Asia Pacific journal of clinical nutrition最新文献

Background and objectives: To compare the effectiveness of silymarin or its combination with lifestyle modifications, Mediterranean hypocaloric diets, and medications for improving nonalcoholic fatty liver disease (NAFLD).

Methods and study design: PubMed, Embase, Cochrane Library, Web of Science, and Clin-icalTrails.gov were used to identify relevant studies. The treatment arm was silymarin or its combination with Mediterranean hypocaloric diets, medications, or lifestyle modifications. The comparators were placebo, Mediterranean hypocaloric diets, medications, and lifestyle modifications.

Results: This meta-analysis included 25 studies with 2283 patients. Total cholesterol levels were reduced by silymarin+Mediterranean hypocaloric diets (SMD: -0.39 (-0.81, 0.03), p=0.072) or medications [SMD: -1.12 (-1.67, -0.58), p<0.001]. Triglyceride levels were decreased by silymarin combined with the medication [SMD: -0.92 (-1.98, 0.14), p=0.080]. Low-density lipoprotein cholesterol levels were reduced by silymarin alone [SMD: -0.25 (-0.48, -0.03), p=0.027]. The combination of silymarin with Mediterranean hypocaloric diets [SMD: -0.47 (-0.90, -0.04), p=0.031] or lifestyle modifications [SMD: -0.88 (-1.09, -0.66), p<0.0001] decreased alanine aminotransferase levels. Aspartate aminotransferase levels were reduced by a combination of silymarin and life-style modifications [SMD: -0.72 (-1.49, 0.05), p=0.061] or medications [SMD: -1.41 (-2.24, -0.59), p=0.005]. Silymarin (2.5 times) or silymarin plus lifestyle modifications (39%) reduced the hepatic steatosis rate in patients with NAFLD. The silymarin use increased the rate of patients with adverse effects [RR:1.98 (1.11, 3.54)]; gastrointestinal problems were the most common adverse effects.

Conclusions: Despite the overall advantages of therapies, different interventions showed different effects on markers in patients with NAFLD. These results highlight the need for more research to fully comprehend the features of the intervention.

Background and objectives: It has been found that ICU patients may encounter various complications during enteral nutrition (EN). Of these, feeding intolerance (FI) is a common issue that often necessitates the reduction or cessation of EN. This study aims to evaluate risk prediction models for feeding intolerance (FI) in critically ill patients receiving EN by searching major public databases.

Methods and study design: We searched for relevant studies in Embase, PubMed, Web of Science, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and cqvip.com up until January 2024. Two researchers independently conducted the screening and data extraction processes, and the quality of the literature was assessed using bias risk assessment tools.

Results: A total of 13 references were included, and the subjects included patients with sepsis, pancreatitis or cerebral apoplexy; the incidence of FI was 35.2%-49.3%. The studies discussed the predictive performance of various models, with 11 studies reporting on their accuracy and calibration. The models demonstrated the area under the curve (AUC) of the receiver operating characteristic (ROC) curve or the concordance index (C-index) between 0.70 and 0.91, sensitivity from 0.81 to 0.93, and specificity from 0.68 to 0.83.

Conclusions: There is a critical need for risk prediction models for FI in critically ill patients on EN that are both internally and externally validated and exhibit high performance.

Background and objectives: Micronutrient status encompasses a range of indicators that reflect the levels and balance of macro- and microelements, as well as vitamins within the body. These essential substances, required in minimal amounts, are crucial for supporting normal physiological processes, immune system functioning, and tissue repair. The aim of this systematic review is to summarize data on the deficiency or excess of microelements, macroelements, and vitamins in patients with diabetic foot ulcers.

Methods and study design: Databases were searched for studies on vitamin, macronutrient, micronutrient levels and their impact on the course, treatment and healing of diabetic foot ulcers. The Cochrane Risk of Bias tool was employed for assessing randomized trials, while the Newcastle-Ottawa Scale was utilized for evaluating observa-tional studies in terms of quality and bias risk.

Results: The findings revealed a notable correlation between deficiencies in vitamins D, C, A and the severity of clinical symptoms. Low vitamin D levels were linked to elevated proinflammatory cytokines. Higher concentrations of folate and vitamin B-12 were associated with improved ulcer healing, supplementation with zinc and magnesium contributed to a reduction in ulcer size. Inadequate intake of zinc, vitamins E, C was found to compromise antioxidant defences. Elevated ferritin levels may serve as an indicator of inflammation.

Conclusions: The most important task is to adjust the in-take of micronutrients to maintain balance and prevent deficiency and excess, which is important in the complex therapy of patients.

Background and objectives: Hypertension is a major risk factor for cardiovascular diseases, with dietary fats playing a critical role in its regulation. While unsaturated fats are associated with blood pressure (BP) reduction, saturated and trans fats may exacerbate hypertension. This systematic review and meta-analysis aimed to evaluate the impact of various fatty diets on systolic (SBP) and diastolic blood pressure (DBP) and identify dietary patterns most effective for BP management.

Methods and study design: A comprehensive search of MEDLINE and ClinicalTrials.gov (inception to February 2025) identified randomized clinical trials and observational studies assessing dietary fats' effects on BP. Twenty-five studies (n=14,522 participants) met inclusion criteria. Data were analyzed to estimate mean differences (MDs) with 95% confidence intervals (CIs). Funnel plots were generated to assess publication bias. Risk of bias was assessed using the RevMan Web tool, and sensitivity analyses were conducted.

Results: Food-based oil diets significantly reduced SBP and DBP (MD: -18.43 and -12.90 mm Hg). Low-fat and unsaturated fat-enriched diets lowered SBP (-6.91 and -4.46 mm Hg) and DBP (-3.78 and -0.74 mm Hg). The DASH diet had moderate effects (SBP: -3.83, DBP: -2.18 mm Hg). Omega-3 and high-fat diets showed smaller reductions. Saturated fat restriction had minimal impact.

Conclusions: Food-based fatty oil diets had the greatest BP reduction, while low-fat, unsatu-rated fat-enriched, and DASH diets (fat-based variation) showed moderate effects. High-fat and omega-3 diets had smaller impacts, emphasizing diet's role in BP management.

Background and objectives: Obesity and obesity-related diseases is increasing worldwide. The widely accepted approach in the dietary treatment of obesity is the calorie-restricted six meal diet; however, alternative approaches are needed. This study aimed to compare time-restricted eating (TRE), a method that can be easily conveyed and applied in overcoming obesity, to six meals diet.

Methods and study design: A total of 174 participants aged 18-65, BMI>25 kg/m2 were included, with 88 participants in the time-restricted eating group and 86 participants in the six-meal group. Diet lists with similar calorie, macro counts suitable for their respective groups were prepared. Anthropometric measurements, blood pressure, blood tests were analyzed before the study and at the end of the 8-week.

Results: More weight loss [MD: 1.17 kg, (95% CI: 0.23-2.06), Cohen's d=0.42], higher decrease in BMI [MD: 0.41 kg/m2 (95% CI: -0.77 to -0.06), Cohen's d=0.39] , decrease in waist-to-hip ratio [MD: 0.008 (95% CI: -0.016-0.000), Cohen's d=0.35], decrease in obesity degree [MD: 2.35 (95% CI: -3.99 to -0.70), Cohen's d=0.50] were observed in the time-restricted eating group (p<0.05). In the six meals group, decrease in LDL values was higher compared to the time-restricted eating group [p<0.05, MD:0.23 mmol/L (95% Cl:0.41-15.79), Cohen's d=0.36]. More participants preferred to continue TRE (p<0.001).

Conclusions: TRE resulted in greater weight loss, body fat reduction, and improved metabolic parameters, proving more effective for weight management. The six-meal diet was superior for LDL reduction. Both approaches yielded positive outcomes, with TRE emerging as an alternative weight loss strategy.

Background and objectives: Life's Essential 8 (LE8) is a comprehensive indicator that evaluates cardiovascular health (CVH). There have been limited studies on the relationship between LE8 and hyperuricemia (HUA). This study explored the association and dose-response relationship between LE8 and HUA among elderly people in China.

Methods and study design: The subjects were the elderly aged 60 and over who participated in the China Health and Nutrition Survey (CHNS) in 2018. The definition of American Heart Association (AHA) was used to measure the score of LE8. Multivariate Logistic regression and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between LE8 and HUA.

Results: A total of 4229 subjects were included, and the prevalence of HUA was 13.2%. The LE8 score was 68.5 points, and physical activity (85.8) and blood pressure (37.6) were the highest and lowest scores, respectively. People with low, medium and high CVH accounted for 5.7%, 77.3% and 17.0%, respectively. Multivariate Logistic regression showed that high CVH in LE8 score reduced the risk of HUA (OR = 0.62, 95%CI = 0.39-0.99) significantly, and the risk decreased by 15% (OR = 0.85, 95%CI = 0.78-0.93) for every 10-point increase in LE8 score. RCS showed a linear dose-response relationship between LE8 and HUA, and the beneficial protective threshold was 68.6 points. The negative association between LE8 score and HUA was more significant in 60-69 years.

Conclusions: This study suggested that the elderly in 15 provinces of China were at a moderate level of CVH, and a higher LE8 score was beneficial for reducing the risk of HUA.

Background and objectives: Menopausal women with chronic heart failure (CHF) exhibit unique physiolog-ical characteristics and prognostic features. The aim of this study is to analyze the significant predictive factors for the prognosis of chronic heart failure in menopausal women and the impact of different nutritional interventions on prognosis.

Methods and study design: A total of 270 menopausal women with CHF were enrolled in the study and divided into two groups based on the nutritional intervention received. Analyze the significant predictive factors of all-cause mortality, readmission rate, deterioration of cardiac function, deterioration of nutritional status, and deterioration of quality of life, as well as the impact of nutritional interven-tion on these prognoses. Build a risk score model based on significant factors in the prognostic model. Evaluate the predictive ability of the model through the ROC curve.

Results: Multivariate logistic regression analysis showed that NYHA grading BNP, eGFR, The level of estradiol (E2) and nutritional intervention are signif-icant influencing factors in multiple prognostic indicators, among which the enhanced nutritional support and micronutrient supplementation program in nutritional intervention have a significant protective effect on poor prognosis. The constructed nutritional risk model has good discriminative ability and robustness in predicting prognosis.

Conclusions: This study identified menopausal characteristics, NYHA classification, BNP, eGFR, and estradiol levels as important prognostic predictors in menopausal women with CHF. Enhanced nutritional support and micronutrient supplementation significantly improved patient prognosis. The risk model based on nutritional intervention provides scientific basis for the management strategy of chronic heart failure in menopausal women.

Background and objectives: The incidence of hypertension is higher in individuals with the methylenetetra-hydrofolate reductase (MTHFR) 677TT genotype. Riboflavin serves as a coenzyme of MTHFR, but its role in hypertension prevalence is poorly understood. This study aimed to explore the relationship between riboflavin levels and hypertension and the impact of genotype on this relationship.

Methods and study design: The case-control study used data from the Tianjin Elderly Nutrition and Cognition study, with 200 hypertensive patients and 200 matched non-hypertensive controls. It collected questionnaires, clinical data, and measured blood riboflavin levels using the dried blood spot technique. Conditional logistic regression analyzed varia-bles related to hypertension prevalence, with effects assessed by odds ratios (ORs) and 95% confidence intervals (CIs).

Results: The hypertensive group had significantly lower riboflavin concentration than the non-hypertensive group (p<0.001). The regression analysis indicated that regardless of adjustment for sociodemographic characteristics, riboflavin concentration was negatively associated with the prevalence of hypertension. In the multivariable model, the OR was 0.607 [95%CI, 0.507-0.727], p<0.001. Additionally, we found an interaction between MTHFR genotype and riboflavin status. Compared with the combined TT genotype and below-median riboflavin levels as the reference category, the CC genotype and above-median riboflavin levels decreased the prevalence of hypertension (OR, 0.189 [95%CI, 0.071-0.501], p=0.001).

Conclusions: In conclusion, riboflavin status impacts the development of hypertension. There is also interaction between the MTHFR genotype and riboflavin. Specifically, low riboflavin status increases the prevalence of hypertension when combined with the MTHFR 677TT genotype.

Background and objectives: To establish a new method for developing an efficient and region-specific semi-quantitative food frequency questionnaire (SQFFQ), and to make it a simple, effective and widely applicable measurement tool, this study takes Xi'an City, Shaanxi Province as a case study.

Methods and study design: For 129 common food items, an initial food frequency questionnaire (FFQ) and a 24-hour dietary recall survey (24hDR) are constructed, and a variety of methods are combined to improve the convenience and credibility of the questionnaire itself in the inspection process, and the reliability and validity test are carried out.

Results: A total of 367 questionnaires are collected in study, including FFQ and 24hDR at various correction stages, in a three-month interval, and finally a semi-quantitative food frequency questionnaire containing 104 food items is obtained. The Pearson correlation coefficient of SQFFQ1 and SQFFQ2 ranges from 0.60-0.75, and the Spearman and Kendall correlation coefficients range from 0.50-0.89, and the corre-lation coefficient increases slightly after logarithmic transformation by logarithmic transformation, and the CCC correlation coefficient increases to 0.5-0.95. On average, more than 80% of subjects are classified as identical or adjacent tertiles per SQFFQ result. The Pearson, Spearman, Kendall, CCC correlation coefficients between 24hDR and SQFFQ2 range from 0.50-0.90, and on average more than 75% of participants are in the same or adjacent energy and nutrient tertiles in SQFFQ2 versus 24hDR results.

Conclusions: The semi-quantitative food frequency questionnaire for dietary pattern surveys in Xi'an, Shaanxi can effectively assess nutrient intake in dietary nutrient correlation studies.

Background and objectives: To explore the relationship between sleep, plant-based diets, and cognitive function in the elderly, addressing the challenges of global aging.

Methods and study design: Using data from the 2005 China Longitudinal Healthy Longevity Survey (CLHLS), cognitive function was assessed with the Mini-Mental State Examination (MMSE), dietary patterns through a short-form FFQ, and sleep duration and quality via self-report measures. A Cox regression model analyzed the associations between sleep, plant-based diet, and cognitive function, with mediating effect analysis to explore these relationships further.

Results: A total of 5911 subjects were included in the study. In both univariate and multivariate Cox regression analysis, the sleep quality with average level (HR=1.26; 95%CI=1.06-1.48), sleep duration (HR=1.03; 95%CI=1.01-1.05), the unhealthful plant-based diet index (uPDI) (HR=1.02; 95%CI=1.01-1.03), the healthful plant-based diet index (hPDI) (HR=1.01; 95%CI=1.00-1.03), and the plant-based diet index (PDI) (HR=0.99; 95%CI=0.97-1.00) were always significantly correlated with cognitive function. The sleep quality with bad level (HR=1.28; 95% CI=1.03-1.58) was associated with cognitive function only in multivariate Cox regression analysis. In the mediating analysis, PDI and hPDI had a significant overall effect on cognitive function, and the proportion mediated by sleep duration were about 4.4% (95%CI=0.01-0.15) and 7.92% (95%CI=0.03-0.25).

Conclusions: A significant correlation exists between sleep, plant-based diets, and cognitive function in older adults, with sleep duration mediating the relationship between diet and cognitive function. These findings emphasize the role of diet and sleep in preventing cognitive decline in the elderly.