Annals of Nutrition and Metabolism最新文献

Introduction: Excessive visceral fat area is a risk factor for postoperative complications in gastric cancer patients undergoing minimally invasive gastrectomy. This prospective pilot study aimed to evaluate the safety, compliance, and efficacy of prehabilitation in obese patients with gastric cancer who were scheduled to undergo curative gastrectomy.

Methods: Patients with a preoperative visceral fat area ≥100 cm2 who were scheduled to undergo curative minimally invasive gastrectomy for stage I-III gastric cancer were included. The patients were instructed to walk 10,000 steps per day and consume a low-carbohydrate, high-protein diet without energy restrictions for 1 month before surgery. The primary outcome was the visceral fat area reduction rate, and clinical significance was set at a 10% reduction.

Results: Eighteen patients were enrolled in the study, and no adverse events were observed. The mean number of steps per day was 10,572. The mean exercise time greater than or equal to moderate intensity was 42.3 min per day, and 88% of the patients completed the 1-month intervention. Although the skeletal muscle mass was preserved, the visceral fat area reduced by 17% (95% confidence interval: 11%-24%, p = 0.039).

Conclusion: Prehabilitation can safely reduce visceral fat area before performing minimally invasive gastrectomy in patients with gastric cancer who are obese.

Background: Sleep health includes quality, quantity, and timing of sleep and is negatively affected by surgery. Poor preoperative sleep health is associated with worse surgical outcomes, including greater morbidity and hospital length of stay. Summary: In this narrative review, we describe the rationale and supporting evidence for preoperative sleep interventions (i.e., sleep prehabilitation) to improve perioperative outcomes. Our review highlights the link between impaired sleep health and surgical outcomes via several mechanisms including chronic, systemic low-grade inflammation, insulin resistance, and cognitive function. Instruments and intervention strategies to measure and improve sleep health, respectively, are discussed. Key Messages: We conclude with sleep prehabilitation recommendations and identify research priorities for the field.

Introduction: Being overweight, with a body mass index (BMI) ≥25, is associated with multiple comorbidities, including chronic kidney disease (CKD). A plant-based diet, such as a vegetarian or lacto-ovo vegetarian diet, serves as a preventive strategy for CKD in patients. We hypothesized that a vegetarian diet lowers the occurrence of CKD in overweight subjects.

Methods: The retrospective study was performed in Taipei Tzu Chi Hospital by a self-paid health exam. Age younger than 40 years old and the subjects without sufficient biochemical or hematologic results were excluded. The incidence of CKD was evaluated according to the self-reported eating habits (vegetarians, lacto-ovo vegetarians, or omnivores), overweight (with a BMI ≥25 or higher abdominal circumference [>90 cm in males or >80 cm in females]) or not, or other biochemical or hematologic parameters. The interaction between different factors for the development of CKD was analyzed by structural equation modeling (SEM).

Results: Among these 6,567 subjects, the subjects with lacto-ovo vegetarian diet had a lower incidence of CKD than those with other dietary habits such as vegans and omnivores. The incidence of overweight was the highest in the omnivore group. The lacto-ovo vegetarian group had a lower risk of CKD occurrence than the omnivore group. After adjusting for age and sex in SEM, the lacto-ovo vegetarian diet lowered the risk of CKD for those with a high BMI or a higher triglyceride (TG)/high-density lipoprotein (HDL) ratio.

Conclusion: Lacto-ovo vegetarian dietary habits are associated with a lower occurrence of CKD in obese patients. The mitigating effect of the lacto-ovo vegetarian diet was due to the hazard of a higher BMI and TG/HDL ratio.

Background: Breastfeeding is the ideal method of feeding for all newborns and is associated with multiple positive health outcomes. Human milk provides all essential nutrients and bioactive molecules needed for optimal infant health and development. Maternal nutrition during lactation plays an important role in supporting breastfeeding and in preventing nutrition and metabolic imbalances. The aim of this narrative review was to describe the most prevalent nutrition issues in lactating women and provide a summary of current diet recommendations as well as controversies on supplementation, in order to facilitate the information for clinicians and health professionals.

Summary: Breastfeeding is a nutritionally demanding stage and adequate nutrition is key to avoid alterations in maternal nutritional status, to produce an adequate quantity of milk with good quality, and to avoid nutrition programming of diseases. Anemia and vitamin D, A, iodine, and iron deficiencies are common, while obesity and metabolic diseases keep rising. Inadequate maternal intake of many nutrients is also frequent in this stage.

Introduction: The Global Leadership Initiative in Malnutrition (GLIM) consensus highlights the importance of using the GLIM criteria as a standardized approach to diagnosing malnutrition, particularly in patients with cachexia. Although many existing studies have utilized the GLIM criteria to assess the association between malnutrition and malignant tumor patients, there remains relatively little research exploring the specific relationship between malnutrition and sarcopenia. This study aimed to investigate the correlation between malnutrition under the GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies. By looking into the relationship, we hope to find better ways to prevent and treat sarcopenia in these patients, which will lead to better clinical outcomes.

Methods: In this study, we selected 210 patients with gastrointestinal malignant tumors from Northern Jiangsu People's Hospital between June 2022 and July 2023. We diagnosed and graded the nutritional status of these patients using the GLIM criteria. At the same time, body composition analysis, calf circumference, and grip strength were detected in all patients to observe whether they had sarcopenia.

Results: According to GLIM criteria, 30.1% of the patients were diagnosed with malnutrition, of which 25.1% were classified as moderate malnutrition and 15% as severe malnutrition. The risk of sarcopenia in patients with severe malnutrition was 2.5 times that of patients with good nutrition, and 1.19 times that of patients with moderate malnutrition. Patients with BMI <18.5 kg/m2 were 9.12 times more likely to develop sarcopenia than those with BMI ≥18.5 kg/m2. Due to inadequate nutrient intake and resultant malnutrition in patients with malignant tumors, muscle protein synthesis is affected, exacerbating muscle protein breakdown and leading to an overall decline in muscle strength and function.

Conclusion: This study highlights the urgent need for nutritional screening in early gastrointestinal tumor patients, revealing a strong link between sarcopenia and malnutrition. Higher malnutrition levels, low BMI, and high nutritional risk significantly predict sarcopenia, with risk increasing alongside worsening malnutrition and disease stage.

Background: Prehabilitation programs have advanced considerably; however, critical issues related to sex- and gender-specific factors remain largely unaddressed. Historically, research has been male-centered due to the underrepresentation of females in clinical trials, often attributed to concerns over hormonal variability. This focus has resulted in significant knowledge gaps and potential biases that impact effectiveness across sexes. We aim to highlight the need for integrating sex- and gender-specific considerations into prehabilitation to optimize surgical outcomes and promote equitable care for all patients.

Summary: Both biological (sex-related) factors, such as differences in muscle mass, metabolism, and body composition, and social (gender-related) factors, such as caregiving roles and stress management, influence individuals' responses to presurgical preparation. A review of the existing literature reveals a scarcity of data on sex and gender differences in prehabilitation, highlighting a major barrier to designing equitable and effective programs. Evidence underscores that comprehensive prehabilitation approaches, integrating physical, nutritional, and psychological elements, must account for these differences to optimize recovery outcomes.

Key messages: Sex- and gender-specific factors significantly shape patients' responses to prehabilitation and should be systematically incorporated into program design. The current lack of research on these differences limits the effectiveness of prehabilitation strategies, emphasizing the need for focused investigations. Addressing these gaps will facilitate the development of tailored, equitable prehabilitation programs that enhance presurgical care and improve recovery outcomes for all patients.

Introduction: Larger mean platelet volume (MPV), a measure of platelet activity, increases atherosclerotic cardiovascular disease (ASCVD) risk. Intake of n-3 polyunsaturated fatty acid (n-3 PUFA) found in fish may lower platelet count (PLC) and activity. We investigated the relationship between fish intake, PLC, MPV, and n-3 PUFA intake.

Methods: We conducted a cross-sectional study among 9,870 participants (average age: 47.5 years; 55.9% men). N-3 PUFA intake was calculated based on fish intake frequency and information from the Nutritional Health Survey of Japan.

Results: The average fish intake frequency was 2.14 ± 1.26 days/week. Higher fish intake frequency was associated with lower PLC and larger MPV. In a multi-regression analysis, fish intake frequency was a determinant of PLC (β = -0.081, p < 0.0001) but not MVP; however, lower PLC was a determinant of larger MPV (β = -0.421, p < 0.0001). N-3 PUFA intake significantly increased with increased fish intake frequency.

Conclusion: Although higher fish intake frequency is associated with greater MPV, this relationship is not direct; instead, it may depend on lower PLC linked to higher fish intake. The antiplatelet effect of n-3 PUFA, which intensifies with higher fish intake, may suppress platelet activity with larger MPV, preventing ASCVD risk.

Introduction: The diet during pregnancy has long-term effects on the health outcomes of both mothers and their children. This study aimed to undertake a systematic review to explore the association of high-fiber diet, DASH diet, and Mediterranean diet with metabolic outcomes among mothers and their children.

Methods: We searched for relevant articles published from Jan 2012 to Nov 2022 through PubMed, MEDLINE, and Embase. Randomized trials and observational studies that considered high-fiber diet, DASH diet, Mediterranean diet during pregnancy and metabolic outcomes in pregnant women and their children were included in the systematic review. Thirty studies were included involving 41,424 pregnant women and children.

Results: A high-fiber diet was associated with reduced risk of gestational diabetes mellitus (GDM) (OR: 0.22; 95% CI: 0.11-0.42), pregnancy hypertensive disorders (OR: 0.45; 95% CI: 0.25-0.81), and lower birth weight (-109.54 g; 95% CI: -204.84 to -14.24). The adherences to the Mediterranean diet and DASH diet were associated with reduced risk of GDM (OR: 0.60; 95% CI: 0.45-0.80; OR: 0.36; 95% CI: 0.26-0.51), and lower risk of excessive gestational weight gain (OR: 0.41; 95% CI: 0.18-0.93; OR: 0.3, 95% CI: 0.16-0.57). Adherence to the Mediterranean diet was associated with a lower risk of small for gestational age, fetal growth restriction, and childhood overweight in the progeny (OR: 0.83, 95% CI: 0.73-0.95; OR: 0.50; 95% CI: 0.28-0.89; OR: 0.85; 95% CI: 0.74-0.97).

Conclusions: During pregnancy, the high-fiber diet and adherences to the Mediterranean diet and DASH diet were associated with lower risk of adverse metabolic outcomes in pregnant women and their children.

Background: Current scientific research on breastfeeding provides substantial evidence of its numerous positive impacts, not only for children in both the short and long term but also for mothers who engage in breastfeeding.

Summary: In addition to the gold standard effect of human milk on infant nutrition, breastfeeding is associated with a lower incidence of infections, reduced infant/childhood mortality, necrotizing enterocolitis, and obesity during childhood and later in life, better cognitive performance, and a higher IQ score. For mothers, breastfeeding prolongs lactational amenorrhea, may facilitate postpartum weight loss, and may reduce breast and ovarian cancers and cardiovascular diseases. Breastfeeding can also play a beneficial role in preventing antibiotic resistance, which is a global concern across all age groups. Implementing exclusive breastfeeding for all infants has the potential to enhance child development and decrease healthcare expenses, leading to economic savings for both individual families and society. Human milk is a biologically active food that functions as both prebiotic and probiotic because of its oligosaccharides and the composition of its microbiota, which act as synergistic synbiotics.