BMJ Nutrition, Prevention and Health最新文献

Background: Malnutrition and food insecurity are common challenges among patients with cancer. Nutrition interventions can support patient nutrition needs and quality of life during cancer treatment, though measures to assess impact of interventions are lacking. In prior work, our team developed a Nutrition Experience Survey to assess patient-important domains related to impact of nutrition interventions during cancer treatment, from which a 9-item food-related and nutrition-related quality-of-life (FN-QoL) measure emerged. In this work, we report results from administering the overall Nutrition Experience Survey, including the FN-QoL measure, to a sample of patients with cancer and present initial validity testing of the FN-QoL measure.

Methods: This is a cross-sectional survey study in which we administered the Nutrition Experience Survey to a convenience sample of English-speaking patients with cancer in Philadelphia, Pennsylvania. Survey responses were summarised with descriptive statistics. Validity and internal consistency of the FN-QoL measure were evaluated with bivariate correlation matrices and Cronbach's alpha followed by a multiple linear regression analysis.

Results: 117 individuals completed the survey: mean age 62 (21-90), 49.6% white, 58.3% women. Cronbach's alpha confirmed adequate internal consistency (0.856) for the FN-QoL. The bivariate correlation matrix indicated that the FN-QoL was correlated with items as expected (eg, poorer subject health ratings, r=-0.48, p<0.001 and nutrition self-efficacy, r=0.38, p<0.05). Multiple linear regression found that receipt of medically tailored meals and treatment-related symptoms were related to FN-QoL when adjusting for all other variables.

Conclusion: Results suggest validity and potential utility of the FN-QoL measure to assess impact of food and nutrition interventions on quality of life among patients with cancer. Future work should assess applicability of this tool across populations who do not have cancer and sensitivity of this measure to change over time related to receipt of nutrition interventions.

Introduction: Endoscopic duodenal mucosal resurfacing (DMR) induces mucosal regeneration through hydrothermal ablation. Studies have shown that DMR improves hyperglycaemia in patients with type 2 diabetes. The INSPIRE study (n=16) aimed to eliminate insulin by combining DMR with a glucagon-like peptide-1 receptor agonist (GLP-1RA). At 18 months, 53% of patients were off insulin with adequate glycaemic control. This retrospective analysis evaluates long-term effects of DMR and GLP-1RA.

Research design and methods: Fourteen patients gave consent for the prolonged follow-up and data on glycaemic control, medication and DMR satisfaction were obtained via general practitioners. Primary endpoint was the number of patients off insulin with glycaemic control (haemoglobin A1c (HbA1c) ≤58 mmol/mol (7.5%)) at 4 years post DMR. Secondary endpoints were changes in HbA1c, fasting plasma glucose (FPG), weight, body mass index (BMI), use of glucose-lowering medications, treatment satisfaction and willingness to undergo DMR retreatment.

Results: Nine out of 14 patients (64%) were off insulin at 4 years. Of these, five patients (36% of study population) were adequately controlled. HbA1c and FPG did not change significantly, whereas BMI decreased at 3 and 4 years. Among the responders at 12 months, there was 80% durability at 4 years. Patients rated the DMR procedure 9 out of 10 and 86% were willing to undergo DMR retreatment.

Conclusions: Despite a stable number of patients remaining off insulin, a decrease in patients with adequate glycaemic control was observed. This suggests a slightly fading long-term DMR effect on glycaemia. High patient satisfaction and willingness for DMR retreatment indicate a promising avenue for further research.

Obesity prevalence in Sweden is rising, especially among 16-29 years old. Bariatric surgery in women of younger ages has risen accordingly. About 1% of all pregnancies in Sweden are in women who have undergone bariatric surgery. Not all women adhere to the recommendations about nutrition and timing of conception after surgery. This study aimed to assess midwives' perception of weight and nutritional management during antenatal care for pregnant women who had undergone bariatric surgery.

Method: We interviewed 17 midwives and analysed the text data with content analysis.

Results: The majority of midwives had treated women who were pregnant after bariatric surgery and who did not take sufficient vitamins and minerals and therefore were in a poor nutritional state. Many had met women who had become pregnant much earlier after surgery than recommended. Midwives often felt upset for the malnutrition risks for the baby, and sometimes blamed themselves for not providing enough nutritional support. Meanwhile, they found it easier to talk about weight with women who had undergone surgery than with other women with overweight or obesity.

Conclusion: These findings confirm the importance of prebariatric and postbariatric surgery support and information for young women regarding nutrition in relation to pregnancy. Preconception nutrition counselling with a dietician may be beneficial. Conversations about weight during pregnancy may be easier with women who have undergone bariatric surgery.

In 2020, the Saudi Food and Drug Authority introduced the Wajbati Rashaqati initiative to improve the quality of meals served in food establishments. The initiative included creating a menu for healthy meals with balanced nutritional elements; monitoring salt, sugar and fat content and reducing portion sizes. This study aimed to measure: (1) the awareness of Saudi adults regarding food calories and the method of calculating them; (2) the extent of Saudi adults' knowledge of the initiative; (3) the readiness and extent of willingness of Saudi adults to commit to the initiative; (4) the relationship between Saudi adults' body mass index (BMI), their calorie awareness and their readiness to implement the initiative and (5) the relationship between Saudi adults' demographic factors, their calorie awareness and their readiness to implement the initiative. This cross-sectional study took place in the Eastern Region of Saudi Arabia, and the study data were collected through an electronic questionnaire. 519 Saudi adults participated in this study, and over 50% of the participants were female, married, with a bachelor's degree and of a normal weight. Over 50% of the participants reported that they had knowledge of food calories and how to calculate their daily calories. Over 70% of the participants supported the initiative for determining the sizes and calories of foods available in food establishments, believing that this initiative might contribute to reducing obesity and chronic diseases. The χ² analysis revealed a significant correlation between participants' BMI and their commitment to daily calorie needs (p=0.001). Based on regression analysis findings, individuals highly aware of their daily calorie intake were more likely to practice portion control, understand the health implications of dietary choices, and support the Wajbati Rashaqati initiative. Sociodemographic characteristics influenced individuals' knowledge and endorsement of the initiative. Females, low-income participants and those with a high school diploma or less were more supportive, knowledgeable and informed about the initiative. The results of this study may contribute as a guide to implementing the initiative. It also may help decision makers to raise community awareness regarding dietary reference values, as well as to plan programmes to improve dietary behaviours.

Background: In the early 1940s, before antihypertensive drugs were available, the Rice Diet Programme (RDP) was developed to treat severe hypertension and, later, diabetes and obesity. Despite significant advancements in dietary management for these conditions since then, debates remain regarding the proper guidelines for sodium and macronutrients intakes. The patient care records of RDP offer a unique source of longitudinal examination of a very low sodium (<10 mmol/day), fat, cholesterol and protein diet on blood pressure (BP), other health markers and survival.

Methods: In 2019, the Rice Diet Database Project (RDDP) digitised handwritten patient care records and retinal photographs of 17 487 RDP participants, establishing a digital database for analyses. Manual transcription accuracy exceeded 97%. We used regression models to investigate the impact of dietary adherence on systolic BP (SBP) and body weight. Further, we performed Kaplan-Meier survival analysis to compare 5-year survival probability of participants defined by baseline level of SBP.

Results: The database encompasses a wide array of health markers, including BP, weight, urine chloride (UCl) concentration and retinal features that offer a unique resource for studying the impact of the RDP on hypertension, diabetes and obesity. Initial analysis shows reductions in BP and weight as well as improved survival in participants with severe hypertension, underscoring the effectiveness of the diet. The data also permit examining the safety of extreme dietary sodium reduction.The database has numerous strengths (large patient population; extensive, long-term measurements and the use of UCl excretion to document dietary adherence) and limitations (missing data; temporal changes in methodologies over 50 years and lack of control subjects).

Conclusion: The RDDP database allows exploration of the effects of a diet extremely low in sodium, protein, fat and cholesterol on health indicators and patient survival. This report highlights the database's potential for detailed and intricate future analyses.

Background: Several modifiable risk factors, including dietary habits, are linked to cardiovascular disease (CVD) progression. However, lifestyle changes remain notoriously challenging, perhaps due to psychosocial factors. This pilot study aims to investigate the relationship between adherence to a healthy diet, CVD risk factors, psychological factors and sociodemographic variables among middle-aged adults in Sweden.

Methods: Data were collected from March to December 2012 in the SCAPIS diet sub-study, where a total of 200 participants aged 50-64 years were enrolled. Dietary intake was assessed using the MiniMeal-Q food frequency questionnaire, and adherence to healthy eating patterns was evaluated using the Diet Quality Index-Swedish Nutrition Recommendations (DQI-SNR). Psychological factors, stress and sleep patterns were assessed through a comprehensive questionnaire. Statistical analyses included t-tests, analysis of variance, X² tests and logistic regression to identify predictors of unfavourable apolipoprotein (Apo) B/Apo A1 ratios.

Results: Out of 200 participants, 182 had complete and reliable dietary data. The majority exhibited intermediate adherence to a healthy diet, with women showing better adherence to dietary fibre intake compared with men. Women with high dietary quality had better cardiovascular profiles, including higher levels of Apo A1 and high-density lipoprotein cholesterol, lower Apo B/Apo A1 ratios and higher plasma carotenoids. Significant predictors of unfavourable Apo B/Apo A1 ratios included low socioeconomic status (SES), higher body mass index, larger waist circumference and smoking. Stratified adjusted analyses revealed distinct predictors based on SES, with depression increasing the OR of an unfavourable lipid profile by 6.41 times (p=0.019) in low SES areas.

Conclusions: This study highlights the potential of tailored recommendations considering socioeconomic and psychological factors. Addressing mental health and promoting physical activity may be crucial for CVD risk reduction, particularly in low SES areas. Further research is needed to confirm these findings in larger cohorts and to develop targeted interventions for diverse population groups.

Background: Inadequate energy intake among athletes can lead to low energy availability (LEA) which in turn can result in negative effects on athletic performance and physical and psychological health. This syndrome is known as relative energy deficiency in sports (REDs).

Objective: To map perceived changes in overall food intake among adolescent athletes during the previous year, as well as weekly changes during a 3-month period and to examine how these changes are associated with mental health, physical load and sex.

Methods: A total of 168 high school athletes from eight different sports participated. A baseline questionnaire examined changes in training habits and food intake in the past year, mental health (short version of the Warwick-Edinburgh Mental Well-being Scale (SWEMWBS)), injury history and previous periods of poor psychological health. Weekly digital questionnaires for 3 months tracked weekly physical and mental load and changes in food intake. Comparative and correlation analyses were performed with p<0.05 considered significant.

Results: A decreased food intake during the previous year was reported more often among athletes experiencing periods of poor mental health than those without such periods (10% vs 2%; p=0.034). Athletes who decreased their food intake reported lower mental well-being than athletes who increased their food intake (mean difference in SWEMWBS=4.69±1.57; p=0.021). Over a 3-month period, most athletes did not change their food intake, yet fluctuations in physical load were reported.

Conclusion: This study showed that athletes experiencing lower mental health or period(s) of poor mental health reported decreased food intake more often than those with better mental health or those without period(s) of poor mental health. In addition, the mismatch found between perceived weekly changes in overall food intake and changes in physical load during the same time period could potentially result in an increased risk for LEA.

Background: Postprandial lipemia (PPL) has been recognised as a cardiovascular disease risk factor. Appetite and PPL can be influenced by the length of saturated fatty acids (FAs). Thus, this study aims to investigate if different FA chain lengths have different impacts on appetite and PPL in healthy volunteers.

Methods: This is a randomised crossover single-blinded intervention study of 20 healthy adults. Coconut oil and palm oil were consumed in the form of biscuits. Blood serum samples were withdrawn after an overnight fast and 1, 2, 4 and 6 hours after eating the test meals and examined for blood lipid profile (total cholesterol (TC), high-density lipoprotein (HDL) and triglycerides (TG)), while Friedewald's equation was used to calculate low-density lipoprotein (LDL). Visual analogue scales were used by participants to rate their appetites, and an ad libitum meal was weighed to determine the energy intake.

Results: The net area under the curve of TG and TC following the coconut oil were significantly lower than following the palm oil (P value ≤0.05). In the mean of the change in TC, LDL and HDL from the baseline, a significant difference was found after 6 hours of eating the biscuits (P value ≤0.05). The perceptions of hunger and fullness did not significantly differ between the two types of FAs. Also, the energy and macronutrient intakes were not significantly different after the two types of oil, neither at the ad libitum meal nor on the day following the treatments.

Conclusion: The selection of FA chain length may influence PPL, and thus cardiovascular disease risk in a way that is functionally significant. However, this study detected no influence of FA chain length on appetite up to 40 hours post-treatment.

Trial registration number: NCT05539742.

Abstract:

Background: Health policies promote optimal care, yet policies that address disease-related malnutrition (DRM) are lacking. The purpose of this study was to conduct a scoping review to identify literature on existing and planned policy to address DRM in children or adults and explore the settings, contexts and actors of DRM policy.

Methods: A search strategy comprising DRM and policy keywords was applied to eight databases on 24 February 2023. Articles that addressed DRM and policy were selected for inclusion after two independent reviews. The health policy triangle (HPT) framework (ie, actors, content, contexts and processes considerations for policy) guided data extraction and thematic analysis.

Results: A total of 67 articles were included out of the 37 196 identified. Some articles (n=14) explored established policies at the local level related to food and mealtime, nutrition care practices, oral nutritional supplement prescribing or reimbursement. Other articles gave direction or rationale for DRM policy. As part of the HPT, actors included researchers, advocacy groups and DRM champions while content pertained to standard processes for nutrition care such as screening, assessment, intervention and monitoring. Contexts included acute care and care home settings with a focus on paediatrics, adults, older adults. Processes identified were varied and influenced by the type of policy (eg, local, national, international) and its goal (eg, advocating, developing, implementing).

Discussion: There is a paucity of global DRM policy. Nutrition screening, assessment, intervention and monitoring are consistently identified as important to DRM policy. Decision makers are important actors and should consider context, content and processes to develop and mobilise DRM policy to improve nutrition care. Future efforts need to prioritise the development and implementation of policies addressing DRM.