Asia Pacific journal of clinical nutrition最新文献

Background and objectives: This study aimed to investigate nutritional status of hospitalized Chinese pa-tients according to the Global Leadership Initiative on Malnutrition (GLIM) and the European Society of Clin-ical Nutrition and Metabolism (ESPEN) criteria and to identify the effects of nutritional characteristics and nutritional support on clinical good outcome.

Methods and study design: Inpatients participated in Chinese nutritionDay 2010-2020 surveys were included. Malnutrition was defined according to the ESPEN and GLIM criteria after being risk evaluated by Malnutrition Universal Screening Tool (MUST). Cumulative incidence curves were plotted for 30-day good outcomes in patients according to the ESPEN and GLIM criteria. Cox regression models were used to determine the factors associated with good outcomes in the univariate and multivariable analyses.

Results: The prevalence of malnutrition defined by the GLIM criteria (22.8%) was higher than that defined by the ESPEN criteria (16.2%). Patients with malnutrition defined by the ESPEN and GLIM criteria had a significantly prolonged median length of hospital stay (LOS) after nutritionDay compared with non-malnutrition patients (8 days vs. 6 days, p < 0.001). Inpatients defined as nutritionally at-risk by the MUST or malnutrition defined by the ESPEN criteria and the GLIM criteria, and patients with pre-operative conditions, decreased mobility, prolonged LOS over three weeks before nutritionDay, as well as those receiving nutritional support had a reduced chance of good outcome.

Conclusions: The patients with nutritional risk or malnutrition and those who received nutritional support were significantly associated with decreased good 30-day outcomes, highlighting the necessity for standardized nutrition training in the healthcare setting.

The education and accreditation system of dietitian-nutritionists has gone through various changes throughout the years. These systems are important to produce competent nutrition professionals. Standardization attempts have been done internationally by the International Confederation of Dietetic Associations. Many countries have developed their own standards to educate and accredit nutrition professionals to ensure the quality of the nutrition and dietetic profession. Through internet and database searching, this paper aims to review and describe the education requirements and accreditation system of nutrition professionals in Indonesia and compare it to other countries including the United States, United Kingdom, Australia, Japan, South Korea, Malaysia, Philippines, Thailand, and Singapore. Most countries, including Indonesia, require a minimum of bachelor's degree to be a nutritionist and a dietitian, whereas the US requires a minimum of master's degree. In Indonesia, there is also an additional one-year training program after completing the undergraduate study that need to be taken if an individual wants to register as a dietitian or nutritionist, while other countries have included this similar program to their undergraduate or master course. A certification exam to be a dietitian or nutritionist is required by Indonesia, the US, Japan, South Korea, Philippines, and Thailand, while the remaining others do not. In conclusion, differences in dietetic education and accreditation system were found. Indonesia's nutrition and dietetic education system already meet the International Confederation of Dietetic Associations standard and on par with some countries reviewed here. However, further improvements are still needed.

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.

Background and objectives: Gut microbiota and liver are closely linked, and disruption of the gut-liver axis has been associated with various conditions, including non-alcoholic fatty liver disease (NAFLD). The Die-tary Index for Gut Microbiota (DI-GM), a recently developed measure of gut microbiota variety, has not been researched in connection with NAFLD.

Methods and study design: We conducted a cross-sectional analysis of 12,910 eligible participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 by adjusting for covariates. Dietary recall data were used to calculate the DI-GM (including components beneficial and unfavorable to gut microbiota). Multiple logistic regression and subgroup analyses were used.

Results: A total of 12,910 patients were included in the study, of whom 4673 (36.2%) were identified as NAFLD. Each point increase in DI-GM was associated with an 8% decrease in the prevalence of NAFLD (OR = 0.92, 95% CI = 0.90, 0.94, p <0.001), the associations remained significant after adjusting for potential confounders (OR = 0.92, 95% CI = 0.89, 0.95, p <0.001). After grouping DI-GM, in the fully adjusted model, participants with DI-GM ≥ 6 were significantly negatively associated with the prevalence of NAFLD (OR = 0.71, 95% CI = 0.61, 0.82, p <0.001) compared to participants with DI-GM ≤3 group with adjustment for potential confounders. After subgroup analyses and sensitivity analyses, the relationship between DI-GM and NAFLD remained robust.

Conclusions: Our findings indicate an inverse association between the newly proposed DI-GM and the presence of NAFLD in adult Americans, offering a novel perspective on NAFLD research.

Background and objectives: Protein-energy wasting (PEW) is common among maintenance hemodialysis (MHD) patients and is strongly associated with mortality and adverse outcomes. This study aimed to assess the effects of low-protein energy supplements on the nutritional status of MHD patients with PEW.

Methods and study design: We conducted a prospective randomized controlled trial in 68 MHD patients suffering from PEW. Patients randomized to the intervention group received dietary counseling along with daily low-protein supplements containing 212 kcal of energy and 2.4 g of protein every day for 3 months. The control group received dietary counseling only. Dietary data, nutritional assessments, anthropometric measurements, bioelectrical impedance analysis and blood analysis were collected at baseline and after three months from both groups.

Results: Fifty-nine MHD patients completed the study. Patients in the intervention group showed an increase in energy intakes (p < 0.001). A significant decrease in the Malnutrition Inflammation Score (MIS) (p < 0.001) and Nutrition Risk Screening 2002 (p< 0.001) were found in the intervention group compared with the control group. Moreover, significant improvements in mid-upper arm circumference (p < 0.001), mid-arm muscle circumference (p < 0.001), albumin (p = 0.003), and prealbumin (p = 0.033) were observed in the intervention group compared with the control group.

Conclusions: The combination of oral low-protein supplements and dietary counseling for three months was more effective than dietary counseling alone in terms of improving the nutritional status of MHD patients with PEW.

Background and objectives: Behavioural strategies can promote adherence to intensive lifestyle treatments for obesity. This study aimed to explore effective behavioural strategies for weight maintenance in Chinese patients with overweight or obesity.

Methods and study design: Retrospective analysis of weight mainte-nance data was conducted. Patients with overweight or obesity, who had received a 3-month weight loss and behavioural intervention, were asked to complete questionnaires to monitor compliance with behavioural strategies after the weight loss. They continued to follow a daily calorie restriction for 12 months to maintain their weight. The primary outcome was to evaluate the association between a total weight loss (TWL) of more than 5% and compliance with behavioural strategies during the 6-month weight maintenance phase.

Results: A total of 131 patients completed the questionnaire. The top three easy-to-perform behaviours were eating vegetables and protein first and carbohydrates later, self-weighing each day and having regular eating times. Of 131 patients, 61 (46.5%) and 42 (32.1%) were followed up for 6 months and 12 months respectively. Reducing high-fat food intake (p = 0.002) and eating an average frequency of 5 times a day (p = 0.034) were associated with a TWL of more than 5% during 6 months weight maintenance. Reducing high-fat food intake was associated with a TWL of more than 5% during 12 months weight maintenance (p = 0.029).

Conclusions: Chinese patients with overweight or obesity who experienced a TWL of more than 5% were more likely to reduce high-fat food intake during long-term weight maintenance.

The classification for underweight adults, defined as a body mass index (BMI; <18.5 kg/m²) by the World Health Organization (WHO), has been consistent globally with respect to populations. Although the WHO has recognized that body composition and health risks differ according to ethnicity by offering adjusted BMI cut-offs for overweight and obesity (23-24.9 kg/m² for overweight and ≥25 kg/m² for obesity) in Asian-populations, the underweight threshold has strangely not been modified. Because there is evidence of unique physiological and metabolic profiles of Asian populations the applicability of this uniformity to Asian populations remains as an important question.

Background and objectives: Nutrition is important in promoting health and preventing disease, while malnutrition can exacerbate disease symptoms and lead to adverse clinical outcomes in patients. The process of nutritional diagnosis and treatment includes nutritional risk screening, nutritional assessment, and nutritional therapy. This study aims to understand the number of publications, cooperation of research subjects, progress of research content, and research hotspots of nutritional risk screening and assessment, and then identify the future trends and directions of global nutritional screening.

Methods and study design: Articles on nutritional risk screening, nutritional assessment and application of nutritional diagnostic tools were identified from the Web of Science and the collected data were analysed using bibliometrics and information visualisa-tion with the help of CiteSpace software. A total of 10632 articles published between 1991 and 2024 were selected.

Results: The country with the highest number of articles was the United States; two institutions, the University of São Paulo and the Karolinska Institutet, had higher centrality and number of articles. Keyword emergent analysis revealed that global leadership initiatives on malnutrition, diagnosis, criteria, myasthenia gravis, and clinical nutrition were the five emergent terms that lasted until 2024 and were the most popular hot topics among experts and scholars.

Conclusions: We describe the characteristics of the development of nutritional risk screening and assessment studies and their trends. Currently, there is not a close collaboration between institutions and authors in the research process, while the field is trending towards more specific research and a greater focus on the disease progression in patients.

Background and objectives: The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet is an effective dietary intervention for irritable bowel syndrome (IBS), yet up to 50% of patients fail to re-spond adequately. Identifying reliable predictors of response could optimize treatment selection and improve treatment outcomes while avoiding unnecessary dietary restrictions. This narrative review examines current evidence for predictors of response to the low FODMAP diet and highlights gaps in knowledge that must be addressed to develop clinically useful indicators for routine practice.

Methods and study design: We re-viewed the literature on the low FODMAP diet, and studies investigating factors that may predict treatment response, including clinical, diagnostic, biological, biochemical, and microbial markers.

Results: Several po-tential predictors to the low FODMAP diet have emerged, including baseline symptom severity, psychological factors (particularly depression), hydrogen breath test results, volatile organic compounds in fecal samples, and specific gut microbiota profiles. Clinical and psychological measures show the most immediate potential for implementation due to accessibility and established measurement tools. Biological markers, including breath testing, metabolomics, and microbiome analysis, show promise but require further validation in larger, diverse populations and standardization of methodologies.

Conclusions: Despite promising research, signifi-cant gaps remain in developing reliable, accessible predictors of response to the low FODMAP diet. Future research should focus on validating simple clinical tools that combine symptom profiles with psychological assessment to guide treatment decisions. A personalized approach to dietary management of IBS based on reliable response predictors would optimize clinical outcomes while minimizing unnecessary dietary restriction and healthcare resource utilization.

Cow's milk protein allergy is an adverse immune reaction to proteins found in cow's milk, primarily casein and whey, affecting artificially fed, breastfed and mixed-fed infants. The immunological mechanisms involved lead to diverse clinical presentations, most commonly affecting the digestive, respiratory, and integumentary systems. Diagnosis relies primarily on clinical evaluation due to the absence of specific diagnostic tests, making accurate identification crucial to prevent misdiagnosis or underdiagnosis. Treatment requires strict avoidance of cow's milk proteins in the diets of both children and breastfeeding mothers, with close monitoring of nutritional status during long-term management. Recent advancements in treatment, including the use of probiotics, provide new options for improving clinical outcomes. This narrative review aims to provide clinicians with evidence to standardise diagnosis and treatment, improve food allergy management by non-allergy specialists and develop accurate feeding recommendations.