Nutrition最新文献

Objective: To evaluate the reliability, construct, and criterion validity of the screening tool for childhood cancer (SCAN), stratified by age in oncology patients admitted to a tertiary referral hospital.

Methods: Hospitalized children from birth to 18 years old, with an oncological diagnosis and expected length of stay (LOS) of >24 hours were included. Interrater and intrarrater agreements were used to evaluate the reliability of SCAN. Construct validity and criterion validity were explored in SCAN. Also, predictive validity was explored by comparing SCAN risk categories against LOS.

Results: Three hundred ninety-four children were included in the study. The scores obtained after dietitians and physicians used SCAN showed good agreement (ICC = 0.80, 95%CI 0.71-0.86, P < 0.001). The intrarrater agreement within the evaluation of the same dietitian to the same group of patients was also good (ICC = 0.83, 95%CI 0.75-0.88, P < 0.001). After applying SCAN, 66.2% of participants scored >3 points, classified as at risk of malnutrition. The agreement observed when comparing the risk classification given by the tool with the malnutrition assessment using anthropometry variables as the criterion reference was fair (κ = 0.22, 95%CI 0.15-0.29, P < 0.001). Predictive validity indicated a slight agreement (κ = 0.16, 95%CI 0.08-0.25, P < 0.001) between malnutrition risk by SCAN and LOS. When assessing construct validity, comparing the scores given by SCAN with those provided by STRONGkids, a fair agreement was found (κ = 0.21, 95%CI 0.15-0.26, P < 0.001).

Conclusions: Our results show that SCAN is a reliable and valid tool for detecting malnutrition in oncology pediatric patients upon hospital admission.

Objective: Although water is essential for maintaining life and health, the association of water turnover (WT) with mortality is, to our knowledge, unknown. We aimed to 1) determine the annual mean and variance of WT and 2) evaluate the association between WT and mortality in all 47 prefectures in Japan.

Methods: This cross-sectional, prefecture-level ecological study used data from government surveys that provided prefecture-level data. WT was calculated considering lifestyle and environmental factors using an equation previously developed by the international doubly labeled water database group. Each prefecture was classified into a WT quartile. We obtained data on age-standardized mortality from the 2015 Vital Statistics. The mortality rate ratio (RR) was calculated using a multivariable Poisson regression model.

Results: The annual mean and variance of WT were 3771 and 990 mL/d in men and 3084 and 990 mL/d in women, respectively. After adjusting for confounders, compared to the prefecture in the highest WT quartile, those in the lowest WT quartile were associated with a higher mortality RR for all-cause (Men: RR = 1.07 [95% confidence interval (CI) = 1.02-1.11]; Women: RR = 1.05 [95% CI = 1.00-1.11]) and stroke (Men: RR = 1.16 [95% CI = 1.00-1.33]; Women: RR = 1.18 [95% CI = 1.01-1.42]). This association was moderately weaker when adjusted for exercise habits, especially among women.

Conclusions: Our findings indicate large regional and seasonal variations in WT in Japan and that the risk of excess death due to lower WT may be partially explained by physical activity.

Objectives: Radical resection combined with prophylactic hyperthermic intraperitoneal chemotherapy (p-HIPEC) is a promising treatment for locally advanced gastric cancer (LAGC), though factors influencing its long-term benefits remain unclear. This study aimed to assess the impact of computed tomography (CT)-based body composition parameters on survival in patients undergoing this combination treatment, exploring nutritional factors affecting long-term survival and developing a prognostic model.

Methods: We retrospectively analyzed clinical and CT data from 230 patients with LAGC who underwent radical resection with p-HIPEC between January 2017 and December 2020. Cox regression and Kaplan-Meier analysis were used to identify independent risk factors, and nomograms were constructed based on significant predictors. The models' accuracy was evaluated using receiver operating characteristic (ROC) curves and calibration plots.

Results: Of the 230 patients, the 3-year survival rate was 56.1%, with a median overall survival of 49.7 months. Multivariate analysis identified sarcopenia (hazard ratio [HR], 3.078; p < 0.001), low subcutaneous adipose tissue index (HR, 1.739; p = 0.002), high visceral-to-subcutaneous adipose tissue ratio (HR, 1.746; p = 0.002), pT stage (p < 0.001), pN stage (N3: p = 0.004; N2: p = 0.049), and vascular invasion (p < 0.001) as independent risk factors for poor survival. Nomograms incorporating body composition and tumor features predicted 1-, 3-, and 5-year overall survival with high accuracy (AUC >0.7).

Conclusions: Body composition and tumor characteristics are independent predictors of overall survival in LAGC patients. Nomograms integrating these factors provide reliable prognostic predictions.

Background and aim: Gut microbiota dysbiosis plays a critical role in malnutrition caused by food intolerance and intestinal inflammation in children, which needs to be addressed. We assessed the efficacy and safety of washed microbiota transplantation (WMT) for gastrointestinal disease-related malnourished children.

Methods: This was a prospective observational study involving gastrointestinal disease-related malnourished pediatric patients who underwent WMT. The primary outcome was the clinical response rate at 3 mo post-WMT. Clinical response was defined as an improvement in the children's nutritional status of one level or more. The secondary outcomes were changes in gastrointestinal symptoms, laboratory nutritional indicators, and adverse events during the WMT procedure.

Results: 29 patients undergoing 74 WMTs were included for analysis. In total, 48.3% (14/29) of patients achieved clinical response post-WMT. Gastrointestinal symptoms, including diarrhea, mucous stool, abdominal pain, abdominal distention, and hematochezia, were significantly relieved post-WMT (all P < 0.05). Serum albumin and prealbumin levels were increased significantly post-WMT (P = 0.028 and 0.028, respectively). Eight self-limiting and transient adverse events, including diarrhea, abdominal pain, and abdominal distension, occurred after WMT.

Conclusion: This study indicated that WMT might be effective and safe for improving nutritional status and gastrointestinal symptoms in gastrointestinal disease-related malnourished children at 3-mo follow-up. WMT was expected to be a new therapeutic option for these patients.

Background: The most frequent early gastrointestinal (GI) toxicity symptoms are nausea (58%), diarrhea (46.7%), and vomiting (45.5%) in patients with cervical cancer (CC). Approximately 90% of patients undergoing abdominopelvic radiotherapy present with changes in the GI tract, such as degenerative alterations in mucosal epithelial cells and nutrient malabsorption.

Objective: To evaluate the effect of a diet modified in fiber, lactose, and fat on the prevention of chemoradiotherapy (QTRT)-induced GI toxicity compared to the usual prescription in women with locally advanced CC.

Methods: A total of 134 women with a confirmed diagnosis of CC in locally advanced stages (IB2-IVA) were included in a randomized clinical trial conducted between February 2017 and March 2020. The intervention group (IG) received a modified diet of fiber, lactose, and fat, while the usual prescription group (UP) followed habitual nutritional recommendations. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) v4.

Results: A total of 134 women were included in the IG (65) and UP (69) groups. The mean age in the IG and UP groups were 47.2±13.4 and 49.7±14.2 years, respectively. Radiotherapy doses received by the IG and UP groups were 50.1±6.7 and 49.9±4.6 Gy, respectively. IG had a lower risk of presenting with mild constipation compared to the UP (hazard ratio: 0.46, 95% confidence interval: 0.28-0.76, P<0.01).

Conclusion: Patients with locally advanced stages of CC undergoing QTRT who received fiber, lactose, and fat-modified diet may have a lower risk of mild constipation during abdominal radiotherapy.

Objective: To investigate whether segmental phase angle (PhA) is a useful predictor of severe chronic obstructive pulmonary disease (COPD) exacerbation.

Research methods and procedures: This prospective cohort study enrolled consecutive patients with COPD with a follow-up period of 3 years. The primary outcome was incidence of severe exacerbation. PhA was measured for the whole body and segmental body sites (trunk and upper and lower limbs). We used receiver operating characteristic (ROC) curves to determine the cut-off values and area under the curve (AUC) for predicting exacerbation based on PhA. We applied Cox proportional hazard regression analyses to estimate the independent prognostic effect of PhA on the incidence of severe exacerbation.

Results: We analyzed 108 male participants (mean age 75.1±7.9 years) and the median follow-up period was 1082 [643-1103] days, with an annual severe exacerbation incidence rate of 0.23 per person-year. ROC analysis revealed that the AUC for Whole-body and segmental PhA were as follows: Whole-body: AUC = 0.69 (95% confidence interval [CI] = 0.59-0.79); right arm: AUC = 0.65 (95% CI = 0.53-0.77); left arm: AUC = 0.68 (95% CI = 0.56-0.79); right leg: AUC = 0.73 (95% CI = 0.64-0.82); left leg: AUC = 0.71 (95% CI = 0.62-0.81); trunk: AUC = 0.58 (95% CI = 0.46-0.69). Cox proportional hazard analysis demonstrated that PhA of the right leg (hazard ratio [HR]=3.50, 95% CI=1.33-9.20), left leg (HR=3.26, 95% CI=1.18-9.04), and left arm (HR=2.61, 95% CI=1.17-6.80) were independently and significantly associated with incidence of severe exacerbation. Whole and trunk PhA were not significantly associated with the incidence of severe exacerbation.

Conclusions: Segmental PhA may serve as a valuable predictive indicator of severe exacerbation in male patients with COPD. Notably, both leg PhA were strongly associated with the occurrence of severe exacerbations.

Registry number: UMIN000044824.

Malnutrition is common in liver cirrhosis and is associated with increased rates of complications, hospitalization, and mortality. There are no consensus guidelines for malnutrition assessment in liver cirrhosis and a large number of clinicians do not routinely assess for malnutrition in patients with liver cirrhosis. This review explores the tools available for assessment of malnutrition in patients with liver cirrhosis, including nutritional screening protocols, anthropometric tools, biochemical tools, techniques analyzing body composition and functional assessments. We evaluate these tools and offer recommendations regarding their suitability for outpatient settings. In this review, we recommend the Royal Free Hospital-Nutritional Prioritising Tool for identifying patients at risk of malnutrition. Additionally, we recommend the use of the anthropometric tools Triceps Skinfold Thickness for females and Mid-Arm Muscle Circumference for males, due to differing patterns of muscle and fat malnutrition. Complementing this Bioelectrical Impedance Analysis can be utilized to assess body composition for the diagnosis of malnutrition. Biochemical markers have thus far failed to show a correlation with malnutrition. While hand grip strength is useful for detecting sarcopenia, a common complication of malnutrition, further evidence is required to validate its correlation with malnutrition.

Objectives: Childhood stunting remains a significant public health issue in India, affecting approximately 35% of children under 5. Despite extensive research, existing prediction models often fail to incorporate diverse data sources and address the complex interplay of socioeconomic, demographic, and environmental factors. This study bridges this gap by employing machine learning methods to predict stunting at the household level, using data from the National Family Health Survey combined with satellite-driven datasets.

Methods: We used four machine learning models-random forest regression, support vector machine regression, K-nearest neighbors regression, and regularized linear regression-to examine the impact of various factors on stunting. The random forest regression model demonstrated the highest predictive accuracy and robustness.

Results: The proportion of households below the poverty line and the dependency ratio consistently predicted stunting across all models, underscoring the importance of economic status and household structure. Moreover, the educational level of the household head and environmental variables such as average temperature and leaf area index were significant contributors. Spatial analysis revealed significant geographic clustering of high-stunting districts, notably in central and eastern India, further emphasizing the role of regional socioeconomic and environmental factors. Notably, environmental variables like average temperature and leaf area index emerged as strong predictors of stunting, highlighting how regional climate and vegetation conditions shape nutritional outcomes.

Conclusions: These findings underline the importance of comprehensive interventions that not only address socioeconomic inequities but also consider environmental factors, such as climate and vegetation, to effectively combat childhood stunting in India.