Asia Pacific journal of clinical nutrition最新文献

Background and objectives: Malnutrition is a major public health concern that increases morbidity and mortality in hospitalized patients, particularly those in developing countries. This study aimed to investigate its prevalence, risk factors, and impact on clinical outcomes in hospitalized children and adolescents.

Methods and study design: We conducted a prospective cohort study in patients aged 1 month to 18 years who were admitted to four tertiary care hospitals between December 2018 and May 2019. We collected demographic data, clinical information, and nutritional assessment within 48 hours of admission.

Results: A total of 816 patients with 883 admissions were included. Their median age was 5.3 years (interquartile range 9.3). Most patients (88.9%) were admitted with mild medical conditions (e.g., minor infection) or noninvasive procedures. The prevalence of overall malnutrition was 44.5%, while that of acute and chronic malnutrition was 14.3% and 23.6%, respectively. Malnutrition was significantly associated with age ≤2 years, preexisting diseases (cerebral palsy, chronic cardiac diseases, and bronchopulmonary dysplasia), and muscle wasting. Addi-tional risk factors for chronic malnutrition included biliary atresia, intestinal malabsorption, chronic kidney disease, as well as inability to eat and decreased food intake for >7 days. Malnourished patients had a significantly longer hospitalization duration, higher hospital cost, and nosocomial infection rates than did well-nourished patients.

Conclusions: Patients with chronic medical conditions on admission are at risk for malnutrition. Therefore, determination of admission nutritional status must be assessed, and its management are requisites for improved inpatient outcomes.

Background and objectives: Assessing knowledge, self-efficacy, and practice among a given population us-ing a validated and reliable questionnaire is crucial. The aim of this study was to translate, validate, and test the reliability of the knowledge, self-efficacy, and practice in the Arabic population. Methods and Study De-sign: A previously published knowledge, self-efficacy, and practice nutrition questionnaire was translated and validated into Arabic. A panel of translation and nutrition experts from Arab countries participated in translation and testing validity. A convenience sampling technique was used to recruit participants across 22 Arab countries. An online self-administered questionnaire was completed twice with an interval of 2 weeks. Tests of validity (face and content) and reliability (consistency and test-retest reliability) were used.

Results: A total of 96 participants had a mean age of 21.5 years, 68.7% were female, and 80.2% were students. The mean expert proportional content validity index scale was 0.95, and intra class correlation values ranged from 0.59 to 0.76; all of these values were highly statistically significant at retest.

Conclusions: The Arabic version of the questionnaire provided valid and reliable results for assessing knowledge, self-efficacy, and practice among Arab adolescents and young adults. This tool could assess nutritional education programs in a community setting and educational institutions targeting this population in Arab countries.

Background and objectives: Falls are common among older females. This study investigated the relationships among falls and dietary patterns, nutritional inadequacy and prefrailty in community-dwelling older Japanese females.

Methods and study design: This cross-sectional study involved 271 females aged 65 and over. Prefrailty was defined as exhibiting one or two of the five Japanese version of the Cardiovascular Health Study criteria. Frailty was excluded (n=4). Energy, nutrient and food intakes were estimated using a validated FFQ. Dietary patterns were determined from intakes of 20 food groups assessed with FFQ, by cluster analysis. Nutritional inadequacy for the selected 23 nutrients in each dietary pattern was examined based on DRIs. Binomial logistic regression was applied to examine the relationships among falls and dietary pat-terns, prefrailty, and inadequate nutrients.

Results: Data from 267 participants were included. The incidence of falls was 27.3%, and 37.4% of participants were classified as prefrailty. Three dietary patterns identified were namely; 'rice and fish and shellfish' (n=100); 'vegetables and dairy products' (n=113); and 'bread and beverages' (n=54). A binomial logistic regression analysis revealed that dietary patterns of 'rice and fish and shellfish' (OR, 0.41; 95% CI, 0.16-0.95), and 'vegetables and dairy products' (OR, 0.30; 95% CI, 0.12-0.78) were negatively correlated with falls, and falls was positively associated with prefrailty.

Conclusions: Dietary patterns characterized by 'rice and fish and shellfish', and 'vegetables and dairy products' were associated with a reduced incidence of falls in community-dwelling older Japanese females. Larger prospective studies are needed to validate these results.

Background and objectives: Older adults residing in senior homes are at a high risk of malnutrition. In this study, we investigated the nutritional status of these individuals and factors associated with malnutrition in this population.

Methods and study design: This cross-sectional study (September 2020-January 2021) included a total of 583 older adults residing in a senior home in Shanghai (mean age, 85.0±6.6 years). The Mini Nutritional Assessment Short Form (MNA-SF) questionnaire was administered to assess the nutritional status of the participants. Patients with possible sarcopenia were identified according to the guidelines recommended by the Asian Working Group for Sarcopenia in its 2019 consensus (AWGS 2019). Moreover, the factors influencing malnutrition were determined through multivariate analyses.

Results: The likelihoods of having malnutrition and being at a risk of malnutrition were noted in 10.5% and 37.4% of the participants, respectively. In both male and female participants, handgrip strength (HGS) and calf circumference (CC) increased significantly with increasing scores on the aforementioned questionnaire (p<0.001). Among the participants, 44.6% had ≥3 chronic diseases and 48.2% used multiple medicines. Multivariate analyses revealed that dys-phagia (OR, 3.8; 95% CI, 1.7-8.5), possible sarcopenia (OR, 3.6; 95% CI, 2.2-5.6), and dementia (OR, 4.5; 95% CI, 2.8-7.0) were correlated with a relatively high prevalence of malnutrition/malnutrition risk. Exercise (at least thrice a week) reduced malnutrition risk.

Conclusions: Malnutrition is common among older adults residing in senior homes; therefore, the associated factors must be identified, and appropriate interventions should be administered.

Background and objectives: To explore the relationship between water intake, hydration biomarkers and physical activity of young male athletes.

Methods and study design: A 7-day cross-sectional study was conducted among 45 male athletes aged 18-25 years in Beijing, China. Total drinking fluids (TDF) was obtained using 7-day 24-h fluid intake questionnaire. Water from food (WFF) was assessed using the methods of food weighing, duplicate portion method and laboratory analysis. Physical activity was evaluated using physical activity energy expenditure (PAEE) and metabolic equivalent of task (MET).

Results: Totally, 42 participants completed the study. The medians of total water intake (TWI), TDF and WFF of participants were 2771 mL, 1653 mL and 1088 mL respectively. Jonckheere-Terpstra test showed a significant increase trend toward higher TWI and TDF with higher PAEE level (Z=2.414, p=0.016; Z=2.425, p=0.015). Spearman's rank correlation showed that TWI was positively correlated with PAEE (rs=0.397, p=0.009). TDF showed a positive correlation with PAEE and MET (rs=0.392, p=0.010; rs=0.315, p=0.042). The median urine volume was 840 mL, urine specific gravity was 1.020, and 24-h urine osmolality was 809 mOsm/kg. Significant differences were found in plasma cortisol among the four MET groups (χ2=8.180; p=0.042).

Conclusions: Young male athletes with higher physical activity level had higher amounts of TWI and TDF than their counterparts but had similar hydration biomarkers. There was a high incidence of dehydration in athletes, and attentions need to be paid on the intake of TDF among them to maintain the optimal hydration status.

Background and objectives: Malnutrition is associated with pulmonary tuberculosis (PTB). The aim of this study is to investigate the association between persistent malnutrition and the effect of PTB treatment.

Methods and study design: A total of 915 PTB patients were included. Baseline demographic information, anthropometry, and nutritional indicators were measured. The treatment effect was assessed by combinations of clinical manifestations, sputum smear, chest computerized tomography, gastrointestinal symptoms, and the indexes of liver function. Persistent malnutrition was considered when one or more indicators of malnutrition were lower than the reference standards in two tests on admission and after one month of treatment. Clinical symptom score (TB score) was used to assess the clinical manifestations. The generalized estimating equation (GEE) was used to assess the associations.

Results: In GEE analyses, patients with underweight had a higher incidence of TB score >3 (OR=2.95; 95% CI, 2.28-3.82) and lung cavitation (OR=1.36; 95% CI, 1.05-1.76). Hypoproteinemia was associated with a higher risk of TB score >3 (OR=2.73; 95% CI, 2.08-3.59) and sputum positive (OR=2.69; 95% CI, 2.08-3.49). Anemia was associated with a higher risk of TB score >3 (OR=1.73; 95% CI, 1.33-2.26), lung cavitation (OR=1.39; 95% CI, 1.19-1.63), and sputum positive (OR=2.23; 95% CI, 1.72-2.88). Lymphocytopenia was associated with a higher risk of gastrointestinal adverse reactions (OR=1.47; 95% CI, 1.17-1.83).

Conclusions: Persistent malnutrition within one month of treatment can adversely affect anti-tuberculosis treatment. Nutritional status during anti-tuberculosis treatment should be continuously monitored.

Background and objectives: We aimed to apply a novel nutrition screening tool to stroke patients and assess its reliability and validity.

Methods and study design: Cross-sectional data among 214 imaging-confirmed stroke patients were collected between 2015 and 2017 in two public hospitals in Hebei, China. Delphi consultation was conducted to evaluate the items in the NRS-S scale. Anthropometric indices including body mass index (BMI), triceps skin fold thickness (TSF), upper arm circumference (AMC) and mid-arm muscle circumference (MAMC) were measured. Internal consistency reliability, test-retest reliability, construct validity and content validity were assessed. In order to estimate content validity, two rounds Delphi consultation of fifteen experts were conducted to evaluate the items in the Nutrition Risk Screening Scale for Stroke (NRS-S).

Results: High internal consistency was indicated by Cronbach's alpha of 0.632 and a split-half reliability of 0.629; test-retest reliability of NRS-S items ranged from 0.728 to 1.000 (p<0.0001), except for loss of appetite (0.436, p<0.001) and gastrointestinal symptoms (0.213, p=0.042). Content validity index of 0.89 indicated robust validity of the items. Regarding construct validity, the Kaiser-Meyer-Olkin value was 0.579, and the result of the Bartlett test of sphericity was 166.790 (p<0.001). Three factors were extracted by exploratory factor analysis, which contributed to 63.079% of the variance. Confirmatory factor analysis was performed on the questionnaire, finding the p-value of the model to be 0.321, indicating a high model fitting index.

Conclusions: A novel stroke-specific nutritional risk screening tool demonstrated a relatively high reliability and validity in its clinical application.

Background and objectives: Osteoporosis is a common complication of chronic obstructive pulmonary dis-ease (COPD). It is impractical to measure bone mineral density (BMD) in all patients with COPD. This study aimed to investigate the relationship between Mini Nutritional Assessment Short-Form (MNA-SF), a simple nutritional status questionnaire, and osteoporosis, and to determine whether it can be used as a reliable screening tool for osteoporosis in patients with COPD.

Methods and study design: Thirty-seven patients with stable COPD were enrolled in this prospective cohort study. Patients with MNA-SF scores >11 were defined as well-nourished, and those with scores of ≤11 being at risk for malnutrition. Body composition, BMD, and undercarboxylated osteocalcin (ucOC), a bone metabolism marker, were measured using bioelectrical impedance, dual energy X-ray, and electrochemiluminescence immunoassay, respectively.

Results: Seventeen (45.9%) were classified as at risk for malnutrition, and 13 (35.1%) had osteoporosis. Patients at risk for malnutrition had significantly more osteoporosis and higher ucOC values than well-nourished patients (p=0.007, p=0.030, respectively). Patients with osteoporosis also had significantly lower body mass index (BMI) and fat-free mass index than those without osteoporosis (p= 0.007 and p=0.005, respectively), although FEV1 % pred was not significantly different. MNA-SF (cutoff value; 11) had better sensitivity to identify the presence of osteoporosis than BMI (cutoff value; 18.5 kg/m2) (sensitivity, 0.769; specificity, 0.708; sensitivity, 0.462; specificity, 0.875, respectively).

Conclusions: MNA-SF was associated with osteoporosis and bone metabolism markers in patients with COPD. MNA-SF may be a useful screening tool for osteoporo-sis in patients with COPD.

Background and objectives: Few studies exist on resistant starch in rice grains. The Okinawa Institute of Science and Technology Graduate University (OIST) has developed a new rice (OIST rice, OR) rich in resistant starch. This study aimed to clarify the effect of OR on postprandial glucose concentrations.

Methods and study design: This single-center, open, randomized, crossover comparative study included 17 patients with type 2 diabetes. All participants completed two meal tolerance tests using OR and white rice (WR).

Results: The median age of the participants was 70.0 [59.0-73.0] years, and the mean body mass index was 25.9±3.1 kg/m2. The difference in total area under the curve (AUC) of plasma glucose was -8223 (95% confidence interval [CI]: -10100 to -6346, p<0.001) mg·min/dL. The postprandial plasma glucose was significantly lower with OR than with WR. The difference in the AUC of insulin was -1139 (95% CI: -1839 to -438, p=0.004) µU·min/mL. The difference in the AUC of total gastric inhibitory peptide (GIP) and total glucagon-like peptide-1 (GLP-1) was -4886 (95% CI: -8456 to -1317, p=0.011) and -171 (95% CI: -1034 to 691, p=0.673) pmol·min/L, respectively.

Conclusions: OR can be ingested as rice grains and significantly reduced postprandial plasma glucose compared to WR independent of insulin secretion in patients with type 2 diabetes. OR could have escaped absorption not only from the upper small intestine but also from the lower small intestine.