoang, Seung-Kwon Myung, Thu Thi Pham
Keywords:Omega-3 fatty acids, endometrial cancer, ovarian cancer, observational study, meta-analysis
Abstract:Background and Objectives: Previous observational epidemiological studies have reported inconsistent findings on the association between dietary intake of omega-3 fatty acids and endocrine-related gynecological cancer including ovarian cancer and endometrial cancer. This study aimed to investigate this association using a metaanalysis of observational studies. Methods and Study Design: We searched PubMed, EMBASE, and Cochrane
library by using keywords related to the topic in December 2019. The pooled odd ratios (pORs), pooled relative risks (pRRs), or pooled hazard ratios (pHRs) with 95% confidence intervals (CIs) were calculated based on a random-effects model. Also, we performed subgroup analyses by methodological quality, type of cancer, study design, and type of omega-3 fatty acids. Results: A total of 10 observational studies with six case-control and four prospective cohort studies were included in the current meta-analysis. In the meta-analysis of all studies, dietary intake of omega-3 fatty acids was not significantly associated with the risk of endometrial and ovarian cancers (pOR/HR, 0.87; 95% CI, 0.73-1.04; I2=67.2%) (highest versus lowest intake). In the subgroup analysis by type of
study, no significant association was found in cohort studies (pHR, 1.03; 95% CI, 0.63-1.67, I2=81.9%), whereas dietary intake of omega-3 fatty acids was associated with the decreased risk of endocrine-related gynecological
cancers in case-control studies (pOR, 0.81; 95% CI, 0.67 to 0.98, 2=55.7%). Conclusions: The current metaanalysis of observational studies suggests that dietary intake of omega-3 fatty acids is not significantly associated
with the risk of endocrine-related gynecological cancer.
Asia Pac J Clin Nutr. 2021;30(1):153-162.doi: 10.6133/apjcn.202103_30(1).0018
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Dietary patterns and smartphone use in adolescents in Korea: A nationally representative cross-sectional study
Author:Kyoung Min Kim, Ilju Lee, Jun Won Kim, Jae-Won Choi
Keywords:adolescents, dietary patterns, smartphone use, addictive potential, sensation seeking
Abstract:Background and Objectives: Diet and smartphone use are daily routines that can affect adolescents’ mental health. This study investigated whether the frequency of the consumption of certain foods is associated with the
duration of smartphone use and problems caused by smartphone overuse in adolescents. Methods and Study Design: Food consumption and smartphone use were investigated in 62,276 Korean adolescents aged 12–18 years by using a nationwide self-report survey. Food intake was assessed on a seven-point scale (“never” to “1, 2, and 3 or more times per day”) for nine items: fruits, vegetables, milk, soda, energy drinks, sweetened beverages, fast
food, instant noodles, and snacks. The durations of smartphone use and problematic use were determined using self-report items. Results: Most respondents (66.5%) used smartphones over 2 hours per day. Higher consumption levels of fruits (F=151.8; p<0.001), vegetables (F=119.9; p<0.001), and milk (F=33.0; p<0.001) were associated with significantly lower smartphone usage, whereas higher consumption levels of soda (F=292.5; p<0.001), energy drinks (F=24.0; p<0.001), sweetened beverages (F=224.8; p<0.001), fast food (F=192.1; p<0.001), instant noodles (F=196.2; p<0.001), and snacks (F=131.6; p<0.001) were positively associated with higher smartphone usage. Conclusions: Our findings provide useful clinical information regarding the association between dietary habits and smartphone use in adolescents. Future studies should investigate underlying mechanisms and examine the efficacy of dietary interventions for adolescents with excessive smartphone use.
Asia Pac J Clin Nutr. 2021;30(1):163-173.doi: 10.6133/apjcn.202103_30(1).0019
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Comprehensive nutritional index for predicting overall survival in hepatocellular carcinoma patients after multiple transarterial chemoembolization
Author:Jun Deng, Jing-Jing He, Lu-Ping Xie, Qi-Wen Zheng,Shui-Li Wu, Hong-Yan Shao
Keywords:hepatocellular carcinoma, post-transarterial chemoembolization, nutrition, prognosis, overall survival
Abstract:Background and Objectives: Little is known about nutritional status in patients with hepatocellular carcinoma (HCC) after multiple rounds of transarterial chemoembolization (TACE). We established a comprehensive nutritional index (CNI) and evaluated its prognostic value for overall survival (OS) and time to progression (TTP). Methods and Study Design: HCC patients (N=282) who underwent multiple TACE treatments were enrolled.
CNI was established by principal component analysis based on body mass index, usual body weight percentage, hemoglobin, total lymphocyte count, and albumin; the cutoff value was determined by receiver operating characteristic curve and Youden index analysis. The correlation between CNI and treatment-related complications was analyzed with Spearman’s method. The Kaplan–Meier method with log-rank test and Cox proportional hazards
model were used to compare the prognostic values of CNI, prognostic nutritional index (PNI), and nutrition risk index (NRI) for OS and TTP. Results: Nutritional status declined after repeated TACE (p<0.001). CNI (cutoff=0.251) varied according to albumin-bilirubin grade, tumor size, and number of TACE treatments (p<0.001 or 0.025) and was negatively correlated with rate of serious complications (r=−0.185, p=0.002). Patients with low
CNI had shorter OS (p=0.014) and TTP (p=0.007); high CNI predicted longer OS (hazard ratio [HR], 0.72; 95% confidence interval [CI]: 0.52–1.00, p=0.048) and TTP (HR, 0.69; 95% CI: 0.50–0.94, p=0.019). Post-treatment
PNI and NRI were unrelated to prognosis (p>0.05). Conclusions: HCC patients have poor nutritional status after multiple TACE treatments, which predicts shorter OS and TTP. The prognostic performance of CNI is superior to
those of PNI and NRI.
Asia Pac J Clin Nutr. 2021;30(1):7-14.doi: 10.6133/apjcn.202103_30(1).0002
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The reporting quality of observational studies relevant to the STROBE-nut statement in journals of nutrition
Author:Jingao Zhang, Xiaobin Zhou, Beibei Li, Jing Zhou, Yao Chen
Keywords:reporting quality, observational studies, nutrition journals, STROBE-nut statement, medical publications
Abstract:Background and Objectives: Observational studies play a vital role in nutrition journals, but no studies have assessed the reporting quality of observational studies after the publication of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)–nutritional epidemiology (STROBE-nut) statement in 2016. This study assessed the reporting quality of observational studies published in high-impact-factor nutrition journals by using the STROBE-nut statement and explored factors affecting the reporting quality. Methods and Study Design: All bservational studies published in those journals were retrieved using the PubMed database from inception to May 1, 2019. The reporting quality of the included articles was assessed as per the STROBE-nut statement checklist. Compliance with each item of the statement and the total STROBE-nut score were calculated. Logistic regression analyses were used to identify potential factors associated with reporting quality. Results: Of the 964 observational studies identified, a random sample of 200 articles was considered for analysis. The median compliance with items was 74.0%. Seven items (12.07%) were reported in <10.0% of articles, with STROBE 10
(3.00%), nut-12.2 (2.50%), and nut-14 (2.00%) having the lowest reporting rates. The mean STROBE-nut score was 40.35, which was suboptimal. STROBE-nut scores were higher for cohort studies (p=0.04) and when statisticians or epidemiologists were involved in the study (p=0.004). Conclusions: Observational studies published in nutrition journals were found to have suboptimal reporting quality. Nutrition journals should endorse the STROBEnut statement checklist for observational studies to improve reporting quality and provide readers with reliable evidence.
Asia Pac J Clin Nutr. 2021;30(1):174-182.doi: 10.6133/apjcn.202103_30(1).0020
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Nutritional practice in critically ill COVID-19 patients: A multicenter ambidirectional cohort study in Wuhan and Jingzhou
Author:Jiajia Lin, Lu Ke, Gordon S Doig, Bo Ye, Zhengying Jiang, Zhiyong Liu, Feng Guo, Jiangtao Yin, Wenkui Yu, Jiakui Sun, Liqun Sun, Renyu Ding, Hongyang Xu, Zhigang Chang, Yi Long, Yajun Qian, Zhihui Tong, Weiqin Li for the Chinese Critical Care Nutrition Trials Group (CCCNTG)
Keywords:enteral nutrition, coronavirus, feeding, target-reaching rate, supplemental parenteral nutrition
Abstract:Background and Objectives: The novel coronavirus disease (COVID-19) epidemic is spreading all over the world. With the number of cases increasing rapidly, the epidemiological data on the nutritional practice is scarce. In this study, we aim to describe the clinical characteristics and nutritional practice in a cohort of critically ill COVID-19 patients. Methods and Study Design: This is a multicenter, ambidirectional cohort study conducted at 11 hospitals in Hubei Province, China. All eligible critical COVID-19 patients in the study hospital intensive care units at 00:00, March 6th, 2020, were included. Data collection was performed via written case report forms. Results: A total of 44 patients were identified and enrolled, of whom eight died during the 28-day outcome follow-up period. The median interval between hospital admission and the study day was 24 (interquartile range, 13-26) days and 52.2% (23 of 44) of patients were on invasive mechanical ventilation. The median nutrition risk in
critically ill (mNUTRIC) score was 3 (interquartile range, 2-5) on the study day. During the enrolment day, 68.2% (30 of 44) of patients received enteral nutrition (EN), while 6.8% (3 of 44) received parenteral nutrition
(PN) alone. Nausea and aspiration were uncommon, with a prevalence of 11.4% (5 of 44) and 6.8% (3 of 44), respectively. As for energy delivery, 69.7% (23 of 33) of patients receiving EN and/or PN were achieving their prescribed targets. Conclusions: The study showed that EN was frequently applied in critical COVID-19 patients. Energy delivery may be suboptimal in this study requiring more attention.
Asia Pac J Clin Nutr. 2021;30(1):15-21.doi: 10.6133/apjcn.202103_30(1).0003
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Outcome of glycemic control in critically ill patients
receiving enteral formulas
Author:Ya-Ling Wang, Chun-Te Huang, Chao-Hsiu Chen, Pin-Kuei Fu, Chen-Yu Wang
Keywords:critically ill patients, hyperglycemia, semi-elemental formula, polymer formula, enteral nutrition
Abstract:Background and Objectives: Stress hyperglycemia is a common condition in critically ill patients. Inappropriate nutritional supplementation may worsen blood glucose control in these patients. The present study aimed to investigate the outcome of blood glucose control status when using various enteral formulas. Methods and Study Design: This retrospective study was conducted at the intensive care unit of a tertiary medical center in central Taiwan. Patients meeting the following inclusion criteria were enrolled in the study: age ≥20 years, respiratory failure requiring mechanical ventilation, and two consecutive blood glucose concentration measurements of ≥180 mg/dL. Demographic data, blood glucose samples, and hospital mortality were collected for analysis. Results: A total of
4,604 blood glucose samples from 48 patients were analyzed. Results demonstrated no significant difference in mortality rate or blood glucose control between patients fed semi-elemental formulas and those fed polymer formulas. Serum HbA1C of <7.5% was a risk factor for hospital mortality (OR: 0.18, 95% CI: 0.04–0.89). Enteral formulas containing less carbohydrate were associated with better blood glucose control. Conclusions: No significant difference in the outcome of blood glucose control was observed between patients fed semi-elemental formula
and those fed polymer formula. To achieve better blood glucose control in critically ill patients, formulas with lower carbohydrate content should be considered.
Asia Pac J Clin Nutr. 2021;30(1):22-29.doi: 10.6133/apjcn.202103_30(1).0004
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A systematic review and meta-analysis of the clinical
effects of Souvenaid in patients with Alzheimer’s disease
Author:YongSoo Shim, Bora Yoon, Seunghee Na, Eun Ye Lim, Yun Jeong Hong, Dong Won Yang
Keywords:Alzheimer’s disease, Souvenaid, cognition, clinical trial, meta-analysis
Abstract:Background and Objectives: We conducted this meta-analysis about the effects of Souvenaid on cognition and functional abilities, with the hypothesis that Souvenaid may have beneficial effects in certain groups and the goal of finding the outcome measures, disease states, and so on, applicable for further clinical trials. Methods and Study Design: We searched Medline, Embase, Web of Science, CINAHL, and the Cochrane Library. Only double-blind randomized controlled trials were included. Outcome measurements were cognition, clinical global change, functional ability, and adverse events. The duration of treatment was not restricted, but trials performed in patients who did not have Alzheimer’s disease (AD) were excluded. Results: This review using meta-analyses of 4 clinical trials showed that Souvenaid had no significant effects on cognition as measured by ADAS-Cog (MD=0.08, 95% CI=−0.71-0.88) and the neuropsychological test battery total scores (MD=0.05, 95% CI=-0,02-
0.12), on global clinical function as measured by CDR-SB (MD=-0.21, 95% CI=−0.47-0.06), or on functional ability as measured by ADCS-ADL (MD=0.36, 95% CI=−0.54-1.25). There were no differences in any adverse events (OR=0.84, 95% CI=0.63-1.12) or in serious adverse events (OR=0.95, 95% CI=0.66-1.36). However, Souvenaid may benefit the domains of cognition that are affected by AD (attention, memory, and executive function), and it may have greater potential for benefits earlier rather than later in the disease. Conclusions: The results of current clinical trials do not suggest that Souvenaid has any beneficial effects on cognition, functional
ability, or global clinical change. Further studies with outcome measures suitable in patients with early stages of AD will be needed.
Asia Pac J Clin Nutr. 2021;30(1):30-41.doi: 10.6133/apjcn.202103_30(1).0005
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Indications, effectiveness and safety of percutaneous
endoscopic gastrostomy: a single center experience and literature review
Author:Bulent Saka, Cansu Zirtil, Sebile Nilgun Erten, Timur Selcuk Akpinar, Mustafa Altinkaynak, Filiz Akyuz, Bilger Cavus, Bahar Ozmen, Serpil Buyukdemir, Cemil Tascıoglu
Keywords:malnutrition, enteral nutrition, percutaneous endoscopic gastrostomy
Abstract:Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) has been widely used since 1980 in enteral feeding of patients that are not able to be fed orally for a long time. The aim of this study is to evaluate the PEG indications, effectiveness and PEG related complications from a single center in Istanbul, Turkey. Methodsand Study Design: 265 patients with PEG who were followed up by the clinical nutrition team of a university hospital between 2010-2018 were evaluated retrospectively. Nutritional Risk Screening-2002 (NRS-2002) test, anthropometric measurements, bioelectrical impedance analysis and laboratory data were used to evaluate the patients’ nutritional status. Results: The most common indications for PEG were dementia (35.1%), amyotrophic
lateral sclerosis (22.6%), stroke (15.8%), and cancer (14%). The mean body weight of the patients was increased
after PEG (63.5±12.2 vs 62.0±12.7 kg). Mid upper arm circumference and calf circumference of the patients increased after PEG (27.5±2.5 vs 25.4±3.1 cm and 32.2±7.9 vs 29.6±5.9 cm, respectively). Serum albumin of the patients was increased significantly after PEG (3.34±0.69 g/dL to 3.64±0.65 g/dL) without any significant change in serum CRP. Subgroup analyses showed a significant increase in the mean serum albumin of patients with dementia after PEG (3.23±0.67 g/dL to 3.54±0.58 g/dL). Local insertion site infection occurred in 15 patients (5.6%)
and only 3 patients had systemic inflammatory symptoms after local infection (1.1%). Conclusions: The results of our study showed that long-term enteral feeding with PEG is an effective and safe method that provides improvement in nutritional status.
Asia Pac J Clin Nutr. 2021;30(1):42-50.doi: 10.6133/apjcn.202103_30(1).0006
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Controlling nutritional score predict the individualized survival of patients with gastric cancer
Author:Xishan Zhu, Ye Zhao, Feiyan Ma, Shikai Wu
Keywords:controlling nutritional score (CONUT), gastric cancer, disease-free survival (DFS), overall survival (OS), cancer prognosis
Abstract:Background and Objectives: The present study aimed to determine the correlation between Controlling Nutritional Status (CONUT) score and prognosis in gastric cancer patients undergoing total gastrectomy. Methods
and Study Design: The clinical data of 245 gastric cancer patients who underwent total gastrectomy in Peking University, First Hospital between January1st 2005 and December 30th 2015 were retrospectively collected. According to the CONUT level, they were divided into high CONUT (>3) group and low CONUT (≤3) group. The relationship between CONUT and the disease-free survival (DFS) and overall survival (OS) were analyzed by
statistical analysis. Results: The results showed that the optimal cutoff value for CONUT to predict the 5-year survival was 3 and CONUT had a higher area under the ROC curve (AUC) for 5-year disease free survival (DFS)
and overall survival (OS) prediction. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that high CONUT correlated with shorter DFS in non-elderly (<65) patients and shorter
DFS and OS in elderly (≥65) patients. Conclusions: High CONUT was significantly correlated with older age, advanced TNM-stage, higher Ki-67 and pathological subtype. Patients with high pre-operative high CONUT levels should be given more observation and constant follow-up after surgery.
Asia Pac J Clin Nutr. 2021;30(1):51-59.doi: 10.6133/apjcn.202103_30(1).0007
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Effects of beclomethasone and aminophylline combined with enteral nutrition in chronic obstructive pulmonary disease on nutritional status and immune function in elders
Author:Can Peng, Dongjie Xiao, Haiyan Chen, Lijie Rao, Haiyan Xiao,Huahua Li
Keywords:aminophylline, beclomethasone, enteral nutrition, nutritional status, chronic obstructive pulmonary disease
Abstract:Background and Objectives: To investigate the efficacy of beclomethasone and aminophylline combined with enteral nutrition in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and the
associated effects of these drugs on patient nutritional status and immune function. Methods and Study Design:In total, 115 elderly patients with COPD were included and were randomized into an enteral nutrition (EN) group
and a control (CON) group. Aminophylline, in combination with beclomethasone, was administered to the CON group, whereas aminophylline and beclomethasone in combination with EN was administered to the EN group.
Results: Patients in the EN group showed significant improvement in partial pressure of carbon dioxide, forced expiratory volume in 1 sec/ expiratory forced vital capacity, and partial pressure of oxygen than those in the CON
group. The levels of IgM, IgG, and IgA as well as the number of CD4+/CD8+ and CD4+/CD3+ T cells were higher in the EN group than those in the CON group (p<0.05); the EN group also exhibited higher levels of inflammatory cytokines, such as tumor necrosis factor-α and interleukin (IL)-1β (p<0.05), and lower levels of IL-6 than the CON group. In addition, patients in the EN group showed a significant increase in serum total protein,albumin, and transferrin levels than those in the CON group (p<0.05). Conclusions: Elderly patients with COPD showed a marked response to a regimen of beclomethasone, aminophylline, and EN, which significantly improved their immune function and nutritional status.
Asia Pac J Clin Nutr. 2021;30(1):60-66.doi: 10.6133/apjcn.202103_30(1).0008
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Pectin-containing compared with standard polymeric formula in enteral nutrition: A randomized controlled parallel study in Thailand
Author:Thanon Khongcharoensombat, Autthapon Khemtong, Narisorn Lakananurak
Keywords:tube feeding, diarrhea, ready to hang (RTH), enteral nutrition, pectin-containing formula
Abstract:Background and Objectives: To evaluate the effects of a Ready to Hang (RTH), pectin-containing enteral nutrition on gastrointestinal symptoms and nutrition status. Methods and Study Design: An open-label, randomized,
prospective controlled study. Thirty hospitalized patients with tube feeding for 9 days or more. Intervention: A pectin-containing enteral formula (Hine E-Gel®) or a standard polymeric formula (Ensure®) was administered for 1 week. Administration methods: Administered via a nasogastric tube 4 times per day (every 6 hours), 30 minutes per administration. Results: There was no significant difference in the frequency of diarrhea or the nutritional indicators. An additional survey was conducted of 50 nurses who were involved in the administration of the
study products. Most respondents replied that the RTH, pectin-containing formula was easier to use and that the duties related to its administration were decreased. Conclusions: The pectin-containing formula was not detectably superior to the standard polymeric formula in terms of gastrointestinal symptoms. The use of RTH may simplify medical care and enable efficient management.
Asia Pac J Clin Nutr. 2021;30(1):67-74.doi: 10.6133/apjcn.202103_30(1).0009
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