Recently, there has been a growing interest in exploring AI-driven chatbots, such as ChatGPT, as a resource for disease management and education. The study aims to evaluate ChatGPT’s accuracy and quality/clarity in providing nutritional management for Type 2 Diabetes (T2DM), the Metabolic syndrome (MetS) and its components, in accordance with the Academy of Nutrition and Dietetics’ guidelines. Three nutrition management-related domains were considered: (1) Dietary management, (2) Nutrition care process (NCP) and (3) Menu planning (1500 kcal). A total of 63 prompts were used. Two experienced dietitians evaluated the chatbot output’s concordance with the guidelines. Both dietitians provided similar assessments for most conditions examined in the study. Gaps in the ChatGPT-derived outputs were identified and included weight loss recommendations, energy deficit, anthropometric assessment, specific nutrients of concern and the adoption of specific dietary interventions. Gaps in physical activity recommendations were also observed, highlighting ChatGPT’s limitations in providing holistic lifestyle interventions. Within the NCP, the generated output provided incomplete examples of diagnostic documentation statements and had significant gaps in the monitoring and evaluation step. In the 1500 kcal one-day menus, the amounts of carbohydrates, fat, vitamin D and calcium were discordant with dietary recommendations. Regarding clarity, dietitians rated the output as either good or excellent. Although ChatGPT is an increasingly available resource for practitioners, users are encouraged to consider the gaps identified in this study in the dietary management of T2DM and the MetS.
{"title":"Artificial intelligence chatbots for the nutrition management of diabetes and the metabolic syndrome","authors":"Farah Naja, Mandy Taktouk, Dana Matbouli, Sharfa Khaleel, Ayah Maher, Berna Uzun, Maryam Alameddine, Lara Nasreddine","doi":"10.1038/s41430-024-01476-y","DOIUrl":"10.1038/s41430-024-01476-y","url":null,"abstract":"Recently, there has been a growing interest in exploring AI-driven chatbots, such as ChatGPT, as a resource for disease management and education. The study aims to evaluate ChatGPT’s accuracy and quality/clarity in providing nutritional management for Type 2 Diabetes (T2DM), the Metabolic syndrome (MetS) and its components, in accordance with the Academy of Nutrition and Dietetics’ guidelines. Three nutrition management-related domains were considered: (1) Dietary management, (2) Nutrition care process (NCP) and (3) Menu planning (1500 kcal). A total of 63 prompts were used. Two experienced dietitians evaluated the chatbot output’s concordance with the guidelines. Both dietitians provided similar assessments for most conditions examined in the study. Gaps in the ChatGPT-derived outputs were identified and included weight loss recommendations, energy deficit, anthropometric assessment, specific nutrients of concern and the adoption of specific dietary interventions. Gaps in physical activity recommendations were also observed, highlighting ChatGPT’s limitations in providing holistic lifestyle interventions. Within the NCP, the generated output provided incomplete examples of diagnostic documentation statements and had significant gaps in the monitoring and evaluation step. In the 1500 kcal one-day menus, the amounts of carbohydrates, fat, vitamin D and calcium were discordant with dietary recommendations. Regarding clarity, dietitians rated the output as either good or excellent. Although ChatGPT is an increasingly available resource for practitioners, users are encouraged to consider the gaps identified in this study in the dietary management of T2DM and the MetS.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"887-896"},"PeriodicalIF":3.6,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01476-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.1038/s41430-024-01475-z
Youngha Choi, Hyejin Yang, Soyoung Jeon, Kyoung Won Cho, Seo Jung Kim, Sujin Kim, Myeongseob Lee, Junghwan Suh, Hyun Wook Chae, Ho-Seong Kim, Kyungchul Song
To investigate the relationship of serum uric acid (Uacid) and derived parameters as predictors of insulin resistance (IR) and elevated liver transaminases in children and adolescents Data of 1648 participants aged 10–18 years was analyzed using nationwide survey. Logistic regression analysis was performed with IR and elevated liver transaminases as dependent variables, and odds ratios (ORs) and 95% confidence intervals (CIs) for tertiles 2 and 3 of each parameter in comparison to tertile 1, which served as the reference. Receiver operating characteristic (ROC) curves were generated to assess predictability of the parameters for IR and elevated liver transaminases. Hyperuricemia, IR, and elevated liver transaminases were significantly associated with each other. All Uacid and derived markers showed continuous increase in ORs and 95% CIs for IR and elevated liver transaminases across the tertiles of several biochemical and metabolic variables of interest (all p < 0.001), and were also significantly predictive in ROC curve. Overall, Uacid combined with obesity indices showed higher ORs and area under the curve (AUC) compared to Uacid alone. Uacid-body mass index (BMI) standard deviation score presented the largest AUC for IR. For elevated liver transaminases, Uacid-BMI and Uacid-waist-to-height ratio showed the largest AUC. Uacid combined with obesity indices are robust markers for prediction of IR and elevated liver transaminases in children and adolescents. Uacid and derived markers have potential as simple markers which do not require fasting for screening of IR and elevated liver transaminases in children and adolescents.
{"title":"Prediction of insulin resistance and elevated liver transaminases using serum uric acid and derived markers in children and adolescents","authors":"Youngha Choi, Hyejin Yang, Soyoung Jeon, Kyoung Won Cho, Seo Jung Kim, Sujin Kim, Myeongseob Lee, Junghwan Suh, Hyun Wook Chae, Ho-Seong Kim, Kyungchul Song","doi":"10.1038/s41430-024-01475-z","DOIUrl":"10.1038/s41430-024-01475-z","url":null,"abstract":"To investigate the relationship of serum uric acid (Uacid) and derived parameters as predictors of insulin resistance (IR) and elevated liver transaminases in children and adolescents Data of 1648 participants aged 10–18 years was analyzed using nationwide survey. Logistic regression analysis was performed with IR and elevated liver transaminases as dependent variables, and odds ratios (ORs) and 95% confidence intervals (CIs) for tertiles 2 and 3 of each parameter in comparison to tertile 1, which served as the reference. Receiver operating characteristic (ROC) curves were generated to assess predictability of the parameters for IR and elevated liver transaminases. Hyperuricemia, IR, and elevated liver transaminases were significantly associated with each other. All Uacid and derived markers showed continuous increase in ORs and 95% CIs for IR and elevated liver transaminases across the tertiles of several biochemical and metabolic variables of interest (all p < 0.001), and were also significantly predictive in ROC curve. Overall, Uacid combined with obesity indices showed higher ORs and area under the curve (AUC) compared to Uacid alone. Uacid-body mass index (BMI) standard deviation score presented the largest AUC for IR. For elevated liver transaminases, Uacid-BMI and Uacid-waist-to-height ratio showed the largest AUC. Uacid combined with obesity indices are robust markers for prediction of IR and elevated liver transaminases in children and adolescents. Uacid and derived markers have potential as simple markers which do not require fasting for screening of IR and elevated liver transaminases in children and adolescents.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"864-871"},"PeriodicalIF":3.6,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01475-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lactobacillus rhamnosus GG (LGG) is a widely used and extensively researched probiotic. Probiotic effects are considered to be strain specific. We aimed to comprehensively assess the strain-specific effects of LGG in preterm infants. A systematic review of RCTs and non-RCTs to evaluate the effect of LGG in preterm infants. We followed the Cochrane methodology, and preferred reporting items for systematic reviews (PRISMA) statement for conducting and reporting this review. We searched the Cochrane central register of controlled trials, PubMed, EMBASE and CINAHL databases till December 2023. The review was registered in PROSPERO 2022 CRD42022324933. Meta-analysis of data from RCTs that used LGG as the sole probiotic showed significantly lower risk of NEC ≥Stage II [5 RCTs, n = 851, RR:0.50 (95% CI: 0.26, 0.93), P = 0.03] in the LGG group. There was no significant difference in the risk of LOS [7 RCTs, n = 1037, RR:1.08 (95% CI 0.84, 1.39), P = 0.55], mortality [3 RCTs, n = 207, RR: 0.99 (95% CI: 0.42, 2.33), P = 0.99], time to reach full feeds [2 RCTs, n = 19, SMD = 0.11 days (95% CI: −0.22, 0.45), P = 0.51] and duration of hospital stay [3 RCTs, n = 293, SMD: −0.14 days (95% CI: −0.37 to 0.09), P = 0.23]. Meta-analysis of data from non-RCTs showed no significant effect of LGG on NEC, LOS, and mortality. RCTs showed beneficial effects of LGG when used as the sole probiotic in reducing the risk of NEC, whereas observational studies did not. Strain-specific systematic review of LGG provides important data for guiding research and clinical practice.
{"title":"Lactobacillus rhamnosus GG as a probiotic for preterm infants: a strain specific systematic review and meta-analysis","authors":"Anitha Ananthan, Haribalakrishna Balasubramanian, Chandra Rath, Saravanan Muthusamy, Shripada Rao, Sanjay Patole","doi":"10.1038/s41430-024-01474-0","DOIUrl":"10.1038/s41430-024-01474-0","url":null,"abstract":"Lactobacillus rhamnosus GG (LGG) is a widely used and extensively researched probiotic. Probiotic effects are considered to be strain specific. We aimed to comprehensively assess the strain-specific effects of LGG in preterm infants. A systematic review of RCTs and non-RCTs to evaluate the effect of LGG in preterm infants. We followed the Cochrane methodology, and preferred reporting items for systematic reviews (PRISMA) statement for conducting and reporting this review. We searched the Cochrane central register of controlled trials, PubMed, EMBASE and CINAHL databases till December 2023. The review was registered in PROSPERO 2022 CRD42022324933. Meta-analysis of data from RCTs that used LGG as the sole probiotic showed significantly lower risk of NEC ≥Stage II [5 RCTs, n = 851, RR:0.50 (95% CI: 0.26, 0.93), P = 0.03] in the LGG group. There was no significant difference in the risk of LOS [7 RCTs, n = 1037, RR:1.08 (95% CI 0.84, 1.39), P = 0.55], mortality [3 RCTs, n = 207, RR: 0.99 (95% CI: 0.42, 2.33), P = 0.99], time to reach full feeds [2 RCTs, n = 19, SMD = 0.11 days (95% CI: −0.22, 0.45), P = 0.51] and duration of hospital stay [3 RCTs, n = 293, SMD: −0.14 days (95% CI: −0.37 to 0.09), P = 0.23]. Meta-analysis of data from non-RCTs showed no significant effect of LGG on NEC, LOS, and mortality. RCTs showed beneficial effects of LGG when used as the sole probiotic in reducing the risk of NEC, whereas observational studies did not. Strain-specific systematic review of LGG provides important data for guiding research and clinical practice.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"830-846"},"PeriodicalIF":3.6,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01474-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1038/s41430-024-01473-1
María Judith Rios-Lugo, Jesús Isimar Serafín-Fabián, Héctor Hernández-Mendoza, Miguel Klünder-Klünder, Miguel Cruz, Estefania Chavez-Prieto, Israel Martínez- Navarro, Jenny Vilchis-Gil, Miguel Vazquez-Moreno
{"title":"Correction: Mediation effect of body mass index on the association between serum magnesium level and insulin resistance in children from Mexico City","authors":"María Judith Rios-Lugo, Jesús Isimar Serafín-Fabián, Héctor Hernández-Mendoza, Miguel Klünder-Klünder, Miguel Cruz, Estefania Chavez-Prieto, Israel Martínez- Navarro, Jenny Vilchis-Gil, Miguel Vazquez-Moreno","doi":"10.1038/s41430-024-01473-1","DOIUrl":"10.1038/s41430-024-01473-1","url":null,"abstract":"","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 9","pages":"823-823"},"PeriodicalIF":3.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01473-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1038/s41430-024-01470-4
Gráinne Whelehan, Sam West, Doaa R. Abdelrahman, Andrew J. Murton, Tim J. A. Finnigan, Benjamin T. Wall, Francis B. Stephens
Mycoprotein is a high-fibre food previously shown to reduce postprandial glucose concentrations when ingested within a mixed-meal. We applied a dual stable isotope tracer approach to determine whether this is due to a reduced rate of appearance of glucose, in participants of ranging BMI. Twenty-four adults (F = 8, BMI 30 ± 6 kg·m−2) attended 2 trials in a double-blind, randomised, cross-over design. Participants ingested two energy and macronutrient matched milk-based drinks (enriched with 1000 mg [U-13C6] glucose in a subset of 12 participants), containing 50 g glucose and either 0 (CON) or 20 g (MYC) mycoprotein. A primed continuous intravenous infusion of D-[6,6-2H2] glucose determined plasma glucose kinetics over 6 h. Postprandial time-course, and AUC, of glucose and insulin concentration, rate of disappearance (RdT) and appearance of exogenous (RaEx), endogenous (EGP), and total (RaT) plasma glucose were assessed using two- and one-way ANOVA. Drink ingestion increased blood glucose and serum insulin concentrations (P < 0.05) and were comparable between conditions (P > 0.05). Both RaT and RdT were higher with MYC compared with CON over 6 h (mean 6 h glucose appearance and disappearance increased by 5 and 9%, respectively, P < 0.05). RaEx was not affected by MYC ingestion over 6 h (P > 0.05). The mean contribution of EGP to total glucose appearance was 15% greater with MYC, with a trend towards significance (P = 0.05). There was no relationship between BMI and the response to MYC ingestion for any of the variables (P < 0.05). The ingestion of mycoprotein within a mixed-meal impacted postprandial glucose kinetics, but not blood glucose or serum insulin concentrations, in individuals of ranging BMI. This trial was registered at clinicaltrials.gov as NCT04084639 and can be accessed at https://clinicaltrials.gov/ct2/show/NCT04084639 .
{"title":"The addition of mycoprotein to a mixed-meal impacts postprandial glucose kinetics without altering blood glucose concentrations: a randomised controlled trial","authors":"Gráinne Whelehan, Sam West, Doaa R. Abdelrahman, Andrew J. Murton, Tim J. A. Finnigan, Benjamin T. Wall, Francis B. Stephens","doi":"10.1038/s41430-024-01470-4","DOIUrl":"10.1038/s41430-024-01470-4","url":null,"abstract":"Mycoprotein is a high-fibre food previously shown to reduce postprandial glucose concentrations when ingested within a mixed-meal. We applied a dual stable isotope tracer approach to determine whether this is due to a reduced rate of appearance of glucose, in participants of ranging BMI. Twenty-four adults (F = 8, BMI 30 ± 6 kg·m−2) attended 2 trials in a double-blind, randomised, cross-over design. Participants ingested two energy and macronutrient matched milk-based drinks (enriched with 1000 mg [U-13C6] glucose in a subset of 12 participants), containing 50 g glucose and either 0 (CON) or 20 g (MYC) mycoprotein. A primed continuous intravenous infusion of D-[6,6-2H2] glucose determined plasma glucose kinetics over 6 h. Postprandial time-course, and AUC, of glucose and insulin concentration, rate of disappearance (RdT) and appearance of exogenous (RaEx), endogenous (EGP), and total (RaT) plasma glucose were assessed using two- and one-way ANOVA. Drink ingestion increased blood glucose and serum insulin concentrations (P < 0.05) and were comparable between conditions (P > 0.05). Both RaT and RdT were higher with MYC compared with CON over 6 h (mean 6 h glucose appearance and disappearance increased by 5 and 9%, respectively, P < 0.05). RaEx was not affected by MYC ingestion over 6 h (P > 0.05). The mean contribution of EGP to total glucose appearance was 15% greater with MYC, with a trend towards significance (P = 0.05). There was no relationship between BMI and the response to MYC ingestion for any of the variables (P < 0.05). The ingestion of mycoprotein within a mixed-meal impacted postprandial glucose kinetics, but not blood glucose or serum insulin concentrations, in individuals of ranging BMI. This trial was registered at clinicaltrials.gov as NCT04084639 and can be accessed at https://clinicaltrials.gov/ct2/show/NCT04084639 .","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 9","pages":"757-764"},"PeriodicalIF":3.6,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01470-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1038/s41430-024-01472-2
Isabela M. Sponchiado, Larissa S. Limirio, Flávia M. S. de Branco, Erick P. de Oliveira
Although several studies have suggested a potential positive association between serum vitamin D levels and muscle strength in older adults, it remains unclear whether this relationship is sex-dependent. To evaluate the association between serum 25 hydroxyvitamin D [25(OH)D] levels and muscle strength in older adults and to assess whether this association is dependent on sex. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2002. A total of 1173 individuals aged 50–85 years (630 men and 543 women) were included in the analysis. The peak isokinetic force of the knee extensor was assessed using a kinetic communicator isokinetic dynamometer. Serum 25(OH)D levels were measured using the standardized liquid chromatography-tandem mass spectrometry method. Linear regression analyses were conducted to estimate coefficients and 95% confidence intervals for muscle strength across tertiles of serum vitamin D levels, adjusting for potential confounders. Tertiles of serum vitamin D were positively associated with muscle strength in older men (p-trend = 0.007), whereas no association was observed in older women (p-trend = 0.140) or in the total sample (men and women together; p-trend = 0.139). Serum vitamin D levels were positively associated with muscle strength specifically in older men, whereas no association was observed in older women. These results suggest that the relationship between vitamin D and strength may be sex-dependent.
背景：目的：评估老年人血清 25 羟基维生素 D [25(OH)D] 水平与肌肉力量之间的关系，并评估这种关系是否与性别有关：这项横断面研究利用了 2001 年至 2002 年间进行的美国国家健康与营养调查（NHANES）的数据。共有 1173 名年龄在 50-85 岁之间的人（男性 630 人，女性 543 人）参与了分析。膝关节伸肌的等动力峰值是通过运动交流器等动力计进行评估的。使用标准化液相色谱-串联质谱法测量血清 25(OH)D 水平。在对潜在混杂因素进行调整后，进行了线性回归分析，以估算血清维生素 D 水平各层次肌肉力量的系数和 95% 置信区间：结果：在老年男性中，血清维生素 D 水平的三等分与肌肉力量呈正相关（p-趋势 = 0.007），而在老年女性（p-趋势 = 0.140）或总样本（男性和女性合计；p-趋势 = 0.139）中未观察到相关性：结论：血清维生素 D 水平与老年男性的肌肉力量呈正相关，而与老年女性的肌肉力量无相关性。这些结果表明，维生素 D 与力量之间的关系可能取决于性别。
{"title":"Sex-dependent association of serum vitamin D with muscle strength in older adults: NHANES 2001–2002","authors":"Isabela M. Sponchiado, Larissa S. Limirio, Flávia M. S. de Branco, Erick P. de Oliveira","doi":"10.1038/s41430-024-01472-2","DOIUrl":"10.1038/s41430-024-01472-2","url":null,"abstract":"Although several studies have suggested a potential positive association between serum vitamin D levels and muscle strength in older adults, it remains unclear whether this relationship is sex-dependent. To evaluate the association between serum 25 hydroxyvitamin D [25(OH)D] levels and muscle strength in older adults and to assess whether this association is dependent on sex. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2002. A total of 1173 individuals aged 50–85 years (630 men and 543 women) were included in the analysis. The peak isokinetic force of the knee extensor was assessed using a kinetic communicator isokinetic dynamometer. Serum 25(OH)D levels were measured using the standardized liquid chromatography-tandem mass spectrometry method. Linear regression analyses were conducted to estimate coefficients and 95% confidence intervals for muscle strength across tertiles of serum vitamin D levels, adjusting for potential confounders. Tertiles of serum vitamin D were positively associated with muscle strength in older men (p-trend = 0.007), whereas no association was observed in older women (p-trend = 0.140) or in the total sample (men and women together; p-trend = 0.139). Serum vitamin D levels were positively associated with muscle strength specifically in older men, whereas no association was observed in older women. These results suggest that the relationship between vitamin D and strength may be sex-dependent.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"847-854"},"PeriodicalIF":3.6,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-10DOI: 10.1038/s41430-024-01469-x
Qinggang Yuan, Lixiang Liu, Kai Wang, Shizhen Zhou, Ji Miao, Bo Gao, Chao Ding, Wenxian Guan
It was reported that the cachexia index (CXI: $$frac{{rm{ALB}}* {rm{SMI}}}{{rm{NLR}}}$$ ) was an essential index for predicting the prognosis of tumor patients. However, since for SMI needs to be measured by CT imaging methods and its calculation was inconvenient. Thus, we developed a modified cachexia index (mCXI: $$frac{{rm{ALB}}}{{rm{NLR}}* {rm{UCR}}}$$ ). The purpose of this study was to evaluate the association between mCXI and prognosis in patients with colorectal cancer. An analysis of 215 patients with newly diagnosed colorectal cancer was carried out retrospectively. An optimal cut-off value of mCXI was established by the receiver operating characteristic (ROC) curves for predicting prognosis. Prognostic implications of mCXI were investigated using Kaplan–Meier curves and Cox regression analysis. A comparative assessment of the predictive capacity between mCXI and the CXI was performed using time-dependent receiver operating characteristic analysis. Patients were classified into two groups based on the cut-off value of mCXI: the LOW mCXI group (n = 60) and the HIGH mCXI group (n = 155). The 3-year Overall survival (OS) (76.6% vs 96.7%, p < 0.01) and 3-year Recurrence-free survival (RFS) (68.3% vs 94.1%, p < 0.01) were significantly worse in the LOW mCXI group in contrast to that in the HIGH mCXI group. In Cox multivariate regression analysis, mCXI was an independent prognostic factor for OS (HR = 8.951, 95%CI: 3.105–25.807, <0.01). Moreover, compared with CXI (AUC = 0.723), mCXI (AUC = 0.801) has better predictive efficacy, indicating that mCXI is more suitable for prognostic assessment. The mCXI significantly correlated with survival outcomes for colorectal cancer patients after radical surgery.
{"title":"Developing and validating a Modified Cachexia Index to predict the outcomes for colorectal cancer after radical surgery","authors":"Qinggang Yuan, Lixiang Liu, Kai Wang, Shizhen Zhou, Ji Miao, Bo Gao, Chao Ding, Wenxian Guan","doi":"10.1038/s41430-024-01469-x","DOIUrl":"10.1038/s41430-024-01469-x","url":null,"abstract":"It was reported that the cachexia index (CXI: $$frac{{rm{ALB}}* {rm{SMI}}}{{rm{NLR}}}$$ ) was an essential index for predicting the prognosis of tumor patients. However, since for SMI needs to be measured by CT imaging methods and its calculation was inconvenient. Thus, we developed a modified cachexia index (mCXI: $$frac{{rm{ALB}}}{{rm{NLR}}* {rm{UCR}}}$$ ). The purpose of this study was to evaluate the association between mCXI and prognosis in patients with colorectal cancer. An analysis of 215 patients with newly diagnosed colorectal cancer was carried out retrospectively. An optimal cut-off value of mCXI was established by the receiver operating characteristic (ROC) curves for predicting prognosis. Prognostic implications of mCXI were investigated using Kaplan–Meier curves and Cox regression analysis. A comparative assessment of the predictive capacity between mCXI and the CXI was performed using time-dependent receiver operating characteristic analysis. Patients were classified into two groups based on the cut-off value of mCXI: the LOW mCXI group (n = 60) and the HIGH mCXI group (n = 155). The 3-year Overall survival (OS) (76.6% vs 96.7%, p < 0.01) and 3-year Recurrence-free survival (RFS) (68.3% vs 94.1%, p < 0.01) were significantly worse in the LOW mCXI group in contrast to that in the HIGH mCXI group. In Cox multivariate regression analysis, mCXI was an independent prognostic factor for OS (HR = 8.951, 95%CI: 3.105–25.807, <0.01). Moreover, compared with CXI (AUC = 0.723), mCXI (AUC = 0.801) has better predictive efficacy, indicating that mCXI is more suitable for prognostic assessment. The mCXI significantly correlated with survival outcomes for colorectal cancer patients after radical surgery.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"880-886"},"PeriodicalIF":3.6,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.1038/s41430-024-01471-3
Meredith Kinoshita, Martin J. White, Anne Doolan
Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation.
{"title":"Clinical assessment of breastfeeding in preterm infants","authors":"Meredith Kinoshita, Martin J. White, Anne Doolan","doi":"10.1038/s41430-024-01471-3","DOIUrl":"10.1038/s41430-024-01471-3","url":null,"abstract":"Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 10","pages":"825-829"},"PeriodicalIF":3.6,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients'' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of –0.21 mg/dL (95% CI –0.39 to –0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by –7.05 mm Hg (95% CI –13.13 to –0.96) and diastolic blood pressure decreasing by –5.31 mm Hg (95% CI –7.99 to –2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of –1.71 mL/min per 1.73 m² (95% CI –3.29 to –0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.
低蛋白饮食（LPD）是非透析慢性肾病（CKD）患者饮食和营养治疗的核心。此外，体育锻炼可以预防和治疗各种疾病和慢性病。本研究旨在寻找和评估与单纯低蛋白饮食相比，额外体育锻炼对患者营养状况和疾病进展指标影响的证据。研究人员检索了 PubMed Central、Embase、Cochrane 和 Web of Knowledge 中的随机对照试验（发表于 1956 年 1 月 1 日至 2023 年 5 月 17 日）。共检索到 8698 项研究，其中 9 项符合条件并纳入我们的分析（N = 250 名参与者）。与单纯的低密度脂蛋白血症相比，额外的体育锻炼可使 CKD 患者的血清肌酐平均降低-0.21 mg/dL (95% CI -0.39至-0.03)。同样，体育锻炼后血压也有所下降，收缩压下降了-7.05毫米汞柱（95% CI -13.13至-0.96），舒张压下降了-5.31毫米汞柱（95% CI -7.99至-2.62）。亚组分析显示，阻力运动（RE）可有效降低估计肾小球滤过率（eGFR）-1.71 mL/min per 1.73 m²（95% CI -3.29至-0.14）。此外，持续 24 周的体育锻炼可使 VO2 峰值增加 2.41 mL/kg/min（95% CI 0.13 至 4.70）。上述结果表明，LPD 加上额外的体育锻炼护理对慢性肾脏病患者更有益。
{"title":"Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis","authors":"Jing Wang, Xiaofen Xiao, Hui Zhang, Dan Wu, Feifei Luo, Juling Yu","doi":"10.1038/s41430-024-01466-0","DOIUrl":"10.1038/s41430-024-01466-0","url":null,"abstract":"Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients'' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of –0.21 mg/dL (95% CI –0.39 to –0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by –7.05 mm Hg (95% CI –13.13 to –0.96) and diastolic blood pressure decreasing by –5.31 mm Hg (95% CI –7.99 to –2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of –1.71 mL/min per 1.73 m² (95% CI –3.29 to –0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 9","pages":"737-747"},"PeriodicalIF":3.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01466-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1038/s41430-024-01464-2
Carolina Aguirre, María Fernanda Tumani, Fernando Carrasco, Jorge Inostroza, Ana María Obregón, Álvaro Reyes, Paulina Pettinelli
The Relative Fat Mass (RFM) is an alternative index to body mass index (BMI) for estimating whole body fat percentage (BF%). Our aims were to determine the accuracy of the RFM for 1) identifying individuals with elevated BF% and, 2) estimating the BF% compared to Dual-energy X-ray absorptiometry (DXA) in a Chilean adult population. Body composition was assessed by DXA in 270 healthy participants (125 women/145 men). Anthropometric measurements were assessed to calculate RFM and BMI. Receiver operating characteristic (ROC) curves were obtained to assess the sensitivity and specificity of both, RFM and BMI. Bland–Altman analysis between BF% measured by DXA vs. predicted BF% derived from RFM was performed to assess validity. Pearson´s correlation coefficients to analyze the association between BMI, RFM and DXA were also calculated. For RFM, the cut-off for elevated BF% was ≥22.7% for men and ≥32.4% for women and for BMI was ≥24.4 kg/m2 for men and ≥24.1 kg/m2 for women. The area under the ROC curve between RFM and BMI was not significantly different in men (0.970 vs. 0.959; p = 0.420) and women (0.946 vs. 0.942, p = 0.750). The Bland–Altman analysis showed that the estimation bias is more pronounced in men than in women. RFM is an accurate tool for identifying individuals with elevated BF%, although it was not as accurate as DXA for estimating the BF%. RFM may be an alternative method useful in primary care to select individuals for lifestyle counseling and in research to select patients for epidemiological studies.
{"title":"Relative fat mass as an estimator of body fat percentage in Chilean adults","authors":"Carolina Aguirre, María Fernanda Tumani, Fernando Carrasco, Jorge Inostroza, Ana María Obregón, Álvaro Reyes, Paulina Pettinelli","doi":"10.1038/s41430-024-01464-2","DOIUrl":"10.1038/s41430-024-01464-2","url":null,"abstract":"The Relative Fat Mass (RFM) is an alternative index to body mass index (BMI) for estimating whole body fat percentage (BF%). Our aims were to determine the accuracy of the RFM for 1) identifying individuals with elevated BF% and, 2) estimating the BF% compared to Dual-energy X-ray absorptiometry (DXA) in a Chilean adult population. Body composition was assessed by DXA in 270 healthy participants (125 women/145 men). Anthropometric measurements were assessed to calculate RFM and BMI. Receiver operating characteristic (ROC) curves were obtained to assess the sensitivity and specificity of both, RFM and BMI. Bland–Altman analysis between BF% measured by DXA vs. predicted BF% derived from RFM was performed to assess validity. Pearson´s correlation coefficients to analyze the association between BMI, RFM and DXA were also calculated. For RFM, the cut-off for elevated BF% was ≥22.7% for men and ≥32.4% for women and for BMI was ≥24.4 kg/m2 for men and ≥24.1 kg/m2 for women. The area under the ROC curve between RFM and BMI was not significantly different in men (0.970 vs. 0.959; p = 0.420) and women (0.946 vs. 0.942, p = 0.750). The Bland–Altman analysis showed that the estimation bias is more pronounced in men than in women. RFM is an accurate tool for identifying individuals with elevated BF%, although it was not as accurate as DXA for estimating the BF%. RFM may be an alternative method useful in primary care to select individuals for lifestyle counseling and in research to select patients for epidemiological studies.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"78 9","pages":"782-787"},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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