BMJ Nutrition, Prevention and Health最新文献

Abstract:

Introduction and objective: Malnutrition is common among the elderly and is a growing public health concern. Identification and subsequent intervention for malnutrition begin with screening. Community screening presents a key opportunity for early identification and intervention for at-risk groups. We aimed to examine the prevalence of nutritional risk and risk factors among Singapore's community-dwelling older adults.

Design: Cross-sectional study.

Setting and participants: Patients from public primary care polyclinics (n=404) were administered locally adapted English and Mandarin Chinese versions of SCREEN-II to determine the prevalence of nutritional risk (score<50). Stepwise logistic regression and latent class analysis (LCA) were performed to examine predictors of low scores.

Results: The overall prevalence of nutritional risk was 67.3% (95% CI 62.5% to 71.9%) affecting 60.2% males and 75.5% females in the sample. On stepwise logistic regression, being female (adjusted aOR (aOR) 1.89, 95% CI 1.21 to 2.95), having multimorbidity (aOR 2.48, 95% CI 1.56 to 3.92) and staying in lower-end housing (aOR 2.30, 95% CI 1.37 to 3.88) were risk factors for malnutrition. LCA two-cluster solution further identified Malay race (aOR 7.29, 95% CI 2.44 to 21.79, p<0.001) and secondary school education (aOR 1.75, 95% CI 1.16 to 2.63, p=0.007) as risk factors.

Conclusions: Findings suggest that nutritional risk is significant among Singapore's older adults and support the identification of higher risk subgroups. Further studies would be worthwhile to direct limited resources towards these at-risk groups in the face of the rapidly ageing population.

Objective: To assess perspectives on transitioning towards more plant-based diets for health and environment in the Icelandic population.

Methods: Online questions to a country representative panel (N=2452; >18 years): (1) transition towards more plant-based personal diets for health and the environment, (2) inclusion of education on plant-based diets in preschool and elementary school curricula and (3) supporting farmers for production of more plant foods. Differences between answers according to demographics were tested by χ² test.

Results: (1) 37% of respondents were positive towards personal diet transition, 33% were negative, (2) 51% were positive towards education about plant-based diets in preschools and elementary schools, 14% negative, (3) 73% were positive towards supporting farmers to increase production of plant foods, 5% negative. Women, those living in the capital area and those with university education were more positive to the changes than men, people living outside the capital area and people with lower educational level, respectively (p<0.01).

Conclusions: More than one-third of adult Icelanders had positive perspectives to transitions towards more plant-based personal diets, and a majority supported incorporation of education on plant-based diets, health and environment in schools. The strongest agreement was found for support to farmers to produce more varied plant-based foods.

Objective: To evaluate the effectiveness of anti-inflammatory diets on health-related quality of life (HRQOL) in adults with at least one chronic disease.

Design: Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data sources: MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Centre Register of Controlled Trials from inception to 6 May 2024.

Eligibility criteria for selecting studies: Full-text RCTs published in English assessing the effectiveness of any anti-inflammatory dietary intervention (ie, a diet that emphasises the intake of nutrient-rich, minimally processed foods rich in polyphenols, carotenoids and omega-3 polyunsaturated fatty acids and limits highly-processed, pro-inflammatory foods) on HRQOL in adults with at least one chronic disease were included.

Methods: Data extraction, risk-of-bias assessments and strength-of-evidence assessments were done by two independent reviewers. Pooled effects (standardised mean difference (SMD)) for HRQOL (separated into mental and physical component scores wherever possible) were calculated using random effects models with restricted maximum likelihood estimations. Subgroup analyses and meta-regressions were performed to assess the influence of study-level characteristics on HRQOL outcomes.

Results: 23 studies reporting HRQOL for 3294 participants were included. The most common chronic diseases were type two diabetes, musculoskeletal conditions and cardiovascular conditions. Anti-inflammatory diets were associated with small improvements in HRQOL physical component scores compared with usual care/other dietary interventions (18 trials, SMD=0.17, 95% CI 0.06 to 0.27) but not in mental component scores (18 trials, SMD=0.09, 95% CI -0.02 to 0.20) or general HRQOL scores (four trials, SMD=0.27, 95% CI -0.22 to 0.77). Pooled effects did not differ by available study-level characteristics; however, diet-only interventions (compared with multi-component interventions) had a greater effect on mental component scores. No study met the Cochrane criteria for low risk of bias. Certainty of evidence was low for physical and mental HRQOL scores and very low for general HRQOL scores.

Conclusions: In adults with at least one chronic disease, anti-inflammatory diets lead to small improvements in physical component HRQOL, which may not be clinically relevant. No effect was found on the mental component or general HRQOL. Further high-quality RCTs may change this conclusion.

Objective: To evaluate the 3-month impact of aerobic cycling on metabolic health and quality of life in middle-aged men with type 2 diabetes in a randomised controlled trial.

Method: A randomised controlled trial was conducted from July to November 2023 in five government hospitals in Lahore, Pakistan. A total of 120 male patients with type 2 diabetes mellitus (aged 50-65 years, body mass index (BMI) >25 kg/m², fasting plasma glucose (FPG) >140 mg/dL) were randomised into an exercise group (EG, n=60) and a control group (CG, n=60). The EG underwent a supervised aerobic cycling programme for 12 weeks (4 sessions/week, 50 min/session), while the CG continued usual care. Outcomes including BMI, weight, waist-to-hip ratio (WHR), FPG, blood pressure (BP), fat mass and Diabetes Quality of Life (DQOL) were measured preintervention and postintervention. Data were analysed using independent t-tests and multivariate regression (p<0.05).

Results: 115 participants completed the study (eg,=55, CG=60). Postintervention, the EG showed significant reductions in FPG (154.6±22.6 vs 174.8±20.2 mg/dL; p=0.004), systolic BP (129.9±13.8 vs 145.2±16.8 mm Hg; p=0.003), diastolic BP (79.2±8.1 vs 82.0±8.8 mm Hg; p=0.022), fat mass (38.2%±7.1% vs 42.0%±6.2%; p=0.005) and WHR (1.0±0.1 vs 0.9±0.1; p=0.045). DQOL scores improved significantly in the EG (2.5±0.53) vs CG (3.5±1.2; p=0.004). Weight and BMI also decreased in the EG (p=0.047, p=0.053). Multivariate regression showed exercise as a significant predictor of weight loss (β=-1.5, p=0.004).

Conclusions: A 3-month aerobic cycling programme significantly enhanced metabolic health and quality of life in middle-aged men with type 2 diabetes.

Background: Vitamin D plays a crucial role in immune function and respiratory infections, yet its association with latent tuberculosis infection (LTBI) and long-term mortality remains unclear. This study investigates the relationship between serum 25-hydroxyvitamin D levels, dietary vitamin D intake, LTBI risk and mortality.

Method: We analysed data from the 2011-2012 cycle of the US National Health and Nutrition Examination Survey, including 5286 adults (≥18 years) who underwent tuberculosis (TB) testing. Serum 25-hydroxyvitamin D levels were measured using high-performance liquid chromatography-tandem mass spectrometry, and dietary vitamin D intake was assessed via a 24-hour dietary recall. LTBI was defined as an induration>10 mm on the Tuberculin Skin Test or a positive QuantiFERON-TB Gold-In-Tube test. Mortality data were obtained through linkage with the National Death Index, with follow-up until 31 December 2019.

Results: Among 5286 participants, 708 (13.4%) had LTBI. Individuals with LTBI had significantly lower serum 25-hydroxyvitamin D levels than those without LTBI. A 10 nmol/L increase in serum 25-hydroxyvitamin D was associated with a 5% lower risk of LTBI (adjusted OR: 0.95, 95% CI: 0.92 to 0.99, p<0.05). Among LTBI participants, low serum 25-hydroxyvitamin D levels (<50 nmol/L) were independently associated with a higher risk of all-cause mortality (adjusted HR: 3.45, 95% CI: 1.33 to 8.90, p<0.05). However, dietary vitamin D intake was not significantly associated with LTBI risk or long-term mortality.

Conclusion: Vitamin D deficiency was associated with an increased risk of LTBI and long-term mortality in this population-based study. Although adequate serum 25-hydroxyvitamin D levels were linked to more favourable outcomes, the role of vitamin D supplementation in individuals with TB infection remains uncertain. Further research is needed to clarify these associations and guide evidence-based supplementation strategies for TB prevention and management.

Abstract:

Introduction: The literature primarily examines the mental health effects of dietary patterns, with 'healthy' diets linked to fewer depressive symptoms, although no standardised definition of a 'healthy' diet exists. Many individuals adopt restrictive diets such as caloric or nutrient restriction or medically prescribed patterns (eg, diabetic diets) to improve health, yet their impact on depressive symptoms remains understudied. This study aims to evaluate the association between restrictive dietary patterns and depressive symptoms stratified by sex and body mass index (BMI).

Methods: A cross-sectional study was performed using the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Adults who completed dietary assessments and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptom severity were included. Statistical analyses were performed using R. Multivariable linear regression was used to examine associations, and interaction effects were explored by including BMI or sex, with subgroup analysis performed when appropriate.

Results: The study included 28 525 adults, of whom 7.79% reported depressive symptoms. Compared with individuals not following a specific diet, those adhering to calorie-restrictive diets had a 0.29 point increase in PHQ-9 scores (95% CI 0.06 to 0.52). Among overweight individuals, calorie-restricted diets were associated with a 0.46 point increase (95% CI 0.02 to 0.89) and nutrient-restricted diet was associated with a 0.61 point increase (95% CI 0.13 to 1.10) in PHQ-9 scores. Men who followed any diet showed higher somatic symptom scores than those not on a diet. Additionally, men on a nutrient-restrictive diet had a 0.40 point increase in cognitive-affective symptom scores (95% CI 0.10 to 0.70) compared with women not following a diet.

Conclusions: There are potential implications of widely followed diets on depressive symptoms, and a need for tailored dietary recommendations based on BMI and sex.

Introduction: The increasing prevalence of non-communicable diseases (NCDs) is strongly linked to unhealthy diets. In Sri Lanka, malnutrition remains a public health issue, with rising rates of overweight and obesity coexisting with persistent underweight and micronutrient deficiencies. This study assesses the relationship between dietary patterns and the double burden of malnutrition (DBM) in Sri Lankan women, aged 15-49 years.

Methods: Data from 24-hour dietary recalls, collected during a nationally representative cross-sectional household survey in 2021, were analysed. DBM prevalence was defined using body mass index (BMI) classifications, including women categorised as underweight, overweight or obese. Diet quality was assessed using three globally recognised dietary tools: Global Dietary Recommendations (GDR) score, Global Diet Quality (GDQ) score and Minimum Dietary Diversity for Women (MDD-W). A total of 722 women aged 15-49 years were studied.

Results: The prevalence of DBM was 57.3% (95% CI: 53.7% to 60.9%), with the lowest prevalence observed among women aged 20-29 years. Most participants (98%) met at least 6 out of 11 GDR scores, with an average score of 8.0±1.2. Underweight women had significantly lower GDR scores compared with other BMI groups (p<0.05). Regarding MDD-W, only 0.6% of women consumed all 10 food groups, while 87.5% consumed five or more (mean score: 6.2±1.5). Women from the Muslim ethnicity (100%), the wealthiest quintile (94.5%) and urban areas (96.3%) had higher MDD-W scores (p<0.05). The average GDQ score was 24.8±3.4, with 71.1% of women classified as having low NCD risk. Medium NCD risk was observed among women aged 15-19 years, and those of Tamil ethnicity (p<0.05). However, no direct relationship was found between DBM and dietary scores (p≥0.05).

Conclusions: Global dietary scoring tools provide useful insights into diet quality but do not directly associate with DBM in this population. Further longitudinal studies are needed to explore causal links between diet quality and malnutrition outcomes.

Objective: Comparing two dietary cost measurements at the individual level: 'Food Frequency Questionnaire (FFQ) and supermarkets prices' with 'cash-register-receipts-items'.

Design: Method comparison study. Reference method: participants collected receipts of food purchases for 28 days; conventional method: participants completed a diet-specific online FFQ.

Setting: A Vegan Israeli Study substudy.

Participants: 30 participants were recruited using advertisements on social media.

Main outcome measure: Average diet cost, energy and nutrients consumption, generated by: (1) items on receipts; (2) online FFQ with supermarkets prices.

Analysis: Examining correlations between methods and generating Bland-Altman graphs.

Results: Agreement between measurement tools increased when 'eating-away-from-home' dietary costs were omitted from the analysis, from differences of 1453 New Israeli Shekel (NIS)/28 days (414 US$/28 days) higher to 1010 NIS/28-days (288 US$/28days) lower compared with differences of 756 NIS/28 days (215 US$/28 days) higher to 1159 NIS/28 days (330 US$/28 days) lower. Moreover, the Pearson correlation between methods, which was r=0.29 (p=0.13), increased to r=0.52 (p<0.0042). Finally, Pearson correlations between questionnaire-based and receipt-based nutrients were: energy=0.58 (p=0.001); protein=0.46 (p=0.012); fat=0.50 (p=0.005); carbohydrates=0.76 (p<0.001); calcium=0.46 (p=0.012); and iron=0.37 (p=0.049).

Conclusions and implications: The dietary cost of the 'FFQ-and-supermarket-prices' method is more strongly correlated and agreeable with the 'cash-register-receipts-items' method when 'eating-away-from-home' items are omitted, indicating that 'eating-away-from-home' costs are poorly estimated when using the standard 'FFQ-and-supermarket-prices' method. Finally, estimating energy, carbohydrates, protein, fat, calcium and iron using 'cash-register-receipts-items' is feasible.

Objective: To assess adherence to a dietary approach to stop hypertension (DASH) and associated factors among hypertensive patients on follow-up at public hospitals in Iluu Abbaa Boor Zone, Southwest Ethiopia, 2021.

Methods: An institution-based cross-sectional study was conducted among 410 study participants in public health hospitals in the Iluu Abbaa Boor Zone. A systematic random sampling technique was used to select participants.Data were collected through face-to-face interviews using a structured questionnaire. Table, graphs and charts were used to present descriptive statistics. Bivariable and multivariable logistic regression analyses were run. Variables with p<0.25 in bivariable logistic regression were considered candidates for multivariable logistic regression.Finally, variables with p<0.05 at 95% CI were considered to be statistically significant.

Result: The overall adherence to DASH was 37%. Male sex (adjusted OR (AOR)=5.8, 95% CI (2.9, 11.6), p<0.01), age >40 years (AOR=3.6, 95% CI (1.7, 7.5), p<0.01), marital status (married) (AOR=4.0, 95% CI (1.7, 9.5), p<0.001), employed individuals (AOR=4.0, 95% CI (1.3, 12.5), p<0.015) and rural residents (AOR=3.0, 95% CI (1.7, 8.2), p<0.001) were more likely to adhere to DASH than their counterparts.

Conclusion: Adherence to the DASH was very low among the study participants in the study area.Health professionals must give due attention to promoting adherence to the DASH. Special attention should be given to young adults, females and urban residents, unmarried and unemployed individuals.