Journal of the American Nutrition Association最新文献

Objective: Despite the increasing prevalence of obesity and diet-related chronic diseases, nutrition education has been historically lacking in medical education. With increasing access to effective diet-related chronic disease treatments, physicians have an increasingly important role to play in nutrition counseling. We evaluated the attitudes and comfort related to nutrition and nutrition counseling among a cohort of internal medicine residents at a large academic training program.

Methods: An online survey was administered to internal medicine residents on nutrition attitudes and counseling practices using a previously validated questionnaire. The survey was open for responses following an outpatient didactic session in March 2023. Responses were captured using Qualtrics and analyzed using descriptive statistics.

Results: The survey was distributed to 70 trainees. Of the 40 residents from all levels of training who completed the survey 60% reported having received no prior nutrition training in their educational background. Residents generally strongly agreed that nutritional assessments and counseling should be included in any routine appointments, just like diagnosis and treatment of patients, and that physicians can have an effect on patient's dietary behavior if they take the time to discuss the problem. Residents also strongly agreed that most physicians are not adequately trained to discuss nutrition effectively with patients and had low comfort with nutrition counseling across all areas.

Conclusions: Internal medicine residents recognize nutrition counseling as a priority, but report lacking education and comfort to effectively provide adequate nutrition education to patients. This highlights the need for more nutrition education in all levels of general medical training.

Background: The relationship between obesity and glenohumeral joint osteoarthritis (GJO) remains unclear, and the metabolic mechanisms involved are not well understood. This study investigated the prospective association between central obesity, assessed by waist-to-height ratio (WHtR), and GJO incidence, and examined whether triglycerides (TG) mediate this relationship.

Methods: We analyzed data from 32,881 UK Biobank participants enrolled between 2006 and 2014, with a median follow-up of 8.85 years (IQR: 7.15-10.75). Cox proportional hazards models and causal mediation analysis were used to estimate the direct and indirect effects of WHtR and TG on GJO risk, adjusting for demographic, socioeconomic, lifestyle, and comorbidity variables.

Results: Both WHtR and TG levels at baseline were significantly associated with higher GJO risk (p < 0.05). Compared to individuals with normal WHtR, those with severe central obesity had a 1.52-fold higher GJO risk (AHR = 1.52, 95% CI: 1.02-2.27, p = 0.038), independent of BMI. Similarly, participants in the highest TG tertile had a 1.46-fold increased risk compared to the lowest tertile (AHR = 1.46, 95% CI: 1.06-2.02, p = 0.022). These associations were consistent across subgroups by age, sex, physical activity, work intensity, and BMI. Mediation analysis showed that TG explained 21.9% of the WHtR-GJO association. The mediating effect was stronger in younger adults, women, and physically inactive individuals, but not significant in those with normal BMI or low physical workload.

Conclusions: Central obesity, as measured by WHtR, is an independent risk factor for GJO. TG partially mediates this association, suggesting that lipid toxicity may contribute to the metabolic pathogenesis of GJO.

Objective: Assessing the nutrition risk of preschoolers is crucial for promoting their healthy growth and development. This study aimed to develop a Korean version of NutriSTEP^® by assessing its feasibility, validity, and reliability.

Methods: A quantitative cross-sectional study was conducted with parents of preschoolers aged 3-6 years. Five scholars independently translated the English version of NutriSTEP^® into Korean. One-on-one online cognitive interviews were conducted with 10 parents, and an expert panel review with the five scholars was conducted using an item content validity index. A total of 201 parents participated in an online survey, and the criterion validity of NutriSTEP^® was assessed using receiver operating characteristic (ROC) curves. Construct validity was examined through item analysis using the Rasch model and known-groups validity, while internal consistency was assessed using the test-retest reliability.

Results: Eight items were revised to improve cultural acceptability and comprehensibility. Each item of NutriSTEP^® had an Item-content validity index (I-CVI) of 1.0, and the area under the curve for the ROC curve was 90.5%. A cut-point of NutriSTEP^® score to determine moderate risk (> 25) had a sensitivity of 90.5% and specificity of 71.7%, compared to the moderate nutrition risk (≥ 5). The Korean version of NutriSTEP^® was unidimensional, and scores varied significantly based on parents' income levels (F = 11.154, p < .001) and children's physical activity levels (t = -4.107, p < .001). The test-retest reliability was .661.

Conclusion: This study confirms that NutriSTEP^® is a valid and reliable tool for assessing Korean preschooler's nutrition risk. Using NutriSTEP^® could offer valuable insights for promoting healthy dietary behaviors in preschoolers.

Objectives: Nutrition during pregnancy is an important issue that should be investigated as it directly affects the health of the mother and the baby. Factors such as socioeconomic status, education, and health literacy influence nutrition. The aim of this study is to evaluate the relationship between diet quality and health and digital healthy diet literacy, cooking and food preparation skills of pregnant women.

Methods: This study carried out 310 volunteer pregnant women in their third trimester who applied to the obstetrics and gynecology outpatient clinic. The data was obtained through a questionnaire applied by face-to-face interview. The survey consists of socio-demographic characteristics, health status and nutritional habits, Health Literacy Scale-Short Form (HLS-SF12) and Digital Healthy Diet Literacy (DDL) Scale, Cooking and Food Preparation Skills (CS and FS) Scale, anthropometric measurements and 24-h food consumption records. Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) scores, which evaluate the adequacy of the diet in terms of nutrients, were calculated.

Results: The total scores of the CS and FS scales in pregnant women differed significantly based on their education level, income level, cooking frequency, and BMI groups (p < 0.05). There was a significant association between the MAR score and the sub-dimension score of CS (p < 0.05). However, there was no significant relationship between the MAR score and the HL and DDL indices (p > 0.05).

Conclusion: While a relationship was identified between pregnant women's diet quality and cooking skills, no relationship was found between diet quality and health and digital healthy diet literacy. This study supports the view that pregnant women's cooking and food preparation skills may improve their diet quality.

Objective: Various bacterial Bacillaceae and Bacillus strains have demonstrated health benefits, but less is known about probiotic characteristics of strains of Bacillus velezensis. In this randomized, double-blind, placebo-controlled clinical trial, we investigated the safety and efficacy of B. velezensis BV379 supplementation for 8 weeks (2 × 10⁹ colony-forming units (CFU)/day).

Methods: During the baseline and final weeks, GI symptoms were recorded daily using the 8-item Gastrointestinal Tolerance Questionnaire (GITQ). The primary outcome was the proportion of participants showing an improvement from baseline to week 8 in the 7-day, 3-item composite score for abdominal distention/bloating, burping, and gas/flatulence. Plasma chemistry, hematology, intestinal permeability, and fecal metagenomes were also investigated.

Results: Eighty participants (54% female; age: 50.3 ± 10.1 years) were randomized to BV379 (n = 39) or placebo (n = 41). At end of study, no significant difference was observed in the percentage of participants with improvement in the 3-item composite GITQ score (BV379: 36.1%; placebo: 28.2%; p = 0.46). Analysis of individual GI symptoms showed that more participants experienced improvement in abdominal distention/bloating with BV379 compared to placebo (38.9% vs 17.9%; p = 0.044). There were no clinically meaningful changes in plasma chemistry, hematology, or intestinal permeability between groups. Fecal metagenomic analyses showed no overall shifts in microbial composition between groups. In addition to B. velezensis, a few commensal species such as Lacticasei bacillus casei were significantly enriched in the BV379 group.

Conclusion: Despite not significantly improving the composite GITQ score of distention/bloating, burping, and gas/flatulence, BV379 supplementation was a well-tolerated approach to specifically lower abdominal bloating.

Background: Despite dietary cholesterol not being considered a nutrient of concern, dietary guidelines still recommend that people with elevated LDL cholesterol limit their intake of egg yolks.

Objective: We examined the effects of the daily consumption of eggs in the context of the Dietary Approach to Stop Hypertension (DASH) diet for 8 weeks on cardio-metabolic risk factors in adults with hyperlipidemia.

Methods: The study was a randomized, controlled, single-blind, crossover trial involving 45 adults (mean age 59.5 years; 35 females, 10 males; 42 Caucasian, two African American, one Asian) with hyperlipidemia. Participants were randomly allocated to one of the two possible sequence permutations of two treatments: the DASH diet with eggs (I) and the DASH without eggs (C). There was a 4-week run-in phase before treatments and an 8-week washout period between treatments. Participants received menus and guidance from the study dietitian on adhering to the DASH diet. They also received advice to exclude or include two whole eggs daily for 8 weeks in their DASH diet while displacing other foods based on instructions to maintain an isocaloric intake. Primary outcome measures were LDL cholesterol and endothelial function assessed as flow-mediated dilation. Secondary outcome measures included insulin sensitivity, other lipids, blood pressure, C-reactive protein, and dietary intake. Data were analyzed using repeated measures ANOVA.

Results: Daily addition of eggs to the DASH (Δ_I) compared with DASH without eggs (Δ_C) did not negatively affect endothelial function (Δ_I: 2.7 ± 10.8% versus Δ_C: 3.7 ± 19.9% versus Δ_I - Δ_C = -1.1, p = 0.767) or LDL cholesterol (Δ_I: 13.0 ± 23.5 mg/dL versus Δ_C: 8.9 ± 19.6 mg/dL; Δ_I - Δ_C = 4.2, p = 0.317). The DASH diet with eggs compared with the DASH without eggs relatively increased the consumption of choline (Δ_I: -29.6 ± 136.8 mg/d versus Δ_C: -148.2 ± 146.3 mg/d; Δ_I - Δ_C = 118.6, p = 0.002) while the intake of carbohydrates decreased (Δ_I: -26.4 ± 327.3 kcal/d versus Δ_C: 147.7 ± 282.3 kcal/d; Δ_I - Δ_C = -174.1, p = 0.032). Compared with DASH diet without eggs, the addition of 2 eggs per day in the DASH did not impact other cardio-metabolic risk factors (blood pressure, other lipid profiles, CRP, and glycemic control).

Conclusions: In adults with hyperlipidemia, daily egg consumption as part of a heart-healthy diet did not compromise cardio-metabolic health indicators.

Clinical trial registration number: https://clinicaltrials.gov/study/NCT05807334.

Background and objective: Controversies exist regarding the effects of calcium supplementation on lipid metabolism, and the time-specific effects and underlying mechanisms remain unclear. This study aims to elucidate the differential impacts of calcium intervention at different times (morning/evening) on hepatic lipid metabolism and the molecular mechanisms involved.

Methods: Forty female CD-1 (ICR) mice were randomly divided into four groups: Morning Control Group (MCN), Morning Calcium Intervention Group (MCI, intragastric administration of calcium carbonate at 08:00), Evening Control Group (ECN), and Evening Calcium Intervention Group (ECI, intragastric administration of calcium carbonate at 20:00). Mice were fed a normal calcium or low-calcium diet for 10 wk. In vitro experiments used HepG2 cells, which were divided into groups simulating whole-day (CON), daytime (DC, high calcium from 08:00 to 20:00), and nighttime (NC, high calcium from 20:00 to 08:00) calcium exposure. PER1 was knocked down using siRNA. Serum/hepatic/cellular lipid levels, hepatic pathology, transcriptome, and gene/protein expressions (PER1, PPARα, CPT1A, APOA5, etc.) were detected.

Results: Morning calcium intervention (MCI) in mice significantly increased serum and hepatic total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) levels, and induced lipid droplet deposition and swelling in hepatocytes. Transcriptome and validation experiments showed upregulated hepatic PER1 expression in the MCI group, while PPARα and its downstream lipid metabolism genes (CPT1A, APOA5) were downregulated. In HepG2 cells, nighttime calcium incubation (NC) significantly increased intracellular TG and LDL contents, upregulated PER1 expression, and inhibited PPARα, CPT1A, and APOA5 expressions. Knocking down PER1 reversed the abnormal gene expression and lipid-elevating effects in the NC group. Collectively, our findings demonstrate that the circadian timing of calcium intake critically regulates hepatic lipid homeostasis via the PER1-PPARα axis, highlighting the importance of chrono-nutrition in metabolic health.

Objective: This study aimed to evaluate the compatibility between the Mini Nutritional Assessment (MNA), a validated tool for screening for malnutrition among older adults, and the Healthy Diet Indicator-2015 (HDI-2015), a diet quality index, to investigate their relationship in assessing nutritional status.

Method: This cross-sectional study included 6094 community-dwelling older adults aged 65 and older. The MNA was administered to assess the nutritional status, and the adherence to the World Health Organization's HDI-2015 was determined based on 24-hour dietary recalls.

Results: According to the MNA, 70.4% of older adults had a normal nutritional status, 27.6% had a risk of malnutrition, and 2.0% were malnourished. Advanced age, female sex, poor appetite, difficulty chewing and swallowing, consistently skipping meals, and not exercising regularly were significantly associated with the rate of malnutrition in older adults (p < 0.001). Only 3.8% of older adults demonstrated high adherence to the HDI-2015, whereas 27.0% demonstrated moderate adherence and 69.2% demonstrated low adherence. The rate of malnutrition was higher in older adults who demonstrated low adherence to the HDI-2015 (p < 0.001). A weak positive correlation was found between the MNA and the HDI-2015 (r = 0.119; p < 0.01).

Conclusions: Even if older adults living in the community have a normal nutritional status according to the MNA, periodically obtaining dietary recalls to assess diet quality, such as using HDI-2015, is important for developing personalized nutrition plans.

Background and objective: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood, causing cognitive and social dysfunctions. Symptoms may persist into adolescence and adulthood or may occur later in life without childhood onset. Nutrition, which is an environmental risk factor, is also important in the treatment of ADHD. The Mediterranean diet (MD) is a dietary model in accordance with the nutritional recommendations indicated in ADHD. The aim of this study was to investigate the relationship between ADHD and dietary alignment with the MD.

Methods: This cross-sectional study was conducted with 440 students aged 18 to 24 years studying at Tekirdağ Namık Kemal University, Türkiye. The data collection tools used in the study were a sociodemographic characteristics form, an MD Quality Index (KIDMED), and the Adult ADHD Self-Report Scale (ASRS).

Results: The mean scores for the Attention Deficit subscale, Hyperactivity/Impulsivity subscale, and total ASRS total score of the participants with low dietary alignment with the MD were significantly higher than those of the participants with moderate and high dietary alignment with the MD (p < 0.001). The KIDMED scores showed a strong negative correlation with the total ASRS scores (r = -0.681; p < 0.001) and the Attention Deficit subscale scores (r = -0.643; p < 0.001) and a moderate negative correlation with the Hyperactivity/Impulsivity subscale scores (r = -0.533; p < 0.001). According to the results of the multivariate linear regression analysis, a one-unit increase in the KIDMED score is associated with a decrease of 2.333 units in the ASRS score (β = -2.333, p < 0.001).

Conclusion: Greater dietary alignment with the MD was associated with a lower risk of ADHD symptoms, including attention deficit and hyperactivity/impulsivity, and the positive relationship between the ASRS subscales suggests that these symptoms often co-occur. Though the findings suggest that the MD may help reduce ADHD risk, the cross-sectional design precludes causal inference.

The study aims to investigate the incidence of sesame allergy, to study common allergens and clinical manifestations, and to analyse the diagnosis and treatment of sesame allergy. A literature search on the topic was conducted, with each item studied separately. The study determined that the popularity of sesame seeds in cooking is growing. Consequently, the prevalence of allergic reactions to this product is also increasing. Most countries, including Poland, include sesame in the list of allergens that must be labelled on any food product. Sesame cross-reaction with Brazil nuts, sunflowers, peanuts, soybeans, carrots, hazelnuts, and pollen was determined. Anaphylaxis was the most common clinical manifestation, accounting for 37.7%. Allergy diagnostics are carried out using skin tests, specific and total immunoglobulin E, antibodies to recombinant allergens, double-blind, placebo-controlled oral tests or a combination of these. The introduction of sesame seeds at the age of over 6 months is considered to be prevention. An alternative effective and safe method is oral immunotherapy with or without omalizumab. This data suggests the importance of studying the issue of sesame allergy, despite its low prevalence, as patients most often had life-threatening anaphylactic reactions.