Clinical Nutrition Open Science最新文献

Background & Aims

Epidemiological studies have indicated a potential association between dietary acid load (DAL) and the risk and prognosis of cancer; however, the evidence needs more research. Hence, we performed an updated systematic review and meta-analysis to comprehensively investigate the relationship between DAL and risk for different types of cancer.

Methods

We conducted a systematic literature search in the PubMed, Embase, Web of Science, and Scopus databases from inception to November 2023. We calculated pooled odds risks (ORs) with 95% CIs using a random-effects model. We also conducted analyses on publication bias, subgroups, and sensitivity. This systematic review and meta-analysis included fifteen case-control studies.

Results

The pooled OR showed a statistically significant association between potential renal acid load (PRAL) (OR: 2.73, 95%CI: 2.62–2.83, P: <0.0001) and net endogenous acid production (NEAP) (OR: 2.70, 95%CI: 2.66–2.74, P: <0.0001) and a considerably increased risk of cancer. To identify potential sources of heterogeneity, subgroup analyses were performed depending on gender and country. Iranian females showed a higher odds ratio for developing cancer, according to statistical research on the PRAL index. However, the NEAP variable revealed a higher cancer risk among Uruguayan males.

Conclusion

The high DAL may be associated with an increased cancer risk and a poor cancer prognosis. We need more high-quality prospective studies to explore the connections between DAL and the risk and prognosis of specific cancers.

Background & Aims

Chewing difficulties are associated with poor physical and mental well-being in elderly populations. Little is known about these relationships in other age groups. Pain and biopsychosocial domains of eating (physical – anatomical, physical – functional, sensory, cognitive, behavioural, social/cultural, and emotional), as defined by the Altered Eating Framework (AEF) ⁽²³⁾ have also not been considered as influential factors when exploring the impact of chewing difficulty on well-being. This study aimed to a) investigate relationships between chewing difficulty, pain, AEF domains, and well-being, and b) explore pain as a potential mediator between chewing difficulty and well-being.

Method

One-hundred and seventy-nine participants, aged 19–82 years (mean = 43.39 yrs, SD = 15.46 yrs) completed an online survey comprising 8 measures, including chewing difficulty, pain and health, altered eating, and well-being. Data were collected April to November 2023.

Results

Chewing difficulty was a significant positive predictor of depression, anxiety, and stress. Pain positively predicted depression and partially mediated the relationship between chewing difficulty and depression. The emotional AEF domain positively predicted depression and stress.

Conclusion

Chewing difficulty was associated with poor well-being across a wide age range, findings highlight the importance of considering the impact of pain when exploring such relationships. The emotional AEF domain was most strongly associated with poor well-being, suggesting a possible hierarchical relationship between AEF domains. Future work is needed using prospective designs, and to develop a validated altered eating scale to capture eating experiences and impacts on well-being in real-time.

Background

An optimal nutritional strategy has not been established for the patients with muscle atrophy. Moreover, acute critical illness causes drastic changes in skeletal muscles, complicating nutritional treatment. Here, we present a case of myotonic dystrophy suffered acute respiratory distress syndrome (ARDS). We aimed to describe the changes in skeletal muscle as well as nutrition therapy.

Methods

A female in her 30s with myotonic dystrophy received mechanical ventilation for severe ARDS. Her respiratory status improved by day 15 of admission, but she developed severe weakness. We evaluated the cross-sectional area and mean computed tomography (CT) value of the psoas muscle at the level of the third lumber vertebra using abdominal CT scans performed on days 1 and 15. We also performed bioelectrical impedance analyses (BIA) on days 37 and 44. The patient received enteral nutrition from day 4, which was increased to administer 21.1 kcal/kg of energy and 1.05 g/kg of protein per day as the maintenance dose.

Results

The cross-sectional area remarkably decreased from 8.59 cm² on day 1–7.39 cm² on day 15. The CT values decreased from 47.2 HU to 13.6 HU. BIA performed during the recovery phase showed impaired muscle quality (phase angle of 2.6 or 2.9°). The muscle volume was preserved with maintenance doses of enteral nutrition.

Conclusion

Acute muscle volume loss and deteriorating muscle quality was observed during acute critical illness in a patient with myotonic dystrophy. The patient received a standard dose of energy and protein, and the muscle volume was preserved.

Ageing affects food choices, food-related life and the nutritional status of older people. The latter may be addressed through the targeted development of specific food products. For example, the development of protein-fortified foods could help older adults increase their protein consumption, thus contributing to the prevention of age-related diseases. This exploratory qualitative study focused on exploring the factors affecting the choice of protein-fortified foods amongst community-dwelling Irish adults ≥ 55 years of age. Sixteen community-dwelling adults (between 55 and 89 years) residing in Ireland were interviewed online in relation to their preferences and perceptions of these foods. Thematic analysis of the transcribed interviews revealed that the willingness to consume protein-fortified foods was low and that the interviewees generally preferred to consume foods naturally high in protein. However, if they had to consume protein-fortified foods, their choice and acceptance would depend on the product characteristics such as its sensory properties, functionality, composition, nutritional value and digestibility. Moreover, most of the interviewees would prefer to consume savoury (e.g. bread, soup) rather than sweet (e.g. pancake, ice cream) products. The study also revealed individual-related factors that affected acceptance of protein-fortified foods including sociodemographic characteristics (living situation), physiological factors (health issues), food-related life (diet and food habits) and food-related awareness (lack of information about protein). This preliminary qualitative study provides valuable information to help guide the development of protein-fortified foods acceptable by the target population.

Background & aims

Accurate fat mass (FM) and muscle mass (MM) assessment is an informative marker of an individual's health. However, the optimal method for assessing body composition in transgender men remains to be determined. Here, we aim to compare body composition estimates in transgender men by bioimpedance analysis (BIA) using the reference settings for “males” and “females” and by dual x-ray absorptiometry (DXA) scans.

Methods

We conducted a cross-sectional pilot study investigating the body composition of 10 transgender men undergoing hormonal therapy using BIA and DXA scans.

Results

BIA yielded significantly different estimates of body composition depending on the use of either “female” or “male” settings (P<0.05). BIA underestimated FM independent of using the “male” or “female” setting compared to DXA estimates by -6.5% (95% CI -7.2; -5.8) and -5.4% (95%CI -6.8; -4.0), respectively. BIA tend to estimated a higher MM, especially for the trunk area [BIA (“female”) vs. DXA; 6.6kg (95% CI 5.3; 7.9), BIA (“male”) vs. DXA; 5.7kg (95% CI 4.9; 6.4)]. For FM the “female” setting came closest to the DXA scans for the extremities, although the “male” setting seemed more precise for the trunk region. Regarding MM, the BIA “male” setting best resembled the DXA scan estimates.

Conclusions

We observed a significant difference in body composition estimates when using BIA with either “female” or “male” settings in transgender men. In general, BIA tend to estimate lower FM and higher MM compared to DXA. Therefore, we encourage caution when interpreting body composition estimates in transgender persons.

Registered at www.clinicaltrials.gov/ (study ID: NCT05728853).

Background & aims

The prognostic nutritional index (PNI), calculated from the serum level of albumin (Alb) and total lymphocyte count (TLC), has been considered to effectively predict the outcomes of critically ill COVID-19 patients. However, since the establishment of COVID-19 treatment regimens, its effectiveness has become unclear. Therefore, we conducted a multicenter study to establish whether PNI is still valid as a prognostic indicator for these patients.

Methods

We retrospectively examined the medical records of critically ill COVID-19 patients who required intubation and mechanical ventilatory management (MV) between July 2021 and March 2023.

Results

Seventy patients (50 males, mean age 62.9 years) were included and PNI at the start of intensive care was 31.7, which was in the “critical range”. The results obtained showed that PNI was not a predictor of death, whereas the presence of chronic obstructive pulmonary disease (COPD) and a high SOFA score were identified as predictors. The presence of COPD and obesity were also predictive factors for the number of days of MV.

Conclusions

Since the establishment of COVID-19 treatment regimens, PNI may not be an effective tool for predicting the risk of death or MV days in critically ill COVID-19 patients.

Introduction

Research has shown that the Covid-19 pandemic may have had negative effects on lifestyle factors of people in the UK, however research is limited in terms of the impact on people living with neurological conditions such as Multiple Sclerosis (MS), Parkinson's (PD) and spinal cord injury (SCI). This study explores the impact that the pandemic had on mental health and lifestyle factors such as dietary habits, supplement use and exercise in those with MS, PD and SCI.

Methods

A cross-sectional, online, questionnaire study was carried out on a cohort of 134 people in the United Kingdom during the Covid-19 pandemic. Participants completed the questionnaire between June 2021–February 2022. Eligibility criteria included being over the age of 18 years, and declaring having been formally diagnosed with either MS (n=27, female=81%), PD (n=84, female=35%), SCI (n=23, female=61%).

Results

33% of participants reported an increased consumption of alcohol and 29% a decreased consumption of fruit and vegetables. However, 64% of participants reported no change in diet (p < 0.001). Vitamin D, multivitamin/minerals, probiotic and fish oil were the most commonly consumed supplements by participants. Although intake of any supplement was not significantly impacted by Covid-19 for the total cohort, by condition, and by sex, a generalised linear mixed model indicated SCI participants consumed more supplement types during Covid-19 than before (OR:1.98; 95% CI [1.04, 3.77]). Additionally, 29% of participants reported they contacted their families less than pre-pandemic (p=0.001), and 60% reported they experienced more fatigue since the pandemic. Open-ended questions added quality context to the categorical data.

Conclusion

This study suggests that the impact Covid-19 has had on people with neurological conditions is complex and individual, yet the negative effects may be more pronounced than the general public. Overall, there were changes in lifestyle behaviours, some which may be detrimental to health and life quality in these already vulnerable groups. Therefore, these changes need to be considered in the aftermath of the pandemic.

SARS-CoV-2 has had a significant worldwide impact, leading to widespread illness and mortality. With the lack of specific antiviral treatments, there is a growing interest in exploring the potential therapeutic effects of various nutritional supplements, including vitamin D. Vitamin D plays an essential role in health, has been implicated in modulating the immune response and reducing inflammation, which may have implications in the prevention and management of coronavirus disease 2019 (COVID-19). Patients having low level of vitamin D are predisposed to severe consequences. Vitamin D and COVID-19 have shown an inverse relationship. This review is an understanding of the remedial effects of vitamin D in COVID-19, including its potential mechanism of action, evidence from clinical studies, and recommendations for supplementation of vitamin D in patients suffering from COVID-19.

Material and Methods

Google scholar, Sci-Hub, pubmed.

Objective

Sarcopenia, characterized by the loss of muscle mass and function, is prevalent in peritoneal dialysis (PD) patients. Early diagnosis is crucial, but universal screening is often hindered by the complexity of diagnostic algorithms and limited clinical resources. Therefore, this study aims to investigate the ability of bioelectrical impedance analysis-derived phase angle (PhA), a convenient and cost-effective technique, in detecting sarcopenia among PD patients.

Methods

A single-center cross-sectional study was conducted on 130 multi-ethnic PD patients in Malaysia. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) 2019 diagnostic algorithm. PhA was measured by a multi-frequency bioelectrical impedance analysis device at 50kHz. Multivariable logistic regression was used to determine predictability of PhA on sarcopenia. Receiver operating characteristics analysis was used to evaluate the discriminative performance of PhA in detecting sarcopenia. Optimal gender-specific PhA cut-off values for sarcopenia detection were determined based on desired sensitivity and specificity.

Results

Sarcopenia was identified in 25.4% of the PD patients. PhA emerged as an independent predictor of sarcopenia (adjOR= 0.147; 95%CI =0.042–0.516; P =0.003), exhibiting excellent discriminative power in identifying sarcopenia (adjAUC_overall= 0.818±0.041; bootstrapped 95%CI =0.734–0.899, P <0.001). The optimal PhA cut-off values for sarcopenia detection were ≤4.05° (92.9% sensitivity and 53.8% specificity) and ≤3.75° (78.9% sensitivity and 51.1% specificity) for male and female patients, respectively.

Conclusion

PhA serves as a pragmatic screening tool for identifying multi-ethnic Malaysian PD patients at risk of sarcopenia, facilitating early diagnosis and intervention to improve patient outcomes.