Asia Pacific journal of clinical nutrition最新文献

Background and objectives: In Indonesia, stunting is one of the most public health concerns. This study aims to systematically review and meta-analyze childhood stunting risk factors in the country.

Methods and study design: We did a systematic review and meta-analysis of observational (cross-sectional and longitudi-nal) studies on stunting risk factors published between 2010 and 2021 based on available publications in online databases of PubMed, ProQuest, EBSCO, and google scholar. The quality of the publications was evaluated using the Newcastle-Ottawa Quality Assessment Scale and organized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Publication bias was examined using Egger's and Begg's tests.

Results: A total of 17 studies from the literature search satisfied the inclusion criteria, with 642,596 subjects. The pooled stunting prevalence was 30.9% (95% CI 25.0%-36.8%). Children born with low birth weight (POR 2.39, 2.07-2.76), female (POR 1.05, 1.03-1.08), and did not get the deworming program (1.10, 1.07-1.12) are the primary child characteristics that contributed to stunting. Meanwhile, maternal age ≥ 30 years (POR 2.33, 2.23-2.44), preterm birth (POR 2.12, 2.15-2.19), and antenatal care <4 times (POR 1.25, 1.11-1.41) were among mother characteristics consistently associated with stunting. The primary household and community risk factors for stunting were food insecurity (POR 2.00, 1.37-2.92), unimproved drinking water (POR 1.42, 1.26-1.60), rural residence (POR 1.31, 1.20-1.42), and unimproved sanitation (POR 1.27, 1.12-1.44).

Conclusions: A diverse range of risk factors associated with childhood stunting in In-donesia demonstrates the need to emphasize nutrition programs by scaling up to more on these determinants.

Background and objectives: The composition of the human diet is complex and diverse, and the relation-ship between dietary composition and cognitive decline has not been adequately studied. Therefore, this study explored the possible association between food items and the risk of cognitive impairment.

Methods and study design: This cross-sectional study was based on an ecological longevity cohort and included 2881 participants (1086 men and 1795 women) aged ≥30 years between December 2018 and November 2019. The association between food items and the risk of cognitive impairment was explored using the Bayesian kernel machine regression (BKMR) learning model.

Results: Finally, 2881 participants (1086 men and 1795 women) were included. In all participants, the multivariable logistic analysis showed that fresh fruit consumption was associated with cognitive function (OR=0.999, 95% CI: 0.998-0.999, p=0.021). Using the BKMR model, none of the 18 food items were significantly correlated with cognitive function among women. In men, when the other food items were fixed at the 25th, 50th, and 75th percentile values (P25, estimate=-0.239; P50, estimate=-0.210; P75, estimate=-0.158), there was a negative correlation between fresh fruit consumption and the predicted risk of cognitive function disorders.

Conclusions: Men displayed a negative association be-tween fresh fruit consumption and the risk of cognitive function disorders, but this was not apparent among women.

The prevalence of malnutrition in surgical patients is high, particularly in elderly, oncologic, critically ill and morbidly obese patients. In recent years, as the concept of enhanced recovery after surgery (ERAS) has gained in popularity, the concept and strategy of nutritional care for surgical patients has also evolved. The concept of nutritional management is relatively new in surgical patient management, which promotes integrating the "nutritional screening-assessment-diagnosis-treatment" (NSADT) scheme into the preoperative, intraoperative, postoperative, and post-discharge processes of disease treatment and rehabilitation. This article will review the practice of perioperative nutrition management in surgical patients in China.

Background and objectives: Obesity and related target organ damage such as high carotid intima-media thickness (cIMT) in children is associated with cardiovascular disease (CVD) later in life. However, the asso-ciation between gut microbiota and obesity combined with high cIMT among children remains unclear. Therefore, we compared differences in composition, community diversity, and richness of gut microbiota among normal children and obesity combined with or without high cIMT to identify differential microbiota biomarkers.

Methods and study design: A total of 24 children with obesity combined with high cIMT (OB+high-cIMT), 24 with obesity but normal cIMT (OB+non-high cIMT), and 24 with normal weight and normal cIMT aged 10-11 years matched by age and sex from the "Huantai Childhood Cardiovascular Health Cohort Study" were included. All included fecal samples were tested using 16S rRNA gene sequencing.

Results: The community richness and diversity of gut microbiota in OB+high-cIMT children were decreased compared with OB+non-high cIMT children and normal children. At the genus level, the relative abundances of Christensenellaceae_R-7_group, UBA1819, Family_XIII_AD3011_group, and unclassi-fied_o_Bacteroidales were associated with reduced odds of OB+high-cIMT among children. Receiver operating characteristic (ROC) analysis showed that combined Christensenellaceae_R-7_group, UBA1819, Fami-ly_XIII_AD3011_group, and unclassified_o_Bacteroidales performed a high ability in identifying OB+high-cIMT. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) showed that several pathways such as biosynthesis of amino acids and aminoacyl-tRNA pathways were lower in the OB+high-cIMT group compared with the normal group.

Conclusions: We found that the alteration of gut microbiota was associated with OB+high-cIMT among children, which indicates that the gut microbiota may be a marker for obesity and related cardiovascular damage among children.

Background and objectives: To investigate the association between frailty, malnutrition, comorbid medical conditions and activities of daily living (ADL) in older adult patients with fractures, and to analyse the influential factors of frailty.

Methods and study design: The FRAIL scale including five components: fatigue, resistance, ambulation, illness, and loss of weight, was used to evaluate frailty. Participants were divided into frailty, pre-frailty and non-frailty groups. The ADL was assessed using the Barthel Index, while the nutrition risk screening tool, NRS-2002, was used to assess the nutritional risk, and the Global Leadership Initiative on Malnutrition diagnostic criteria were used to diagnose the nutritional status. Statistical analysis was performed using univariate and multivariate logistic regression to determine the factors associated with frailty.

Results: A total of 166 patients were included in the study, and the incidences of frailty, pre-frailty and non-frailty were 39.2%, 33.1% and 27.7%, respectively. The severe dependence rate (ADL scale of <40) in the frailty, pre-frailty and non-frailty groups was 49.2%, 20.0% and 6.52%, respectively. The prevalence of nutritional risk was 33.7% (56/166), including 56.9% (31/65) in the frailty group and 32.7% (18/55) in the pre-frailty group. Of the 166 patients, 45 (27.1%) were diagnosed with malnutrition, including 47.7% (31/65) in the frailty group and 23.6% (13/55) in the pre-frailty group.

Conclusions: Frailty in older adult patients with fractures is widespread, and the prevalence of malnutrition is high. The occurrence of frailty may be related to an advanced age, increased medical comorbidity and impairment in ADL.

Background and objectives: Cow milk protein allergy (CMPA) can mimic surgical disease, gastroenteritis, sepsis, and necrotizing enterocolitis in the neonatal period. For this reason, we aimed to evaluate the clinical features, differential diagnosis, and treatment methods of neonates with CMPA.

Methods and study design: The charts of twenty-six breastfed full-term and preterm newborns presenting with CMPA between October 2018 and February 2021 were retrospectively reviewed. The clinical symptoms, laboratory findings, and methods used in diagnosis and treatment were analyzed.

Results: CMPA was diagnosed in preterm infants 50% (n=13) at the same rate as in full-term infants 50% (n=13) between 32 to 38 weeks corrected age (median 36 weeks). Among patients with CMPA, 69.2% (n=18) had blood in the stool at the onset. Cow's Milk-related Symptom Score score was found to be significantly higher prior to diagnosis vs. after treatment with the cow milk protein-free mom's milk diet [12(11-13) vs. 4(3-5), p<0.001]. Seventy-two hours after the commencement of the mothers' elimination diet, macroscopic blood in stool disappeared in all patients except one patient. Oral food challenge (OFC) for the diagnosis of CMPA was carried out on all (n=26) neonates. Eosinophilia was seen in 46.2% of patients (n=12). The methemoglobin concentration was 1.1 to 1.5% (median 1.3%).

Conclusions: CMPA should be kept in mind for well-appearing preterm and full-term infants suspected of necrotizing enterocolitis and gastroenteritis, respectively, presenting with bloody stool and eosinophilia. The use of OFC can be implemented since neonates were very well monitored in the neonatal intensive care unit. Treatment is possible by continuing breastfeeding.

Background and objectives: Observational studies have shown that energy restriction could be beneficial for controlling bodyweight in patients with polycystic ovary syndrome (PCOS). We aim to compare the effects of a high-protein diet (HPD), a high-protein and high-dietary fiber diet (HPHFD), and a calorie-restricted diet (CRD) on metabolic health and gut microbiota in overweight/obese PCOS patients.

Methods and study design: We will enroll a total of 90 overweight/obese PCOS patients into this eight-week open-label randomised controlled trial. Participants will be randomly assigned to three groups: CRD group (energy coefficient 20 kcal/kg.day, water ≥1500 mL, 0.8-1.2 g/kg protein, carbohydrate energize 55-60%, and fat energize 25-30%), HDP group (energy coefficient 20 kcal/kg.day, water ≥1500 mL, and 1.5-2.0 g/kg protein) and HPHFD group (based on the high protein diet with 15 g more dietary fiber supplement). The primary outcome is body weight, body fat percentage, and lean body mass. The secondary outcomes will include changes in blood lipids, inflammation, glucose tolerance, blood pressure, and gut microbiota compositions. Between-group differences in adiposity measurements at baseline will be compared using one-way analysis of variance (ANOVA) or Kruskal-Wallis test when appropriate. Within-group difference after 8-week intervention will be compared using paired t-test or Wilcoxon signed rank test. Between-group differences in adiposity measurements after 8-week diet intervention will be compared using linear mixed model and ANCOVA. The gut microbiota will be analyzed using 16S amplicon sequencing and the sequencing data will be analyzed using the standardized QIIME2 piperline.

Background and objectives: To investigate the capacity of clinical nutrition services in secondary and tertiary hospitals in the Sichuan Province, China.

Methods and study design: Convenience sampling was used. E-questionnaires were distributed to all eligible medical institutions in Sichuan through the official network of provincial and municipal clinical nutrition quality control centers. The data obtained were sorted in Microsoft Excel and analyzed by SPSS.

Results: A total of 519 questionnaires were returned, of which 455 were valid. Only 228 hospitals were accessible to clinical nutrition services, of which 127 hospitals had independently set up clinical nutrition departments (CNDs). The ratio of clinical nutritionists to beds was 1:214. During the last decade, the rate of constructing new CNDs was maintained at approximately 5 units/year. A total of 72.4% of hospitals managed their clinical nutrition units as part of their medical technology departments. The specialist number ratio of senior, associate, intermediate and junior is approximately 1:4:8:10. There were 5 common charges for clinical nutrition.

Conclusions: The sample representation was limited, and the capacity of clinical nutrition services may have been overestimated. Secondary and tertiary hospitals in Sichuan are currently in the second high tide of department establishment, with a positive trend of departmental affiliation standardization and a basic formation of a talent echelon.

Background and objectives: Few studies have explored the relationship between overall diet quality and stress load. Therefore, we have evaluated the association between dietary quality and allostatic load (AL) in adults.

Methods and study design: The data were derived from the 2015-2018 National Health and Nutri-tion Examination Survey (NHANES). Dietary intake information was obtained by 24-hour dietary recall. The Healthy Eating Index (HEI) 2015 version was estimated as an indicator of dietary quality. The AL was in-dicative of the accumulated chronic stress load. The weighted logistic regression model was used to explore the relationship between dietary quality and the risk of high AL in adults.

Results: A total of 7557 eligible adults older than 18 years were enrolled in this study. After being fully adjusted, we found a significant asso-ciation between HEI score and the risk of high AL (ORQ2 =0.73, 95% CI: 0.62,0.86; ORQ3 =0.66, 95% CI: 0.55,0.79; ORQ4 =0.56, 95% CI: 0.47,0.67) in logistic regression model. Increased intake of total fruits and whole fruits or decreased intake of sodium, refined grains, saturated fats and added sugars were associated with the risk of high AL (ORtotal fruits =0.93, 95%CI: 0.89,0.96; ORwhole fruits =0.95, 95%CI: 0.91,0.98; ORwhole grains =0.97, 95%CI: 0.94,0.997; ORfatty acid =0.97, 95%CI: 0.95,0.99; ORsodium =0.95, 95%CI: 0.92,0.98; ORre-fined grains =0.97, 95%CI: 0.94,0.99; ORsaturated fats =0.96, 95%CI: 0.93,0.98; ORadded sugars =0.98, 95%CI: 0.96,0.99).

Conclusions: We found that dietary quality was inversely associated with allostatic load. High di-etary quality presumptively less cumulative stress.