Journal of the Academy of Nutrition and Dietetics最新文献

Introduction: In low-resource settings, exclusive breastfeeding (EBF) and household water security are recognized contributors to child health. Yet few studies have examined how they are related.

Objectives: This study aims to 1) test the relationship between domains of household water insecurity and EBF cessation before six months, and 2) examine the association between water insecurity and recent child diarrheal disease and stunting.

Design: The Haramaya University Health and Demographic Surveillance System is a cross-sectional survey.

Participants: /Setting: Mother-child (aged 6-59 months) dyads (n=1,019) were recruited from smallholder agricultural households in rural Eastern Ethiopia in 2019.

Main outcome measures: The primary outcome was EBF cessation before six months. Secondary outcomes were children's diarrhea (last two weeks) and stunting. Exposure variables assessing water insecurity included time spent fetching water, objective water quality (E. coli presence), water source reliability, and overall household water insecurity status (classified using the Household Water InSecurity Experiences Scale).

Statistical analyses: Survey logistic regression models were used to assess associations of water insecurity domains with early EBF cessation, diarrhea, and stunting.

Results: Poor water quality (AOR=1.42: 95% CI: 1.06-1.98), unreliable water (AOR 1.44: 95% CI: 1.04-1.98), and water fetching time >30 minutes (adjusted odds ratio [AOR]=1.54, 95% CI: 1.15-2.05) were associated with early EBF cessation risk. Children in households classified as moderate (AOR=1.54; 95% CI: 1.03-2.30) or high water insecurity (AOR=2.07; 95% CI: 1.33-3.24) had greater risk of diarrhea. No association was observed between domains of water insecurity and stunting.

Conclusion: Multiple domains of water insecurity were associated with early EBF cessation, while overall water insecurity was associated with children's diarrheal risk. Water insecurity has been identified as a key programmatic and policy consideration for early childhood nutrition.

Background: Proposed neonatal malnutrition criteria exist for nutritional assessment. Recommendations differ regarding which growth chart to use after premature birth.

Objective: This study compared malnutrition classification across Fenton, Olsen, and INTERGROWTH growth charts; examined their associations with body composition; and evaluated discrepancies in identifying fat-free mass (FFM) deficit and fat mass (FM) excess in preterm infants.

Design: This was a retrospective cohort study of preterm infants who underwent air displacement plethysmography (ADP).

Participants/setting: 285 preterm infants (<37 weeks) from four Ohio neonatal intensive care units (2012-2023) were included. After excluding 22 infants for early ADP assessments (at or before 14 days) and 5 for gestational age <23 4/7 weeks, 258 remained.

Main outcome measures: Main outcomes were malnutrition diagnosis using weight Z-score decline from birth to ADP assessment for each growth chart and FFM and FM Z-scores.

Statistical analyses performed: Linear regression models compared relationships between weight Z-score change amongst the three growth charts and with FFM and FM Z-scores. Kappa coefficients and Bowker's or McNemar's test assessed malnutrition agreement between charts. Kruskal-Wallis test compared median body composition Z-scores across malnutrition categories.

Results: The three charts demonstrated strong associations between weight Z-score changes (R² 0.8-0.9) but statistically significant discrepancies in malnutrition classifications (Fenton vs. INTERGROWTH κ=0.46, 95% CI: [0.36 to 0.57]; INTERGROWTH vs. Olsen κ=0.49, 95% CI: [0.36 to 0.61]; Fenton vs. Olsen κ=0.69, 95% CI: [0.61 to 0.77]; p<0.05). INTERGROWTH identified fewer cases of malnutrition (p<0.0001). Weight Z-score change and size-for-gestational-age exhibited significant associations with body composition Z-scores (p<0.0001). Fenton classified more malnutrition in infants with low FFM (46.1% vs. 16.4%, p<0.0001), while INTERGROWTH classified more infants with no malnutrition in those with high FM (94.8% vs. 69%, p<0.0001).

Conclusions: Fenton growth chart is more likely than Olsen or INTERGROWTH to categorize infants with low FFM as having malnutrition.

Background: Dietary management is essential in gastroparesis, but existing guidelines primarily focus on diabetic gastroparesis, highlighting a lack of evidence-based guidelines for patients with non-diabetic gastroparesis, who experience higher malnutrition and mortality rates. Management is complicated by a suggested bidirectional relationship with eating disorders.

Objective: To investigate evidence on dietary interventions, patterns and intake in non-diabetic gastroparesis, including effects on symptoms, nutritional outcomes, quality of life (QoL), and their potential role in disordered eating behaviors.

Methods: A scoping review was conducted using the Joanna Briggs Institute methodology. A comprehensive search was conducted across eight databases: Embase, MEDLINE, Web of Science Core Collection, Global Health, CINAHL, Scopus, CENTRAL and PsycInfo, alongside grey literature and citation searching. English-language studies from 2008 investigating dietary interventions, patterns and intake in adults with objectively confirmed non-diabetic gastroparesis (idiopathic, autoimmune-related, post-viral, or eating disorder-associated etiologies) were included. Two reviewers independently screened, extracted data and synthesized findings using a narrative approach.

Results: Of 6,212 articles screened by title/abstract, 88 underwent full-text review and 13 met inclusion criteria. Of these, 7 studies examined dietary interventions, 5 assessed dietary patterns, and 2 reported dietary intake. Two were randomized controlled trials (RCTs) including 16 participants with non-diabetic gastroparesis; the remaining 11 observational studies included 679 participants with confirmed non-diabetic gastroparesis and 752 for whom etiology was unspecified or delayed gastric emptying could not be confirmed. All included studies assessed symptom burden; 5 reported nutritional outcomes, and 2 evaluated dietary impact on QoL. No studies explored the role of diet in disordered eating. Considerable variation was observed in dietary management strategies across studies.

Conclusion: Research on dietary management in non-diabetic gastroparesis is limited, with significant variability in interventions, dietary definitions and study designs, reflecting lack of standardization across intervention protocols and research methodology. Well-designed trials are needed to clarify the impact of diet on symptoms, nutritional status and QoL, considering psychosocial effects and potential disordered eating risks.

Background: Adequate intake of carotenoids and vitamin E support healthy aging, yet evidence is limited on whether multivitamin-multimineral (MVM) supplementation changes their serum concentrations over time.

Objective: The aim of this investigation was to evaluate the effect of daily MVM supplementation among older adults on serum carotenoid and vitamin E concentrations over a 2-year period.

Design: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a large-scale, randomized, placebo-controlled, 2×2 factorial trial, designed to test the effects of daily MVM and cocoa extract (CE) supplementation for chronic disease prevention. Participants completed semi-annual questionnaires and provided optional biospecimen samples at baseline, 1-year, and 2-year follow-up.

Participants/setting: Between 2015 and 2020, US adults (women ≥65 years, men ≥60 years) without major cardiovascular disease or recent cancer were enrolled in COSMOS. This analysis included biospecimen sub-study participants with blood samples provided at baseline and ≥1 follow-up timepoint (N=400; 1 excluded due to unusable sample; final N=399).

Intervention: Participants were randomized to receive daily MVM supplementation or placebo, with or without CE.

Main outcome measures: Changes in serum carotenoids and α-tocopherol concentrations were evaluated over the 2-year follow-up.

Statistical analyses: Multivariable linear mixed models estimated changes in serum biomarker concentrations, comparing MVM to placebo, adjusting for covariates (age, sex, and CE intervention).

Results: Increases in serum carotenoids and α-tocopherol with MVM supplementation emerged at year 1 and persisted through year 2. MVM supplementation led to significantly higher serum concentrations of total carotenoids (percent change: 15.5% [95% confidence interval (CI): 8.72-22.70]), lutein (17.17% [7.53-27.66]), β-carotene (46.96% [35.10-59.85]), and α-tocopherol (29.50% [22.88-36.47]) over two years compared to placebo. No significant differences were observed for lycopene, β-cryptoxanthin, zeaxanthin, or α-carotene. CE supplementation did not modify the effect of MVM on serum carotenoid and vitamin E levels (p≥0.05).

Conclusions: Daily MVM supplementation increased specific serum carotenoids and α-tocopherol concentrations over two years. These findings suggest regular MVM use may support nutritional status in older adults; future research is needed to examine links with aging-related outcomes.

Background: Unintentional weight loss (UWL) is a common occurrence in older patients with chronic obstructive pulmonary disease (COPD). However, it may be overlooked in the intensive care unit (ICU) setting. Despite this, there is limited research on its impact as an independent clinical outcome variable.

Objective: To investigate the impact of UWL on the prognosis of critically ill older patients with COPD.

Design: A retrospective cohort study was conducted in which all participants were followed for at least one year.

Participants/setting: The study included 2767 patients diagnosed with COPD (aged 65 years and older) from a tertiary academic medical center in Boston, USA, between 2008 and 2019.

Main outcome measures: Exposure was UWL, and study outcomes included 30-day, 90-day, and 360-day mortality and prevalence of pressure injuries.

Statistical analyses: Wilcoxon rank-sum and chi-squared tests were used to compare cohort characteristics, while Kaplan-Meier survival analysis, Cox proportional hazards regression, logistic regression models, and subgroup analyses were used to examine the relationship between UWL and outcomes. Causal mediation analysis was used to examine potential mediating variables.

Results: The mean age of participants was approximately 77 years, and 51.9% were male. Of these, 409 older individuals had UWL. The results showed that UWL was significantly associated with increased 30-day (adjusted hazard ratio [aHR]: 1.7; 95% confidence interval [CI]: 1.3-2.1; p<0.001), 90-day (aHR: 1.6; 95% CI: 1.4-2.0; p<0.001), and 360-day mortality (aHR: 1.6; 95% CI: 1.4-1.8; p<0.001). UWL was associated with an increased prevalence of pressure injuries (adjusted odds ratio: 1.6; 95% CI: 1.2-2.1; p<0.001). Pressure injuries partially mediated the relationship between UWL and 30-day mortality (proportion mediated: 16.7%).

Conclusions: This study demonstrated that UWL was a risk factor for poor prognosis in older COPD patients in the ICU. It is recommended that UWL assessment be included in the routine assessment of these older patients.

Background: Critically ill adults in the intensive care unit (ICU) setting are at high risk of malnutrition, which is linked to poor outcomes. Delivery of optimal nutrition support in this population is challenging due to patient complexity and inconsistent nutrition care recommendations.

Objective: To provide a comprehensive, overview of guidelines and systematic reviews systematic reviews relevant to clinicians managing enteral and parenteral nutrition in critically ill adults and determine if an update to the Academy of Nutrition and Dietetics (Academy) Nutrition Support Guideline is warranted.

Methods: The Academy's' Evidence Analysis Center conducted a scoping review following methodologies adapted from Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute. A comprehensive search was performed on January 13, 2025, in MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Guideline International Network and Guideline Central databases. Included sources were English language guidelines, published in 2015 or after, or SRs, published after 2020, on nutrition support for adults (≥18 years) in ICUs. Data were extracted using standardized templates. Guideline quality was assessed independently by two blinded reviewers using AGREE II; SRs were appraised using critical domains from AMSTAR2. Results were summarized using charts and maps.

Results: Eleven guidelines and 58 systematic reviews were included. Guideline topics included provision of enteral vs parenteral nutrition, timing of initiation, and energy/protein provision. Systematic reviews most often cover energy/protein amounts, delivery rates, and fiber/prebiotics. All guidelines had notable quality issues, often lacking patient input, peer review, or implementation strategies. Over half of the systematic reviews met key AMSTAR2 criteria, though many had methodological concerns.

Conclusion: There are numerous guidelines and systematic reviews on nutrition support interventions for critically ill adults, with substantial variability in quality and scope. A comprehensive, high-quality, guideline should be developed through the GRADE-ADOLOPMENT process to leverage current resources. Future systematic reviews of sub-populations are needed to address evidence gaps.

Background: It is unclear how diet is associated with gestational weight gain (GWG) because prior studies focused on individual foods and did not consider diet at multiple timepoints.

Objective: The current study aimed to evaluate associations between changes in diet quality across pregnancy with GWG.

Design: This secondary data analysis included women from the Illinois Kids Development Study - a longitudinal prospective cohort.

Participants: /setting: Participants were 380 women recruited 2013-2018 from obstetric clinics in Champaign-Urbana, Illinois who were followed through delivery.

Main outcome measures: At median 13- and 35-weeks gestation, participants completed three-month semi-quantitative food frequency questionnaires to calculate the Healthy Eating Index (HEI)-2015 and Alternative Healthy Eating Index (AHEI)-2010 excluding alcohol. Change in diet quality was calculated by subtracting diet quality scores at 13-weeks from those at 35-weeks. Gestational age- and pre-pregnancy BMI-specific GWG z-scores were calculated using weight before pregnancy and at median 38-weeks gestation along with an international reference chart. Using pre-pregnancy BMI (kg/m²), women were classified as having under-/healthy weight (<25), overweight (25-29.9), or obesity (≥30).

Statistical analyses performed: Covariate-adjusted linear regression models accounting for total energy intake evaluated associations of improvement in HEI-2015 or AHEI-2010 across pregnancy with GWG z-scores. Differences by pre-pregnancy BMI were also explored.

Results: In women with obesity (who drove overall associations), each 10-point improvement in HEI-2015 across pregnancy was associated with -0.55 (95% CI: -0.82, -0.27) lower GWG z-scores, due to decreased refined grains and increased seafood and plant proteins intake. A similar relationship was observed when considering AHEI-2010 (β: -0.48; 95% CI: -0.81, -0.15) due to higher nuts and legumes intake.

Conclusions: Accounting for energy intake, diet quality improvement across pregnancy was associated with lower GWG z-scores, particularly in women with obesity. Future studies may consider the implications of these findings for maternal and child health.