BMJ Nutrition, Prevention and Health最新文献

Rational: A true increase in prevalence of coeliac disease (CeD) has been witnessed worldwide. This 'on-the-rise' epidemiological trend for CeD is shared with other immune-mediated disorders and could be due to environment-driven gut microbiota perturbances.

Objectives: To summarise recent evidence regarding possible relationships between microbiota disturbances and CeD onset, with a specific focus on pathogenesis and possible biotic-based therapeutic interventions.

Methods: A literature search was launched on 20 August 2024 using Google Scholar, PubMed, EMBASE, Scopus using keywords as follows: celiac disease AND microbiota; celiac disease AND microbiome; celiac disease AND prebiotics; celiac disease AND probiotics; celiac disease AND symbiotics; celiac disease AND postbiotics.

Results: A total of 1779 articles were retrieved from two authors' blinded search, of which 1297 were duplicates. 206 articles were excluded by abstract as they were commentaries, letters, case series. A final set of 276 articles was suitable for the scope of our review and, after carefully reading the full-text articles, only 131 were considered valuable for the review and included as references for the review.

Conclusions: While there is extensive literature on microbiota alterations and CeD, lack of clarity remains regarding whether the changes observed in the microbiota of individuals with CeD are effects of the condition or if and how they play a role in its onset. Limited evidence points towards the utility of specific probiotic strains to reduce symptoms, decrease inflammation, support growth in children and overall enhance recovery in CeD.

In times of metabolic stress, the demand for nutrients increases, which is essential to prevent delayed healing and development of chronic wounds. This study presents a systematic review and meta-analysis examining the effect of zinc treatment on wound healing. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included data from four electronic data bases. Five clinical trials met the inclusion criteria. The meta-analysis suggested that zinc treatment may be associated with improvements in ulcers healing at the final endpoint MD: 1.41 (95% CI 1.04, 1.92, p = 0.03). Given the limitations of the included studies, a Grading of Recommendations, Assessment, Development and Evaluation assessment indicated a moderate quality of evidence.

Gender-based violence (GBV) is disproportionately perpetrated against women and girls, due to harmful gender and social norms, structural gender-based power inequalities and pervasive discrimination against women and girls globally. In settings of fragility (eg, weak governance and humanitarian emergencies), risk factors for GBV are exacerbated while protective factors are eroded. Adequate nutrition is critical for mental and physical health and ensuring adequate nutrition for children in fragile settings is particularly critical. Fragile settings include heightened risk for GBV and malnutrition, but the combined impact of these two health contributors has rarely been examined together. Based on a rapid evidence assessment, we present evidence for associations between GBV against women and girls and child nutrition outcomes, identifying gaps in the evidence base and discussing key conceptual and methodological issues concerning research on this intersection. Improved understanding of the intersections between GBV and nutrition outcomes can help further highlight the linkages between these two public health issues and help inform programming and policy in both sectors.

Background: Micronutrient deficiencies are a significant issue worldwide, particularly in South Asia and sub-Saharan Africa. These deficiencies can impact glucose metabolism and insulin signalling pathways, potentially leading to the beginning and advancement of type 2 diabetes (T2D). This study is a comprehensive assessment of the burden of multiple micronutrient deficiencies among T2D patients. The aim of the study is to resolve conflicting evidence from previous studies that mainly focused on one specific micronutrient.

Methods: The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and the Cochrane Handbook. This comprehensive literature search explored Embase, ProQuest, PubMed, Scopus, Cochrane Library, Google Scholar, LILACS and the grey literature, and studies that met the inclusion criteria. A pre-piloted data extraction sheet was used to extract data for relevant study outcomes and characteristics. Results were produced by R V.4.3.2 (R Core Team 2023 using general packages such as tidyverse, and specific packages such as meta and metafor.

Results: The analysis included 132 studies with 52 501 participants. The pooled prevalence of multiple micronutrient deficiency (vitamins, minerals and electrolytes) was 45.30% (95% CI 40.35% to 50.30%) among T2D patients. The pooled prevalence (48.62%, 95% CI 42.55 to 54.70) was higher in women with T2D than in men. Vitamin D was the most prevalent micronutrient deficiency (60.45%, 95% CI 55% to 65%), followed by magnesium (41.95%, 95% CI 27% to 56%). B12 deficiency (28.72%, 95% CI 21.08% to 36.37%) was higher in the metformin consuming group. The prevalence of micronutrient deficiency varied across WHO regions.

Conclusions: Micronutrient deficiencies were common in T2D patients, the most common being vitamin D deficiency. Women were more likely to be affected by micronutrient deficiency than men. These studies were hospital based and the findings of this systematic review may be used with caution due to inherent selection bias. Diversity of foods, lifestyle choices and cultural practices may contribute to geographic variations in micronutrient deficiency.

Trial registration: PROSPERO CRD42023439780.

Background: Carbonated water has been reported to induce satiety, gastric motility and lower serum glucose concentrations, but the mechanisms remain unclear.

Methods: This report explores the physiological effects of carbonated water, referencing a study published in 2004 on the mechanisms of hypoglycaemia induced by haemodialysis.

Results: Upon consumption of carbonated water, carbon dioxide (CO₂) is absorbed into the bloodstream, and converted into bicarbonate by the enzyme carbonic anhydrase in erythrocytes. This process increases intracellular pH, stimulating anaerobic glycolysis in erythrocytes and leading to higher glucose utilisation. A comparison is drawn with haemodialysis, where CO₂ absorption by the blood similarly enhances glucose metabolism. During haemodialysis, blood glucose levels decrease from an average of 118.3 mg/dL before entering the dialyser to 98.6 mg/dL after passing through, despite the glucose concentration in the dialysate being approximately 105.0 mg/dL.

Conclusion: CO₂ in carbonated water may promote weight loss by enhancing glucose uptake and metabolism in red blood cells. However, the amount is so small that it is difficult to expect weight loss effects solely from the CO₂ in carbonated water. Drinking carbonated water may also affect blood glucose measurements. Further studies are needed to explore its long-term effects and potential side effects.

Background: The WHO recommends taxes on sugar sweetened beverages (SSBs) to improve population health. We examined changes in volume of and amount of sugar in purchases of soft drinks according to household income and composition, 19 months following the implementation of the UK soft drinks industry levy.

Methods: Data were from the Kantar Fast Moving Consumer Goods panel, a market research panel which collects data on weekly household purchases (mean weekly number of households=21 908), March 2014-November 2019. Interrupted time series analysis of volume and sugar purchases was used to estimate absolute and relative differences in the volume and amount of sugar in soft drinks, confectionery and alcohol purchased weekly by household income (<£20 000, £20-50 000 or >£50 000) and composition (presence of children (<16 years) in the household (yes or no)), 19 months after soft drinks industry levy (SDIL) implementation, compared with the counterfactual scenario based on pre-announcement trends and using a control group (toiletries).

Results: By November 2019, purchased weekly sugar in soft drinks fell by 7.46 g (95% CI: 12.05, 2.87) per household but volumes of drinks purchased remained unchanged, compared with the counterfactual. In low-income households, weekly sugar purchased in soft drinks decreased by 14.0% (95% CI: 12.1, 15.9) compared with the counterfactual but in high-income households increased by 3.4% (1.07, 5.75). Among households with children, sugar purchased decreased by 13.7% (12.1, 15.3) but increased in households without children by 5.0% (3.0, 7.0). Low-income households and those with children also reduced their weekly volume of soft drinks purchased by 5.7% (3.7, 7.7) and 8.5% (6.8, 10.2) respectively. There was no evidence of substitution to confectionary or alcohol.

Conclusion: In the second year following implementation of the SDIL, effects on sugar purchased were greatest in those with the highest pre-SDIL purchasing levels (low-income households and those with children). The SDIL may contribute to reducing dietary inequalities.

Trial registration number: ISRCTN18042742. Registered: August 2017.

Background: In a randomised placebo-controlled trial among exclusively breastfed rural Gambian infants aged 6-10 weeks at randomisation, daily iron supplementation for 14 weeks improved iron status. This secondary analysis explores the impact of iron supplementation on duration of exclusive breastfeeding and growth.

Methods: Breastfed 6-10 week-old infants were supplemented for 14 weeks with either daily iron or placebo (n=101). Infant feeding practices were assessed weekly through questionnaires. Survival analysis was used to measure the effect of iron supplementation on age at and time to cessation of exclusive breastfeeding. Groups were also compared regarding the change in anthropometric z-scores between baseline and endline.

Results: At endline, 31% (n=31/101) of infants were exclusively breastfed. There was no evidence that iron supplementation reduced the time to cessation of exclusive breastfeeding (median: 70 days (range: 7-105 days), iron: 67 days; placebo 71 days; Kaplan-Meier, log-rank test: p=0.15; Cox regression, crude HR: 1.42, 95% CI: 0.86 to 2.34, p=0.17; HR adjusting for infant age and sex: 1.40, 95% CI: 0.85 to 2.31, p=0.19) or age at cessation of exclusive breastfeeding (median time: 18 weeks (range:1-24 weeks), iron: 16 weeks; placebo 18 weeks; Kaplan-Meier, log-rank test: p=0.13; crude HR=1.47, 95% CI: 0.89, 2.43; p=0.13; HR adjusting for infant age and sex=1.44, 95% CI: 0.87, 2.39 p=0.16) There was no evidence that iron supplementation affected infant weight (p=0.79) or length (p=0.64) at endline or change in z-scores during the intervention period for weight-for-age (p=0.99), length-for-age (p=0.70) and weight-for-length (p=0.89). There was no evidence that duration of exclusive breastfeeding impacted endline anthropometric outcomes.

Conclusion: Although requiring replication in larger trials, these findings do not raise concerns about iron supplementations' effect on feeding or growth in exclusively breastfed infants.

[This corrects the article DOI: 10.1136/bmjnph-2024-001037.].