BMJ Nutrition, Prevention and Health最新文献

Background: Sarcopenia has become a significant health issue, particularly as a common consequence of COVID-19 in older adults.

Objective: This study aimed to explore the clinical and psychological effects of integrated physical training with a high-protein diet compared with a regular protein diet in community-dwelling older men who had recovered from COVID-19 and exhibited symptoms of sarcopenia.

Methods: This is a single-blinded, randomised, controlled study conducted from March 2020 to December 2023 at the University hospital. The eligible participants were randomly assigned to two groups using the block randomisation method. The first group underwent integrated physical training with a high-protein diet (group A; n=38), with an average age of 64.1±3.8 years, while the second group underwent integrated physical training with a regular protein diet (group B; n=38), with an average age of 64.5±3.6 years over an 8-week period. Clinical parameters (handgrip strength and muscle mass-cross-sectional area CSA) and psychological measures (kinesiophobia and quality of life) were assessed at baseline, the fourth week, the eighth week and at a 6-month follow-up. The data were analysed using a 4×2 mixed model for repeated measures at different time points.

Results: Demographic characteristics such as age, height, weight and body mass index did not show any statistically significant differences between the groups (p>0.05). After the 8-week intervention and at the 6-month follow-up, handgrip strength decreased by -5.0 (95% CI -6.21 to -3.78), midthigh CSA decreased by -3.7 (95% CI -6.53 to -0.86), midcalf CSA decreased by -4.4 (95% CI -6.80 to -2.00), kinesiophobia level increased by 8.1 (95% CI 7.16 to 9.03) and quality of life decreased by -6.3 (95% CI -9.0 to -3.5). The findings indicated significantly greater improvement (p<0.001) in group A compared with group B, although there was no significant difference in muscle CSA in the arm region (p>0.05).

Conclusion: Integrated physical training with a high-protein diet led to improvements in clinical (muscle strength and muscle mass) and psychological (kinesiophobia and quality of life) parameters compared with integrated physical training with a regular protein diet in older men recovering from COVID-19 and displaying symptoms of sarcopenia.

Aims: Most hospitals still lag behind in their policies to stimulate healthier dietary choices by their patients. This study investigates whether a multicomponent nudging intervention, designed to prompt healthy food choices, can influence dietary choices of hospitalised patients.

Methods: This pre-postintervention study included a baseline phase and an intervention phase (7+7 months) and was carried out at the cardiology ward of a large hospital. All 2419 cardiac patients admitted to the ward during this period, and their 7559 meals were part of this study. The nudging intervention consisted of choice architecture, visual cues and informational nudges (eg, traffic light menus, posters). Data on dietary choices (vegetarian, fish, meat, side salad and fruit salad) were collected from the electronic food ordering system. As a secondary outcome, the intention to eat healthy after discharge was measured using the 20-item long Dutch Dietary Intention Evaluation Tool.

Results: During the intervention period, there was a statistically significant increase in the selection of vegetarian meals (20.1% vs 16.3%, p<0.001), fish meals (24.6% vs 18.7%, p<0.001), side salads (54.5% vs 49.5%, p<0.001) and fruit salads (12.8% vs 8.6%, p<0.001) when compared with the baseline period. In addition, patients in the intervention period expressed a significantly higher intention to eat healthy after discharge compared with the baseline period (β=0.167, SE=0.083, p=0.045).

Conclusion: This study demonstrates that a straightforward, easily implementable nudging intervention effectively promotes healthy dietary choices among in-hospital cardiac patients and enhances their intention to eat healthy after discharge.

Objective: Mechanistic studies indicated beneficial effects of choline and betaine on glucose homeostasis during pregnancy. However, limited human studies explored the associations of biomarkers of choline and its related metabolites with gestational diabetes mellitus (GDM) and results remained inconsistent. This study aimed to explore associations of serum choline, betaine and trimethylamine N-oxide (TMAO) with GDM odds among Han Chinese women.

Research design and methods: Pregnant women with singleton gestation were enrolled during GDM screening between 24 and 28 weeks of gestation at the Seventh People's Hospital in Shanghai, China. Women with GDM cases (n=173) and non-GDM controls (healthy women without pregnancy-related complications, n=158) were enrolled. Serum metabolites were measured by ultra-high performance liquid chromatography-multiple reaction monitoring-tandem mass spectrometry method. Multivariable logistic regression analyses were used to estimate ORs and their 95% CIs for the associations of these three metabolites with likelihood of GDM.

Results: Compared with the lowest tertile of serum choline and betaine, women in the highest tertile had a multivariate-adjusted OR (95% CI) for GDM odds of 0.55 (0.30, 1.00) and 0.55 (0.30, 1.00), respectively. No significant association was found between serum TMAO and GDM odds. In addition, the stratified analysis results showed that among women with abnormal weight gain during pregnancy, there was a significant inverse association between serum betaine and GDM odds [OR (95% CI), 0.26 (0.13, 0.57)].

Conclusion: Serum choline and betaine, but not TMAO, tend to be inversely associated with GDM odds among Han Chinese women with singleton gestation. Especially among those women with abnormal weight gain during pregnancy, higher serum betaine was associated with lower GDM likelihood.

Purpose: The aim of the present study was to analyse the associations of family meals and social eating behaviour (SEB) with experiential avoidance (EA) in adolescents from Spain.

Methods: This cross-sectional study involved 617 adolescents (aged 12-17 years, 56.7% females) from the Eating Habits and Daily Life Activities study from Valle de Ricote (Region of Murcia, Spain). Variables were analysed using visual techniques including Shapiro-Wilk test and density and quantile-quantile plots. Continuous data were displayed using medians and IQRs, while categorical data was shown as percentages. The frequency of family meals was assessed by asking participants to indicate how many times their family had shared a meal together during the previous week. SEB was self-reported by the adolescents through responses to three statements. To measure EA, we used the Acceptance and Action Questionnaire-II (AAQ-II). Generalised linear models were employed to ascertain the associations of family meals or SEB with EA.

Results: For each further point in SEB, a lower estimated marginal mean (M) of the AAQ-II was observed (-0.86 points, 95% CI -1.39 to -0.33, p=0.001). In terms of family meal status, the highest AAQ-II score was found in those with low family meal status (M=20.1, 95% confidence interval [CI] 18.1 to 22.2), followed by participants with medium family meal status (M=19.2, 95% CI 17.0 to 21.4) and those with high family meal status (M=18.8, 95% CI 16.1 to 21.0). Significant differences were observed between participants with high SEB status and their counterparts with medium SEB (p=0.004) or low SEB (p<0.001).

Conclusions: This research revealed a significant relationship between SEB and EA and a non-significant relationship between the frequency of family meals and EA. Promoting positive social eating environments and increasing family meal participation could help reduce the prevalence of EA and its negative consequences in adolescents.

While many countries use guidance and policies based on nutrients and food groups to support citizens to consume healthy diets, fewer have explicitly adopted the concept of ultra-processed foods (UPF). UPF consumption is associated with many adverse health outcomes in cohort studies. In the UK, a nutrient profiling model (NPM) is used to identify foods high in fat, salt or sugar (HFSS) and several policies target these. It is not known how well the NPM also captures UPF. We aimed to quantify the proportion of food and drink items consumed in the UK that are HFSS, UPF, both or neither and describe the food groups making the largest contributions to each category. We analysed data from the National Diet and Nutrition Survey, between 2008/2009 and 2018/2019, using descriptive statistics. We used three metrics of food consumption: all foods, percentage of energy in all foods (reflecting that different foods are consumed in different portion sizes and are of different energy densities) and percentage of food weight in all foods (reflecting that some UPFs have few calories but are consumed in large volumes). We found that 33.4% of foods, 47.4% of energy and 16.0% of food weight were HFSS; 36.2%, 59.8% and 32.9%, respectively, were UPFs; 20.1%, 35.1% and 12.6% were both and 50.5%, 27.9% and 63.7% were neither. In total, 55.6% of UPF foods, 58.7% of energy from UPFs and 38.3% of food weight from UPF consumed were also HFSS. The most common food groups contributing to foods that were UPF but not HFSS were low-calorie soft drinks and white bread. The UK NPM captures at best just over half of UPFs consumed in the UK. Expanding the NPM to include ingredients common in UPFs (eg, non-nutritive sweeteners, emulsifiers) would capture a larger percentage of UPFs and could incentivise 'deformulation' of UPF products.

Background: Nutrition is a critical component of healthcare, with healthcare professionals playing a pivotal role in encouraging proper nutrition care among patients. Consequently, it is imperative for all healthcare professionals to have proficiency in nutrition relevant to the prevention and treatment of diseases. This study, to the best of the author's knowledge, is the first study to examine the current level of nutrition competencies among health professionals and medical students in Kazakhstan, as well as the factors influencing these competencies. The findings may potentially help to inform future clinical nutrition educational strategies and improve health outcomes in the region.

Methods: This cross-sectional study surveyed 200 healthcare professionals in Kazakhstan via a 17-item questionnaire adapted from the NUTrition COMPetence tool, which assesses the self-perceived competence of primary health professionals in providing nutrition care, particularly for patients with chronic diseases. It measures several dimensions of competence, including confidence in nutrition knowledge, skills and counselling, and has established reliability and validity. Recruitment was conducted using convenience and snowball sampling methods. Fisher's exact test was used for statistical analysis to identify significant associations.

Results: Most healthcare professionals self-reported their nutrition knowledge as 'average' (52.7%) or 'good' (29.5%). Although 40.2% felt 'somewhat confident' and 27.6% felt 'very confident' in applying this knowledge clinically, half indicated they 'rarely' provide nutrition care. Additionally, the current study found that nutrition education received before entering practice was strongly linked to participants' current level of nutrition knowledge (p=0.011).

Conclusions: The gap between self-reported knowledge and practical application suggests barriers to integrating clinical nutrition education into practice. The quality of nutrition education received during medical training is crucial for shaping current competencies, highlighting the necessity for improved nutrition education in healthcare training programmes.

Objective: To assess the effects of a Vicia faba protein hydrolysate (VFH) on muscular strength and endurance when combined with resistance training for 56 days compared with exercise alone in a mixed population.

Design: A double-blind placebo-controlled parallel trial.

Participants: 72 healthy men and women aged 19-40, stratified in a 1:1 ratio by gender. Participants were excluded if they performed >3 hours of resistance training per week in the 6 months prior.

Setting: Ontario, Canada. Study performed by KGK Science from August 2023 to January 2024.

Intervention: VFH or silica microcrystalline cellulose is given in five capsules daily for 56 days.

Main outcome measures: Primary outcome: Leg strength via one-repetition maximum for bilateral leg extension. Secondary outcomes: Muscular endurance via repetitions to exhaustion, body composition via dual-energy X-ray absorptiometry, plasma biomarkers via ELISA, quality of life via short form survey (SF-36) questionnaire.

Results: Intergroup analysis revealed a significantly greater increase in leg strength compared with placebo at day 28 (p=0.045) and 56 (p=0.05), respectively. Significantly enhanced muscular endurance was also observed from days 0 to 56 with a difference of 2.2 times in the change in repetitions performed from baseline (p=0.022) and a 21.6% increase compared with the placebo. Significant changes in bone mineral content were reported between groups (p=0.032) with a mean increase of 0.7% gained in the VFH group. The improvements in performance were supported by myokine analysis where VFH was shown to modulate a range of biomarkers associated with glucose homeostasis, bone formation, mitochondrial and metabolic function. Quantitative physical strength gains were consistent with qualitative data which showed significantly improved changes in self-assessed health.

Conclusions: VFH supplementation demonstrated significant improvements in muscular strength, endurance and bone mineral content when compared with placebo. These low-dose, peptide-induced improvements enhance the effects of exercise for musculoskeletal health and have the potential to influence all-cause mortality via muscular strength.

Trial registration number: NCT05946746.

Background: High sodium (Na) and low potassium (K) intakes in childhood have health effects across the life course. The objective was to estimate global, regional and national Na and K intakes in children since 1990.

Methods: A systematic search of cross-sectional and longitudinal studies measuring Na or K intake in children aged 0-18 years of age since 1990 was conducted. Random effects multilevel meta-analyses and meta-regressions were performed to investigate age and time trends, country and regional differences, and to derive a worldwide average intake.

Results: A total of 259 studies with 520 630 children aged 0-18 years of age (mean 9.7 years) conducted between 1990 and 2021 in 79 different countries (mostly high-income countries) were included. The pooled Na and K intakes were 2.5 g/d (95% CI 2.4, 2.6) and 2.0 g/d (95% CI 1.9, 2.1), respectively. An estimated 73% of children had high Na intake (≥2 g/d/2000 kcal) and 89% had low K intake (<3.5 g/d/2000 kcal). Na intake was the lowest in Sub-Saharan Africa and the highest in North Africa and the Middle East. K intake was the lowest in South Asia and the highest in Central-Eastern Europe and Central Asia. Na and K intakes tended to decrease slightly linearly between 1990 and 2021 and increased logarithmically with age.

Conclusion: Globally, children's Na intake was too high, while K intake was too low. Data were lacking in many countries. Interventions are needed to reduce Na and increase K from childhood, and monitoring should be improved.

Background: Vitamin D deficiency (VDD) is common among women, particularly those with central adiposity. This study examines the predictors of vitamin D levels, focusing on age, adiposity and muscle composition.

Methods: A cross-sectional study was conducted with 397 women aged 18-59 years in Jordan. Vitamin D levels were measured using high-performance liquid chromatography. Anthropometric and body composition metrics, including fat-free mass index, conicity index, body mass index (BMI) adjusted skeletal muscle mass index (SMI BMI) and central adiposity measures (waist circumference (WC) and waist-to-hip ratio (WHR)), were analysed. Statistical analyses included χ² tests, t-tests and multivariable Lasso regression.

Results: Age was the strongest predictor of vitamin D levels, with older women exhibiting higher mean concentrations (42.80±11.01 years in the adequate group vs 36.45±11.22 years in the inadequate group; p<0.001). Central adiposity measures were significantly associated with vitamin D adequacy: WC<88 cm (73.8% vs 5.0%, p<0.001) and WHR<0.85 (20.3% vs 9.1%, p=0.001). Generalised adiposity measures, including BMI, were not significant in univariate analysis (p=0.668), but BMI was a negative predictor in Lasso regression (β=-1.078, 95% CI -1.400 to -0.756). SMI BMI showed a borderline negative association (p=0.054).

Conclusions: Age and central adiposity are the key predictors of vitamin D levels, emphasising the importance of fat distribution over generalised measures. Public health strategies should target central adiposity and muscle health, especially in younger women at risk of VDD.

Background: The current investigation was carried out to crudely assess and characterise the starch hydrolysis parameters and determine the estimated glycaemic index (eGI) of the selected rice landraces of Nepal (ie, Anadi white (Aw), Bhotange white (Bw) and Kalo Nuniya white (Kw)).

Method: INFOGEST harmonised in vitro protocol using pancreatic amylase instead of pancreatin for the intestinal phase was used to estimate the glycaemic index and starch digestibility parameters of the selected rice landraces of Nepal.

Results: The study showed rice landraces with similar starch contents had significantly different (p<0.05) in vitro starch digestibility parameters, that is, hydrolysis index, eGI, rapidly digestible starch, slowly digestible starch, resistant starch and total hydrolysed starch with Bw showing the lowest eGI of 51.77±2.48 followed by Kw with eGI of 55.35±1.05 and Aw showing the highest eGI of 60.60±1.03.

Conclusions: None of the landraces fell under the high GI class (>70). B_w fell under the low GI class (<55). This study offers novel qualitative and quantitative insights into the digestive fate of Nepalese rice landraces, providing a foundation for creating rice-based recipes with a lower GI and sheds light on their nutritional value, providing a foundation for further research into their metabolic benefits. It also advocates for integrating these lesser-known landraces into global efforts to address diet-related diseases, enhancing the nexus of agriculture, nutrition, and public health. Using in vitro enzymatic methods provides an efficient means of assessing the GI of food products, offering valuable insights into their potential impact on postprandial blood glucose levels. However, the heterogeneity in the application of in vitro methods for starch digestion makes comparing the results difficult. The current study is preliminary, and further research using standardised methods such as INFOGEST is warranted to validate these findings and expand our knowledge of the glycaemic properties of rice landraces through more interlaboratory findings and clinical trials involving human subjects.