BMC Nutrition最新文献

Background: Malnutrition is a significant challenge in stroke patients, affecting both rehabilitation and independence. This study aims to evaluate whether early L-carnitine supplementation can effectively improve anthropometric parameters and malnutrition status in acute-phase ischemic stroke patients to mitigate the catabolic state.

Methods: Eighty-two first-ever ischemic stroke patients were randomly assigned to either the L-carnitine group (1000 mg three times/day for seven consecutive days) or the matching placebo group. The study outcomes based on intention-to-treat analyses included changes in weight, body mass index, triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, arm muscle area, calf circumference, serum ALB and malnutrition status over the seven-day treatment protocol. Malnutrition was assessed based on the serum ALB concentration, mid-arm muscle circumference, and triceps skinfold thickness. Analysis of covariance (ANCOVA) was applied for assessing the between-group changes along with adjusting the baseline mean value effect.

Results: Patients receiving L-carnitine had significantly lower changes in terms of weight, body mass index, triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, and calf circumference than did those in the placebo group. After the intervention, the placebo group experienced a significantly greater reduction in the mid-arm muscle circumference indicator (P < 0.001). The between-group change in the serum ALB concentration significantly increased in the L-carnitine group (P = 0.001). Moreover, the L-carnitine group was less malnourished than the placebo group [17 (41.5%) vs. 30 (73.2%), respectively; P = 0.01], after the intrvention. The "recovery" frequency was significantly greater in the L-carnitine group (18 (43.9%) vs. 3 (7.3%), P < 0.001) than the placebo group.

Conclusions: Early L-carnitine supplementation effectively improves anthropometric indices and malnutrition, muscle wasting, and rapid weight loss in acute ischemic stroke patients, highlighting its potential as a supportive nutritional therapy during stroke rehabilitation.

Trial registration: The current clinical trial study was registered in the Iranian Registry of Clinical Trials (registration code: IRCT20221206056734N1) at 2023-02-11.

Background: Nutritional management in patients after gastrointestinal cancer surgery has changed throughout the 2000s. However, its evolution has not been formally studied. This study aimed to evaluate changes in nutritional management using real-world data.

Methods: Patient data from 2011 to 2022 were extracted from a nationwide medical claims database. Patients were divided into four groups based on their year of hospital admission: period I, 2011-2013; II, 2014-2016; III, 2017-2019; IV, 2020-2022. For each period, feeding routes in all patients and prescribed doses of parenteral energy and amino acids in fasting patients during postoperative days (POD) 1-7 were determined. The results of the four different periods were compared using statistical trend tests.

Results: The study cohort was comprised of 365,125 patients. During POD 1-3, the proportion of patients administered any oral intake increased over time (I, 40.3%; II, 47.1%; III, 49.4%; IV, 54.2%; P < 0.001), while that of patients receiving parenteral nutrition (PN) decreased (I, 60.1%; II, 55.0%; III, 50.3%; IV, 45.5%; P < 0.001). Of 19,661 patients with PN alone (i.e., neither oral intake nor enteral nutrition) during POD 1-7, the median (interquartile range) prescribed doses on POD 7 of energy (kcal/kg) [I, 15.3 (10.3-21.9); II, 13.9 (8.4-20.0); III, 13.2 (7.7-19.2); IV, 12.9 (7.0-18.7); P < 0.001] and amino acids (g/kg) [I, 0.65 (0.30-0.94); II, 0.58 (0.24-0.89); III, 0.56 (0.00-0.86); IV, 0.56 (0.00-0.87); P < 0.001] both decreased over time.

Conclusion: From 2011 to 2022, more patients who underwent gastrointestinal cancer surgery in Japan were administered early oral intake, while fewer patients were administered early PN. Overall, the energy and amino acid doses prescribed in PN were far below the guideline recommendations.

Background: Low dietary quality significantly contributes to public health risks in low-income countries. This situation is particularly concerning for vulnerable groups, such as women and children, who are at increased risk of malnutrition due to inadequate access to proper nutrition. This study aimed to assess the influence of nutrition-related knowledge, attitudes, and practices, and kitchen characteristics on women's dietary quality in Ethiopia.

Method: A population-based cross-sectional survey was conducted from August to September 2022 in five regions and two city administrations in Ethiopia. A multistage stratified cluster sampling method was employed. From ninety-nine enumeration areas, twenty eligible households were selected. A total of 1,980 women aged 15-49 years were included in this survey. The data were collected using a structured questionnaire about socio-demographic characteristics, food frequency, 24-hour dietary recall, and nutrition-related knowledge, attitudes, and practices. The determinants of dietary quality were identified using Poisson, logistic, and ordinary least square regression analyses. Variables with a p-value less than 0.05 were considered to indicate statistical significance.

Results: The results showed that the average dietary diversity score for women was 3.4 ± 0.85. Only 21.5% of the participants achieved the minimum dietary diversity for women (MDD-W), and the mean adequacy ratio for nutrients was 61.6%. The participants' average nutrition-related knowledge, attitudes, and practices scores were 63%, 39%, and 23%, respectively. The regression analysis showed knowledge and attitude positively associated with dietary diversity and the mean nutrient adequacy ratio (P < 0.01). Cooking time and propensity to prepare new food were also positively associated with dietary diversity and with minimum dietary diversity (P < 0.01).

Conclusion: Our study showed that good nutrition-related knowledge and a positive attitude toward nutrition positively and significantly influence dietary quality, along with cooking time and the propensity to prepare new foods.

Background: Ultra-processed products (UPPs), high in sugar, fat and sodium, contribute to increasing burdens of obesity and non-communicable diseases in South Africa (SA). Increased consumption and acceptability of UPPs is driven, in part by aggressive marketing. Front of package labelling laws, particularly warning labels (WLs) coupled with marketing restrictions, have been recommended to improve consumer awareness of unhealthy products, incentivise reformulation and underpin other interventions. The SA government published a draft regulation to introduce WLs and restrict marketing, called R3337. This study aims to analyse on-package marketing and create a baseline to evaluate compliance with the proposed R3337.

Methods: This study is an analysis of a dataset of 6768 packaged food products, collected as pictures of products in four major grocery stores in Cape Town, SA between March and July 2019. A codebook was developed based on R337. The codebook was used to identify and assess child-directed marketing (CDM) and health claims on products potentially subject to front-of-package WLs. Food packages and their nutritional information were coded and analyzed to determine whether the product would be required to carry a WL and whether the package included regulated marketing.

Results: The majority (80.16%) of products analyzed would require WLs under R3337 due to high levels of sugar, sodium, or saturated fat. CDM was prevalent, with 59.26% of products displaying some form of marketing, primarily animated characters and depictions of children. Health claims were also common, with 83% occurring on WL products.

Discussion: Using a WL system in SA could effectively target common forms of on-package marketing of unhealthy products, given the high prevalence of CDM and health claims on products likely to carry WLs. Such interventions may contribute to improving diets and reducing UPP consumption. Some forms of CDM are not regulated under R3337 and we recommend expanding the regulation to include these. This study provides a baseline which should be used for future research to evaluate R3337 when it is implemented.

Background: This study aimed to assess possible changes in mineral intake correlation between family pairs over time. Mineral intake was measured using a food frequency questionnaire.

Methods: FCOR command of the Statistical Analysis for Genetic Epidemiology software was used to determine the correlation coefficients of minerals in relative pairs. Our first analysis was conducted on adults (n = 748) who had four complete dietary and familial data on the third to sixth surveys of the Tehran Lipid and Glucose Study. In addition, we assessed respectively the 3-year, 6-year, and 9-year changes in mineral correlations among populations with n = 1773, n = 1672, and n = 1352 samples with two mineral intake measurements.

Results: Most of the mineral correlations among various pairs were found to be in the same direction in both four and two measurement analyses. Among the mother-daughter and brother-sister pairs, there was a decreasing correlation for all minerals over time. In father-daughter, we observed decreasing or regression to the mean of correlations. For father-son and spouse pairs, the correlations between minerals showed a decreasing trend or regression to the mean over time, whereas increased for sodium in the father-son and phosphorus in the spouse pair. For mother-son and brother-brother pairs, iron intake correlation increased and other minerals correlations generally showed a decreasing trend or regression to the mean. Among sister-sister pairs, the correlation of calcium and phosphorus decreased, however, the correlation of chromium, selenium, sodium, and potassium increased.

Conclusion: Our study revealed a decreasing trend in correlation or regression towards the mean over time for most minerals in family pairs.

Background: People who face restricted or uncertain physical and economic access to safe, sufficient, and nutritious food to suit their dietary needs or food choices for a productive, healthy, and active life are said to be in a state or situation of food insecurity. There is a dearth of evidence of individual and community-level factors associated with household-level food insecurity in Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with household-level food insecurity to fill the aforementioned gap.

Methods: This study analyzed the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) datasets. A total of 24,965 participants in the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) datasets were included in the analysis. STATA version 17.0 was used to analyze the data. A multi-level mixed-effects logistic regression analysis was used to assess the individual and community-level factors associated with household-level food insecurity. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association, and statistical significance was declared at a P value less than 0.05.

Results: The prevalence of household-level food insecurity in Ethiopia based on 2021 PMA-ET data was 40.9%. Households who have not been educated (AOR: 5.62 with 95% CI: 2.74, 11.5), having primary educational status (AOR: 2.58 with 95% CI: 1.35, 4.92), having secondary educational status (AOR: 2.20 with 95% CI: 1.17, 4.14), households having middle wealth status (AOR: 3.00 with 95% CI: 1.05, 8.50), households having poor wealth status (AOR: 5.18 with 95% CI: 2.00, 13.4), households doesn't owned any livestock (AOR: 1.68 with 95% CI: 1.09, 2.84), and complete household income loss since COVID-19 restrictions began (AOR: 3.63 with 95% CI: 1.76, 7.50) were statistically associated with household-level food insecurity.

Conclusion: The prevalence of household-level food insecurity in Ethiopia was high. Hence, governmental and non-governmental organizations should focus on increasing the literacy status of the community since having low literacy status, including being not educated, has been found to contribute to food insecurity. The link between households that have not owned any livestock and food insecurity is one of our findings, suggesting that there is a need to participate in nonagricultural enterprises, including livestock production. Furthermore, besides government support, households should better to develop an emergency response plan for food security during any emergency including pandemics by increasing their source of income to avert the impact of different socioeconomic derangements.

Background: Malnutrition is a global burden, with 171 million under-five children stunted and 45% of child deaths linked to it. Despite high undernutrition such as stunting in Mchinji, Mangochi, and Mzimba, no study has focused on all three hot spots. This study examined socio-economic and demographic determinants of undernutrition among children aged 6-59 months, offering insights to guide targeted interventions in these areas.

Methods: This cross-sectional study of 1,275 caregiver-child pairs from Mzimba, Mchinji, and Mangochi used multi-stage sampling. Data were analyzed with Stata 17.0, employing descriptive statistics and binary logistic regression to explore associations and identify determinants of malnutrition in children aged 6-59 months based on WHO Z-scores.

Results: The study identified socio-demographic factors influencing wasting, underweight, and stunting among children aged 6-59 months. Wasting was linked to occupation, marital status, household size, religious affiliation, and vaccination, with protective factors including farming (AOR = 0.023), business (AOR = 0.001), being single (AOR = 0.034), and full vaccination (AOR = 0.146), while Muslim affiliation increased odds (AOR = 71.284). Underweight was associated with occupation and household type, with higher risks in business (AOR = 9.408) and single-parent households (AOR = 20.929) but protection in smaller households (AOR = 0.596). Stunting was related to unemployment (AOR = 2.339) and full vaccination (AOR = 1.472). Education and income showed no significant association with stunting.

Conclusion: Socio-demographic factors significantly influenced wasting, underweight, and stunting in children, highlighting the need for targeted interventions on livelihoods, vaccination, and household conditions to reduce undernutrition and inform policy and program development.

Background: The World Health Organization (WHO) actively promotes breastfeeding as the optimal source of nourishment for infants and young children. However, not all newborns have access to breast milk, leading to deprivation of its nutritional benefits or incurring financial burdens from alternative feeding options. Establishing Human Milk Banks (HMBs) can help ensure equitable access to donated human milk. However, several factors may hinder breast milk donation. This study aims to identify the factors influencing milk donation to HMBs in Iran.

Methods: We conducted a case-control study involving mothers who had given birth at least one year prior to the study. The study included 51 cases (mothers who donated their milk to HMBs) and 153 controls. Data were collected using a questionnaire designed to gather retrospective information on individual health, social networks, and other relevant factors. Logistic regression analysis was performed to examine the relationships between breast milk donation and these factors. Additionally, qualitative data were collected through face-to-face interviews with HMB senior staff and mothers. Thematic analysis was employed to identify perspectives on factors influencing milk donation.

Results: Family factors, social influences, individual social welfare scores, and breast milk adequacy were significantly associated with increased milk donation. Among these, family support emerged as one of the strongest predictors of milk donation.

Conclusion: To establish HMBs and promote human milk donation, health policymakers and planners should implement strategies that motivate mothers to donate. Evidence-based training and motivational programs for mothers and their families, which address barriers to milk donation, are essential to achieving this goal.

Background: Gestational Diabetes Mellitus (GDM) prevalence is rising worldwide, but optimal dietary strategies remain unclear. The eMOM pilot RCT compared a plant-protein rich Healthy Nordic Diet (HND) and a moderately carbohydrate restricted diet (MCRD) and their potential effects on time in glucose target range (≤ 7.8 mmol/L, %TIR), and on newborn body composition.

Methods: Forty-two participants were randomized to either HND (n = 20) or MCRD (n = 22) face-to-face nutritional counseling from gestational weeks (GW) 24 + 0-28 + 6 (baseline) until delivery. The HND intervention had no restriction in carbohydrate intake and emphasized plant-based protein sources and Nordic food, while the MCRD had a moderate carbohydrate restriction (~ 40% in proportion to total daily energy consumption, E%). Continuous glucose monitoring was worn for 14 days to assess glucose levels and %TIR. Blood samples for glucose and lipid metabolism and 3-day food diaries were collected at baseline and at GW 34 + 0-35 + 6. Neonatal body composition was measured by air displacement plethysmography. Difference between groups were analysed with t-test and Wilcoxon test.

Results: Thirty-two women completed the study. Both groups maintained the %TIR during majority of the time (98.9 and 99.3% for MCRD and HND respectively, p = 0.921) in GW 34 + 0 - 35 + 6. The mean glucose was lower in the MCRD group compared to the HND group (5.0 SD 1.03 vs. 5.2 SD 0.96 mmol/l, p < 0.001). No differences were observed in glucose variability, lipid metabolism, gestational weight gain, or in the body composition of the newborns. HND had lower diet macronutrient adherence than the MCRD, resulting in similar macronutrient composition in both groups. The mean macronutrient intakes were fat: 40.6 vs. 39.5 E%, carbohydrate: 40.5 vs. 42.4 E%, protein: 18.9 vs. 18.1 E% for the MCRD and HND groups, respectively. The HND decreased intake of meat and increased fish consumption significantly compared to the MCRD.

Conclusions: Both a moderately restricted carbohydrate diet and a diet focused on plant-based protein effectively maintained a large time within the treatment target range in women with GDM. Further research could explore the impact of protein quantity and sources in maternal diets on glycemic control and newborn outcomes.

Trial registration: The eMOM pilot trial is registered in Clinicaltrials.gov (21/09/2018, NCT03681054).

Background: Urine is an attractive biospecimen for nutritional status and population health surveys. It is an excellent non-invasive alternative to blood for appropriate biomarkers in young children and is suitable for home-based collection, enabling representative collections across a population. However, the bulk of literature in this population is restricted to collection in primary care settings. Feasibility of home-based collection at scale has not been tested. Here, we describe a mixed method approach to collect urine samples in a large cohort study with children under 5 years.

Methods: The ORIGINS Project is an ongoing birth cohort investigating early life influences on child health outcomes in Perth, Australia. Recruitment began in 2017, with 3713 children consented by December 2022. Urine is collected longitudinally from children between 2 months and 5 years of age. Mixed methods for sample collection and return accommodates requirements across various ages and study timepoints. Uniquely, courier collection and postal kit deliveries were established in response to participant feedback regarding difficulty with in-person sample drop-offs with young children.

Results: Over half of all eligible caregivers (1929/3713, 52%) returned a sample, 91% meeting quality standards. A third of all samples were returned by courier, with the highest uptake at 2-6 months of age, and increased uptake across all ages during COVID lockdowns. Caregivers cited being time-poor as the greatest barrier to sample completion and very few participants indicated difficulty with study methods.

Conclusion: Our data suggests that home-based urine collection using a mixed method approach is acceptable to caregivers at a large scale, supporting the use of urine for biomarker studies and population surveys with young children.