Annals of Nutrition and Metabolism最新文献

Introduction: It is well known that obese children frequently have high C-reactive protein (CRP) values. There are controversies about the association of the CRP and components of the metabolic syndrome (MetS). The aim of this study was to determine among children and adolescents the link between the most routinely used inflammation marker, CRP, and components of the MetS.

Methods: The study recruited 506 obese/overweight and 249 normal weight participants (ages 4-18 years) with complete fasting laboratory and anthropometric data. Statistical analyses, including multinomial logistic regression, were conducted in R, with significance set at p < 0.05.

Results: Children were divided into three groups according to CRP concentration (low <1 mg/L, medium: 1-3 mg/L, high >3 mg/L). The children were also classified whether they had MetS (n = 249) or were free of MetS (n = 421). We found highly significant difference between CRP groups in the occurrence of the MetS components (p < 0.001), hypertension (p < 0.001), hypertriglyceridemia (p < 0.001), and low high-density lipoprotein (HDL) cholesterol (p = 0.001), waist circumference (p < 0.001), body mass index (BMI) z-score (p < 0.001), fasting plasma glucose (p < 0.001), homeostasis model assessment of insulin resistance (p < 0.001), respectively. However, when BMI z-score was included in the model this relationship disappeared, suggesting that BMI has a more significant effect on the MetS components than CRP.

Conclusion: Our results demonstrate that BMI z-score is the main determinant of the MetS and its components. However, CRP remains an important factor to be checked in overweight and obese children.

Background: Prehabilitation, the process of optimizing a patient's physical and nutritional status before surgery, has gained increasing attention for its potential to improve outcomes by enhancing physiological reserves and functional capacity. While body composition may play a role in these outcomes, its specific contribution remains underexplored. This narrative review summarizes current evidence on the effects of prehabilitation on body composition, focusing on exercise, nutritional interventions, and multimodal approaches.

Summary: Exercise, particularly a combination of aerobic and resistance training, has been shown to improve cardiorespiratory fitness, reduce fat mass, and enhance skeletal muscle and strength. Nutritional interventions, including increased protein intake, support skeletal muscle preservation, and recovery. A multimodal approach, integrating both exercise and nutrition, yields the most significant improvements in body composition, showing enhanced skeletal muscle, reduced fat mass, and better functional outcomes. However, the limited duration of prehabilitation and the time required for detectable changes in body composition often prevent consistent observations. Furthermore, variations in assessment techniques and protocols across studies confound definitive conclusions.

Key messages: Despite some promising results, further research is needed to standardize protocols and explore the effects of prehabilitation on body composition across diverse patient populations. Finally, further research is needed to investigate the impact of prehabilitation on measurable changes in body composition as this represents a critical gap in the field.

Introduction: This study aimed to evaluate safety and feasibility of perioperative exercise and nutrition therapy and to explore perioperative changes in skeletal muscle mass (SMM) in patients with esophageal cancer.

Methods: Patients scheduled for curative esophagectomy at two hospitals were enrolled. Exercise and nutrition therapy were performed for 3 weeks preoperatively and 4 weeks postoperatively. Outcomes included SMM, which was the sum of both mid-thigh cross-sectional area on computed tomography and physical function, assessed at T1 (intervention start), T2 (just before surgery), and T3 (1-month postoperatively). The SMM change rate between T1 and T3 was compared with the hypothesized value (-7.5%) from our previous study.

Results: Thirty-six patients underwent intervention and esophagectomy (intervention completion rate: 94.4%, no serious adverse events). The SMM increased by 4.9% for T1-T2 (p < 0.001) but decreased by 10.1% for T1-T3 (p < 0.001), suggesting that the primary outcome was not achieved. Physical function results were significantly better at T3 than at T1. Postoperative SMM loss was lower in patients who maintained postoperative caloric intake and physical activity than in those who could not (-8.3% vs. -15.4%, p = 0.011).

Conclusions: Perioperative exercise and nutrition therapy were safe and feasible. An increase in preoperative SMM and postoperative physical function were observed, although SMM decreased after surgery. Further investigation is warranted to evaluate the efficacy of this intervention.

Introduction: Malnutrition during a critical window of development in a fetus or infant can result in abnormal cardiac remodeling and function. It is uncertain whether the contribution of these effects continues to impact the cardiac remodeling and function of adults over the course of several decades of growth. Our study examined the impact of early Chinese famine exposure on cardiac remodeling, left ventricular (LV) diastolic function, and LV systolic function in adults.

Methods: Participants at high risk of cardiovascular disease from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (PEACE MPP) were enrolled. The famine in China lasted from 1959 to 1962. A total of three groups were formed based on the participants' birth dates: pre-famine group, famine exposure group, and post-famine group. Logistic regression and linear mixed models were used to explore the association between famine exposure and cardiac remodeling, LV diastolic function and LV systolic function in adults.

Results: The study included 2,758 participants, the mean age was 57.05 years, 62.8% were female, 26.4% had LV hypertrophy (LVH), 59.6% had LV diastolic dysfunction (LVDD), and 10.5% had reduced global longitudinal strain (GLS). Compared to post-famine exposure, participants had independently increased risk of LVH in the famine exposure group (OR: 2.02, 95% CI: 1.60-2.56) and pre-famine exposure (OR: 1.36, 95% CI: 1.06-1.76). Compared to post-famine exposure, the risk of LVDD remarkably increased in the famine exposure group (OR: 3.04, 95% CI: 2.49-3.71) and pre-famine exposure group (OR: 1.87, 95% CI: 1.52-2.31). Famine exposure had no significant impact on GLS but was associated with a significant increase in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Significant interactions were observed between the effects of famine exposure and other clinical/sociodemographic variables (gender, systolic blood pressure [SBP] ≥140 mm Hg or not, high school or above or not, and annual income <50,000 RMB or not) on these outcomes.

Conclusion: Exposure to famine, particularly during fetal and infant stages, increases the risk of LVH and LVDD in adults. However, the LV systolic function remains preserved. These impacts are more pronounced in females, individuals with SBP ≥140 mm Hg, those with low income, or those with high educational status.

Introduction: Tea consumption with meals affects iron absorption, increasing the risk of iron deficiency. Our study investigated the association between tea consumption patterns and serum ferritin levels among women of childbearing age (WCA) in Nandi County, Kenya.

Methods: We conducted a cross-sectional analytical study among 160 WCA selected using a systematic random sampling technique from Kapsabet Ward. Information on tea consumption practices was gathered using a researcher-administered questionnaire, and serum ferritin and C-reactive protein were measured. We assessed associations between tea consumption and iron status of respondents by multivariable regression analysis, adjusting for potential confounders, including parasitic infections and recent severe blood losses.

Results: The prevalence of anaemia and iron deficiency among the study participants were 86.2% and 45%, respectively. Majority (90.6%) of the respondents consumed tea or coffee, with an infusion time of more than 5 min (60.0%) and a moderate tea strength (64.1%), within 1 h before or after meals. Iron deficiency was associated the number of teacups consumed (adjusted odds ratio = 7.282, 95% CI = 3.580-14.812).

Conclusion: High tea consumption is positively associated with iron deficiency among WCA. Lower tea infusion strength, shorter tea infusion duration, and a lower number of teacups overall consumed, as well as consuming tea 1 h before or after meals instead of with meals, may be recommended for better outcomes in iron status among WCA.

Introduction: For diagnosing malnutrition as an important modifiable risk factor in surgical cancer patients, GLIM criteria offer a standardised diagnostic pathway. Before assessing malnutrition, it is suggested to screen for malnutrition with an implemented screening tool, i.e., the NRS-2002. Validated data regarding the applied screening tool and its relevance for predicting outcome parameters in surgical patients is sparse.

Methods: 260 patients undergoing major abdominal surgery for cancer were retrospectively analysed. Between January 2017 and December 2019, patients were prospectively screened for malnutrition with the Nutritional Risk Score 2002 (NRS). Irrespective of their screening result malnutrition was assessed with GLIM criteria using CT scan at lumbar level 3 for measuring skeletal muscle mass (GLIM MMCT). Patients with negative screening results (NRS ≤2) were analysed regarding their malnutrition assessment and outcome parameters.

Results: Thirty four of 67 patients with NRS ≤2, posing no risk for malnutrition, were diagnosed malnourished according to GLIM MMCT (n = 34, 50.7%). 19 patients (55.9%) with NRS ≤2 and malnutrition according to GLIM had at least one complication, 12 patients (35.3%) had a severe complication (Clavien-Dindo grade ≥ 3a), in 26.5% re-laparotomy was necessary, readmission within 1 month in 20.6% of patients, and length of hospital stay was 18.76 ± 12.66, which was in total worse in outcome compared to the whole study group (n = 260). Patients with NRS ≤2 but diagnosed malnourished by GLIM were at significant higher risk to develop a severe complication (OR 2.256, 95% CI: 1.038-4.9095, p = 0.036) compared to patients with NRS ≤2 but not being diagnosed malnourished. The risk for overall complications was significantly increased in patients with malnutrition diagnosed by the GLIM criteria using MMCT (OR 2.028, 95% CI: 1.188-3.463, p = 0.009). Patients screened at risk with NRS ≥3 and diagnosed malnourished by GLIM were also at significant higher risk for developing complications (OR 1.728, 95% CI: 1.054-2.832, p = 0.029).

Conclusion: GLIM MMCT is suitable for diagnosing malnutrition and estimating postoperative risk in gastrointestinal cancer patients. Nutritional assessment only in patients with NRS >2 may bear the risk to miss malnourished patients with high risk for poor clinical outcome. In every patient undergoing major cancer surgery, regular assessment of nutritional status regardless of screening result should be performed exploiting CT body composition analysis.

Introduction: This study examined the association between sugar-sweetened beverage consumption before the first 24 months of life and attention-deficit/hyperactivity disorder (ADHD).

Methods: A population administrative cohort study was conducted in Korea (2008-2019) using linked national insurance data and a health screening survey. The cohort included 25,305 children in the exposed group with high sugar-sweetened beverage drinks (≥200 mL) and 339,931 in the reference groups (<200 mL) at 24 months of age. The primary outcome was the development of ADHD based on the International Classification of Disease (ICD) codes. Cox proportional model was used to identify the association between sugar-sweetened beverage consumption during early childhood and the later development of ADHD while controlling for multiple risk factors.

Results: Over a mean follow-up period of 9.2 years, the incidence rates of ADHD were 29.6 and 23.8 per 10,000 person-years in the exposed and reference groups, respectively. Compared with the reference group, children consuming high-sugar drinks were at an increased risk of ADHD (adjusted hazard ratio 1.17, 95% confidence interval [CI] 1.08-1.27). These associations remained significant even after applying alternative ADHD definitions or adjusting for confounding variables.

Conclusion: Children who consume sweetened beverages during early childhood are at increased risk of developing ADHD later in life.

Introduction: Given the clinical association between thyroid dysfunction and iron deficiency anemia (IDA), as well as their shared association with iron status, this study aimed to investigate the causal relationship between iron status and thyroid dysfunction, while also examining the risk of IDA in relation to thyroid dysfunction.

Methods: A two-sample mendelian randomization (MR) study was conducted to identify the causal relationship of iron status on thyroid dysfunction, as well as thyroid dysfunction on IDA. Large-scale European population-based genome-wide association study databases were utilized (Genetics of Iron Status consortium, ThyroidOmics consortium, FinnGen consortium, and UK Biobank). Inverse variance-weighted (IVW) was used as the main analysis. In addition, we used weighted median and MR-Egger to enhance the robustness. Sensitivity analysis was conducted to evaluate the robustness of MR results.

Results: The IVW estimates did not reveal any significant causal relationship between serum iron status markers and thyroid dysfunction. However, a significant causal relationship was observed between hypothyroidism and IDA (odds ratio [OR] = 1.101, 95% confidence interval [CI] = 1.048-1.157, p < 0.001). Repeated analyses also demonstrated a similar trend (OR = 1.023, 95% CI = 1.011-1.035, p < 0.001). Sensitivity analysis supported that the MR estimates were robust.

Conclusion: In our MR study, an upregulation of the hypothyroidism-associated gene was found to be significantly associated with an elevated risk of IDA in the European population. These findings may offer novel therapeutic insights for clinicians managing patients with hypothyroidism, IDA, or their comorbidities.

Background: Rapid growth characterizes early childhood, with the highest weight gain in early infancy and continued relatively high gains during preschool years.

Summary: Subnormal weight and length gain from birth to about 2 years of age predict increased childhood wasting and stunting, whereas excessive weight gain in infancy and early childhood is associated with increased later obesity. Breastfeeding attenuates the risk of high early weight gain and later obesity, adding another reason for promoting, protecting and supporting breastfeeding. Avoiding high infant protein intakes from infant formula and complementary foods is strongly recommended since it markedly reduces later obesity and adiposity. This can be achieved by avoiding cows' and other animal milks as a drink in infancy and choosing infant formula with a low protein content, more similar to breastmilk, for infants not (fully) breastfed. High weight gain in toddlers is also associated with increased later obesity, predicted by overfeeding, high intakes of sugary foods and beverages, and high intakes of protein, particularly animal protein. In an ongoing controlled trial in Germany and Spain, we randomized 1,618 toddlers to milk drinks in the second year of life, providing protein contents either similar to cows' milk or more similar to human milk. First results show high protein milk inducing high weight and length gains, deviating from normal growth trajectories, whereas reduced protein intakes support weight and length growth matching WHO growth standards. Follow-up until early school age is ongoing to explore a potential impact on later growth and overweight risk.

Introduction: Dietary intake of (poly)phenols has been linked to reduced adiposity and body weight (BW) in several epidemiological studies. However, epidemiological evidence on (poly)phenol biomarkers, particularly plasma concentrations, is scarce. We aimed to investigate the associations between plasma (poly)phenols and prospective BW change in participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods: This study included 761 participants with data on BW at baseline and after 5 years of follow-up. Plasma concentrations of 36 (poly)phenols were measured at baseline using liquid chromatography-tandem mass spectrometry. Associations were assessed through general linear mixed models and multinomial logistic regression models, using change in BW as a continuous or as a categorical variable (BW loss, maintenance, gain), respectively. Plasma (poly)phenols were assessed as log2-transformed continuous variables. The false discovery rate (FDR) was used to control for multiple comparisons.

Results: Doubling plasma (poly)phenol concentrations showed a borderline trend towards a positive association with BW loss. Plasma vanillic acid showed the strongest association (-0.53 kg/5 years; 95% confidence interval [CI]: -0.99, -0.07). Similar results were observed for plasma naringenin comparing BW loss versus BW maintenance (odds ratio: 1.1; 95% CI: 1.0, 1.2). These results did not remain significant after FDR correction.

Conclusion: Higher concentrations of plasma (poly)phenols suggested a tendency towards 5-year BW maintenance or loss. While certain associations seemed promising, they did not withstand FDR correction, indicating the need for caution in interpreting these results. Further studies using (poly)phenol biomarkers are needed to confirm these suggestive protective trends.