BMJ Nutrition, Prevention and Health最新文献

Abstract:

Introduction: Daily intake of vitamin K2-rich Jarlsberg cheese is shown to positively affect bone turnover markers (BTMs) in fertile women. How do postmenopausal women and adult men respond to a cheese intervention?

Purpose: To estimate the optimal daily efficacy dose (OED) of Jarlsberg cheese to increase serum osteocalcin level in postmenopausal females and males past 55 years of age and estimate the effect on BTMs.

Methods: Ten expected healthy postmenopausal females and 10 healthy males past 55 years voluntarily participated in a two-dimensional response surface pathway designed dose-response study with three design levels. The duration of each design level was 4 weeks. Blood samples were taken at baseline and the end of each design level for measurements of osteocalcin (OC), vitamin K₂, the BTMs procollagen type 1 N-terminal propeptide (P1NP) and serum cross-linked C-telopeptide type I collagen (CTX-1) and other biochemical parameters.

Results: In the female group, the OC level increased significantly (p<0.01) during the first design level but decreased slightly during the second and third design levels. Among males, the OC level increased monotonously during the study and significantly in the second and third design levels (p<0.01). There was no significant change in P1NP, but CTX decreased significantly (p≤0.05) in both sex groups. The ratio P1NP/CTX increased significantly (p≤0.05) in the female group. S-phosphate and s-urea increased significantly (p≤0.02) while s-calcium and s-magnesium were unchanged. After the study, four of the participating women received a diagnosis of osteoporosis.

Conclusion: Estimated OED of Jarlsberg cheese was 47 and 67 g/day for postmenopausal females and adult males, respectively. The development in OC and BTMs suggests an anabolic effect of Jarlsberg cheese on bone tissue.

Abstract:

Background: China established a registered dietitian system about a decade ago and has trained many registered dietitians. However, no studies have yet assessed dietitians' job satisfaction. This study aims to fill this gap by providing a comprehensive evaluation of their job satisfaction, professional identity and personal accomplishment.

Methods: This study conducted an online survey across 30 provincial-level administrative divisions in China, targeting nutritional professionals, including nutritional doctors and dietitians. The questionnaire was developed based on internationally recognised scales, such as the Minnesota Satisfaction Questionnaire, translated into Chinese. The study examined differences between nutritional doctors and dietitians in terms of work contents, satisfaction with nutrition-related policies and systems, job satisfaction, professional identity and personal accomplishment. Furthermore, multiple linear regression models were applied to identify factors influencing job satisfaction among nutritional professionals.

Results: A total of 1416 nutritional professionals participated in the study, including 656 nutritional doctors and 760 dietitians. Significant occupational differences were observed in work contents and satisfaction with nutrition-related policies and systems. The Minnesota Satisfaction Questionnaire scores were 55.37±18.49 for nutritional doctors and 46.77±14.54 for dietitians, indicating significantly lower job satisfaction among dietitians. Similar trends were also observed in professional identity and personal accomplishment. Factors influencing job satisfaction among nutritional professionals included holding management positions, the frequency of engaging in nutrition consultations and others.

Conclusion: In this study, dietitians reported lower levels of job satisfaction, professional identity and personal accomplishment compared with nutritional doctors. Implementing more favourable policies could enhance the professional standing of dietitians, shifting their role from behind-the-scenes support to more prominent positions. Such advancements may improve their job motivation and enable them to better address the growing challenges of nutrition-related diseases.

Abstract:

Introduction: Physical inactivity is a pressing global health issue. Health professionals have valuable opportunities to promote physical activity to patients across the lifespan, but they report barriers to providing such guidance. The Promotion of Physical Activity by Health Professionals trial aims to deliver implementation strategies to teams of health professionals (n=30 clusters) to address barriers and leverage facilitators within their clinical context to promote physical activity among their patients (n=720) (individuals aged five or above receiving care in outpatient or private settings). This trial will use a hybrid type 1 effectiveness-implementation design to investigate the effect of this support on moderate-to-vigorous physical activity (MVPA) in patient participants compared with a waitlist control. In addition to determining the effectiveness of this physical activity promotion approach, we will conduct a process evaluation that explores implementation within the trial and seeks to identify mechanisms that help explain the findings.

Methods: Our mixed methods process evaluation will employ measures to address determinants across implementation and intervention delivery, guided by a logic model which articulates how the implementation strategies and intervention are intended to work. This is informed by the UK Medical Research Council's guidance on process evaluations for complex interventions and McKay's implementation evaluation roadmap. Data will be collected using surveys and interviews with participating health professionals and patients. Implementation outcomes will include adoption, reach, fidelity and dose. Implementation determinants will include feasibility and acceptability. Quantitative data will be summarised using descriptive statistics and presented using tables and narrative synthesis. Qualitative data will be analysed using a qualitative descriptive approach. Later stage qualitative analysis will incorporate emergent findings from the quantitative analysis to develop a nuanced picture combining narrative accounts with descriptive statistics, exploring how and why implementation support influenced key drivers of behaviour change.

Discussion: Results of this process evaluation will improve understanding of implementation within the study and mechanisms which may impact MVPA among patient participants. This evaluation aims to guide future implementation and scale-up of the implementation strategies and interventions to suit varied clinical contexts and future research.

Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN12623000920695).

Abstract:

Background: The Republic of Palau is facing a growing burden of non-communicable diseases (NCDs). Dietary diversity is a recognised indicator of diet quality and is linked to body mass index (BMI) and perceived health. However, its role in the rapidly changing food environment in Palau remains unclear. This study aimed to examine associations among dietary diversity, BMI and perceived health among adults and identify region-specific dietary patterns and food items linked to health outcomes.

Methods: A cross-sectional survey using structured door-to-door interviews was conducted between August and December 2023 with 263 Palauan adults aged 20 years and older across urban and rural areas. Data on dietary intake, anthropometry and self-rated health were collected. Dietary diversity was assessed using a modified 11-item Food Diversity Score Kyoto (FDSK-11), which categorised meat and fish into fresh and processed forms. Multiple and logistic regression analyses were performed, adjusting for sociodemographic covariates.

Results: FDSK-11 scores ranged from 3 to 11 (mean: 9.0), with no statistically significant difference between urban and rural areas. However, the consumption of root crops, fresh fish, processed meat and fruits was statistically higher in rural areas, while egg and dairy consumption was more common in urban areas. The obesity rate reached 58.8%, while 57.1% of participants rated their health as poor. The study found no statistically significant association between dietary diversity and BMI or perceived health. In rural areas, higher fruit intake was inversely associated with BMI, and root crop consumption was positively associated with better perceived health. In urban areas, higher intake of fresh fish, processed fish, dairy products and vegetables was linked to better perceived health.

Conclusion: These findings imply that promoting culturally relevant, high-quality local foods may be more effective than emphasising dietary diversity. Thus, public health strategies should prioritise the revitalisation of traditional food systems to address the increasing NCD burden in Palau.

Objectives: To examine the correlation between health literacy (HL) and susceptibility to food-related fake news, and to explore the role of social media and influencers in shaping consumers' food choices.

Design: Cross-sectional survey conducted via an online questionnaire.

Setting: Nine community pharmacies located in northern, central and southern Italy.

Participants: A total of 2284 consumers recruited between January and March 2024.

Results: Lower HL levels were significantly associated with poorer self-reported education, health and economic status, as well as precarious employment. These same variables were linked to a higher likelihood of believing and spreading food-related fake news. Individuals from socioeconomically disadvantaged backgrounds were also more likely to trust influencers who influenced their food choices.

Conclusions: HL plays a key role in reducing the susceptibility to food-related misinformation, particularly in lower socioeconomic groups. Targeted interventions aimed at improving HL may help mitigate the spread of fake news and empower individuals to make healthier food choices.

Background: Frequent consumption of out-of-home (OOH) foods, including takeaways, is linked to higher energy intake and poorer diet quality. In April 2022, calorie labelling was mandated in England for large OOH businesses to support healthier choices. This paper aimed to explore knowledge and use of calorie labelling when ordering takeaway food online and other factors influencing food choices, overall and by sociodemographic characteristics.

Methods: A cross-sectional survey of 1040 takeaway consumers in England from an OOH purchase panel assessed knowledge and awareness of calorie labelling legislation, self-reported impact on online takeaway choices, and key drivers of takeaway consumption. Data were analysed using descriptive statistics, logistic regressions and thematic analysis.

Results: Over 27% of respondents ordered takeaways once or more per week. Respondents aged 35 years and older were less likely (OR 0.28-0.52, p<0.05), while those with obesity were more likely (OR 2.01, p<0.001) to report frequent takeaway purchases. Women were more knowledgeable about the recommended energy meal content than men (OR 2.06, p<0.001), yet only 15% of respondents knew the guideline amount. Awareness of calorie labelling regulations was 63% overall, but was less likely in middle socioeconomic groups (OR 0.56-0.63, p<0.05). During past online orders, 23% noticed calorie labels; of these, 26% reduced food calories ordered, and 10% reduced drink calories ordered. Taste and price were key drivers of takeaway choices, while health and sustainability were less influential. Strong support emerged for healthier menu options and traffic light labelling to help improve the healthiness of takeaway orders.

Conclusion: Given the limited reported impact, calorie labels may only benefit a minority. As meal healthiness was ranked as a relatively less important driver for takeaway choices, further policies are required to complement calorie labelling in promoting healthier food environments.

Introduction: Severe lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is a major cause of respiratory morbidity in children. Nutritional status is hypothesised to influence the severity of RSV infection, affecting clinical outcomes.

Objective: To evaluate the association between malnutrition and the severity of RSV-related LRTI in children.

Methods: A retrospective study was conducted at Naresuan University Hospital, including children under 5 years of age diagnosed with RSV LRTI between January 2014 and December 2018. Nutritional status was assessed using Z-scores for wasting (weight-for-height), underweight (weight-for-age), stunting (height-for-age) and both undernutrition and overnutrition (body mass index). Data were analysed using STATA V.18. Univariate analysis used t-test and χ² test. Variables with p<0.2 entered multivariate logistic regression to identify risk factors. Adjusted ORs (aORs) with 95% CI were reported; p<0.05 was significant.

Results: A total of 250 children met the inclusion criteria, with 36 (14.4%) classified as having severe RSV LRTI and 214 (85.6%) as non-severe cases. Among those with severe RSV-related LRTI, 16 (44.4%) were male and 20 (55.6%) were female, whereas in the non-severe group, 119 (55.6%) were male and 95 (44.4%) were female. Multivariable analysis revealed that severe wasting (aOR=3.70; 95% CI 1.01 to 13.55; p=0.048) and severe underweight (aOR=9.09; 95% CI 2.62 to 31.50; p=0.001) were strongly correlated with severe RSV LRTI.

Discussion: Severe wasting and severe underweight are significant risk factors for severe RSV LRTI in children. These findings suggest that improving nutritional status may help reduce the severity of RSV LRTI.

Objective: Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disorder that leads to increasing muscle weakening and early death. Steroids, the standard treatment of choice in slowing down disease progression, are plagued with adverse effects. Anti-inflammatory, antifibrotic effects and enhancement of muscle regeneration biomarkers after oral consumption of Aureobasidium pullulans strain N-163-produced beta 1,3-1,6-glucan (Neu REFIX) having been demonstrated in clinical and preclinical studies of DMD; in this study, we have investigated the effects on the gut microbiome in patients with DMD.

Design: Twenty-seven patients with DMD were included in the study (control (n=9), N-163 (n=18)). Whole-genome metagenomic sequencing was performed in pre-N-163 and post-N-163 intervention faecal samples of each of these participants.

Results: After N-163 beta-glucan administration, the constitution of the gut microbiome in all the participants was modified to one with positive outcomes on health. There was an increase in butyrate-producing species such as Roseburia and Faecalibacterium prausnitzii. There was a decrease in harmful bacteria associated with inflammation such as enterobacteria and Alistipes.

Conclusion: Beneficial reconstitution of the gut microbiome after Neu REFIX beta-glucan administration and its safety have been confirmed. These outcomes correlating with the anti-inflammatory, anti-fibrotic effects along with increase in dystrophin in skeletal muscle and plasma, reported earlier make us recommend further in-depth exploration on its role in epigenetic manipulation which when found encouraging might help other genetic diseases as well.

Trial registration number: CTRI/2021/05/033346.

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic condition often accompanied by multiple comorbidities requiring complex pharmacological management. This review aims to examine the prevalence of polypharmacy in patients with MASLD, alongside an exploration of reported associations with side effects and observed relationships with patient-reported outcomes.

Methods: We conducted a systematic review using MEDLINE, CINAHL, Embase, Cochrane CENTRAL and Scopus databases, supplemented by a grey literature search, from inception to August 2024. Inclusion criteria were randomised controlled trials, cohort studies or case-control studies that evaluated the prevalence of polypharmacy and its consequences in adults with MASLD. Three reviewers independently performed study selection and data extraction. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The primary outcome was the prevalence of polypharmacy, with secondary outcomes including side effects and quality of life (QoL). A meta-analysis with a random-effect model was performed.

Results: Six studies were included, of which three (totalling 2194 participants) were used in a meta-analysis. Polypharmacy prevalence ranged from 25% to 89%, with a pooled prevalence of 81% (95% CI 59 to 93), I²=99.5%. Adverse outcomes associated with polypharmacy included increased risk of hepatic encephalopathy-related hospitalisations, reduced QoL across physical and mental health domains, and augmented liver disease progression, particularly in individuals with advanced MASLD. Commonly used medications, such as anticholinergics and insulin, were linked to significant symptom burdens and metabolic dysregulation. Risk of bias assessments revealed that 50% of included studies had high risk due to limitations in study design, such as cross-sectional design and inconsistent definitions of polypharmacy, which reduced the certainty of evidence.

Conclusions: Polypharmacy is highly prevalent in MASLD and associated with poorer clinical outcomes and reduced QoL. Interventions such as deprescribing programmes and enhanced medication management strategies are needed to mitigate risks and optimise patient care.