极早产儿支气管肺发育不良影响因素的多中心临床研究

目的探讨极早产儿发生支气管肺发育不良(BPD)的影响因素。 方法选择2020年1月1日至12月31日,于青岛大学附属医院、青岛市市立医院、济宁市第一人民医院及枣庄市妇幼保健院出生并接受治疗的208例极早产儿为研究对象。根据是否发生BPD,将其分为BPD组(n＝153)和非BPD组(n＝55);再根据BPD严重程度分度,将BPD组极早产儿分为Ⅰ度BPD亚组(n＝31)、Ⅱ度BPD亚组(n＝17)及Ⅲ度BPD亚组(n＝7)。采用回顾性分析法,统计学比较BPD组与非BPD组,以及3个BPD亚组极早产儿出生与治疗情况、生后14 d内液体摄入量等。采用多因素非条件logistic回归分析,探讨极早产儿发生BPD及BPD极早产儿发生Ⅲ度BPD的影响因素。本研究经青岛大学附属医院医学伦理委员会批准(审批文号：QYFYWZLL26841),并且与所有患儿监护人签署临床研究知情同意书。 结果①BPD组极早产儿出生胎龄、体重、头围及身长,以及生后1、5、10 min Apgar评分,均小于、轻于、短于、低于非BPD组;而孕母产前激素使用率,极早产儿出生窒息率、肺表面活性剂(PS)使用率及早发型败血症(EOS)发生率,以及有创及无创机械通气时间,均高于、长于非BPD组,并且差异均有统计学意义(P<0.05)。②BPD组极早产儿生后第2、4、5、7、11、12天的总液体摄入量,以及生后第6、8~14天肠外液体静脉输注量,均多于非BPD组;生后第1~14天肠内液体摄入量,则均少于非BPD组,并且上述差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析：极早产儿生后1 min Apgar评分低(OR＝1.866,95%CI：1.063~3.274,P＝0.030),有创机械通气时间长(OR＝1.834,95%CI：1.158~2.905,P＝0.010),无创机械通气时间长(OR＝1.163,95%CI：1.067~1.267,P＝0.001),发生EOS(OR＝0.071,95%CI：0.011~0.465,P＝0.006)是极早产儿发生BPD的独立危险因素;生后第3、4、5天肠内液体摄入量多(OR＝0.671、0.708、0.746,95%CI：0.483~0.932、0.511~0.846、0.583~0.955,P＝0.017、0.004、0.020),是极早产儿发生BPD的独立保护因素。④3个BPD亚组极早产儿出生胎龄、孕母产前激素使用率、出生窒息率、EOS发生率及有创机械通气时间,生后第1、2、4、5、6天总液体摄入量及肠外液体静脉输注量,以及生后第1天肠内液体摄入量比较,差异均有统计学意义(均为P<0.05)。但是,这16项因素均不是BPD极早产儿发生Ⅲ度BPD的独立影响因素。 结论极早产儿发生BPD是多种因素共同作用的结果,减少出生窒息及EOS发生率,优化呼吸支持策略,增加生后第3~5天肠内液体摄入量,有望降低极早产儿BPD发生率。     

Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients,but Have Variability in Energy Balance and Adequacy of Micronutrient Intake

BackgroundDespite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD).ObjectiveThe aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment.DesignThis was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables.Participants/settingParticipants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time.Main outcome measuresWeight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included.Statistical analyses performedMean differences in intake and weight were assessed using nonparametric tests.ResultsSixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m²) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs.ConclusionsOverall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Lower Dietary Calcium Intake is Associated with a Higher Risk of Mortality in Korean Adults

BackgroundCalcium, one of the most abundant minerals in the human body, has a pivotal role in human physiology. However, only a few studies have examined the association of dietary calcium intake with mortality in a population with low calcium intake.ObjectiveThe aim of this study was to examine the association of dietary calcium intake with risk of all-cause and cause-specific mortality among Korean adults with low calcium intake.DesignThis study was a prospective cohort study.Participants/settingThe analysis was conducted using data from 44,327 eligible Korean adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey 2007-2015. Dietary calcium intake was assessed using 1-day 24-hour recall data.Main outcome measuresThe main outcomes of this study were mortality from all causes, cancer, cardiovascular disease, respiratory disease, and all other causes combined. The outcome was ascertained through linkage to the death registry compiled by Statistics Korea with the use of the resident registration number.Statistical analyses performedWeighted Cox proportional hazard models were used to estimate the hazard ratios and 95% CIs of the all-cause and cause-specific mortality according to dietary calcium intake.ResultsDuring a mean follow-up of 7.28 person-years, 1,889 deaths were ascertained. After multivariable adjustment, the hazard ratios for all-cause mortality for the second quintile to the highest quintile of dietary calcium intake, respectively, compared with the first quintile were 0.86 (95% CI 0.73 to 1.00), 0.82 (95% CI 0.69 to 0.98), 0.85 (95% CI 0.69 to 1.03), and 0.78 (95% CI 0.64 to 0.96) (P for trend from the lowest to the highest quintile = .04). There were no statistically significant associations between dietary calcium intake and risk of mortality from cancer, cardiovascular, or respiratory disease.ConclusionsIn this large prospective cohort study of Korean adults, lower dietary calcium intake was associated with a higher risk of all-cause mortality.     

Comprehensive dietary evaluation of Italian primary school children: food consumption and intake of energy,nutrients and phenolic compounds

Abstract

Information on children’s diet including bioactive compounds is quite scarce. This observational study investigated the composition of the diet of children living in Parma (Italy; n?=?172, 8–10?years) using 3-day food records completed in winter and spring. Mean daily intakes of food groups, energy and nutrients were obtained using the national food database, while (poly)phenol contents were estimated from Phenol-Explorer or by specific literature searches. Food consumption, energy and nutrient intakes decreased in spring and were partially in line with national data. Adherence to the nutritional recommendations was not satisfied for the majority of nutrients. Main contributors to the phenolic intake were flavonoids (flavan-3-ols) and phenolic acids (hydroxycinnamic acids), while main dietary sources were fruit, chocolate-based products, vegetables, and tea & coffee (decaffeinated). This study provided the first comprehensive analysis of the nutritional composition of children’s diet. Future research should look at the health implications of dietary choices in children.     

不同空间插值方法在钠摄入量估算中的应用

目的采用空间插值法对缺失膳食钠摄入量数据的地区进行摄入量估算。方法膳食钠消费数据来自2010—2012年中国居民营养与健康状况监测,调查采用多阶段分层与人口成比例的整群随机抽样方法,共调查了150个区县20岁及以上居民的膳食消费数据。运用连续3天24小时膳食回顾法结合家庭调味品称重法,进行面对面访谈共收集了48826名成年人膳食钠摄入量数据,计算膳食钠消费量平均数据。比较反距离权重法、普通克里金插值法、协同克里金插值法和回归克里金插值法等空间分析技术对膳食钠摄入量估算的精度,并选用插值精度最高的空间分析方法,绘制全国各区县的人均每日膳食钠摄入量预测趋势面,对各省膳食钠摄入量进行估算。结果2010—2012年中国居民的膳食钠平均摄入量为5.18g,其中男性平均摄入量为5.33g,女性平均摄入量为5.03g。比较多种空间分析技术估算膳食钠摄入量的精度发现,回归克里金插值法优于其他3种方法,其均方根误差和平均绝对误差分别为0.54和0.44。利用回归克里金插值法对全国各地区膳食钠摄入量进行估算,经人口加权计算得到全国膳食钠摄入量估算值为5.17g/d,全国男性膳食钠摄入量估算值为5.33g/d,女性膳食钠摄入量估算值为5.01g/d,各年龄组膳食钠的测量值与估算值的差值率均不超过10%。钠摄入量较高的地区为山东省(5.98g/d)、天津市(5.83g/d)和河北省(5.82g/d),摄入量最低的为贵州省(4.27g/d)结论空间插值法可用于对膳食钠消费数据缺失地区的摄入量估算,其中回归克里金插值法估算精度最高。     

2011年与2017年南京市≥25岁居民归因于豆类摄入不足的缺血性心脏病疾病负担研究

目的了解2011年与2017年南京25岁及以上人群归因于豆类摄入不足的缺血性心脏病(IHD)疾病负担和期望寿命损失情况,为IHD的饮食防控策略提供数据支撑。方法本研究资料来源于2011年和2017年南京市慢性病及其危险因素监测、南京市死因监测和2017全球疾病负担(GBD)资料,采用GBD团队提供的Excel插件程序计算人群归因分值(PAF),估算豆类摄入不足导致的IHD死亡和寿命损失。使用SPSS 20.0软件进行t检验。结果2017年,南京市因豆类摄入不足导致IHD的死亡例数占IHD总死亡例数的13.73%,较2011年(12.44%)增长了10.37%。2017年南京市归因于豆类摄入不足的IHD死亡例数和过早死亡损失寿命年(YLL)分别为645例、8116人年,较2011年(449例、6610人年)分别上升43.65%、22.78%;而标化归因死亡率和标化YLL率分别由2011年的11.05/10万、155.72/10万下降至2017年的8.86/10万、118.66/10万,下降率分别为19.82%、23.80%。2017年,豆类摄入不足导致的IHD死亡使期望寿命损失0.17岁,男性、女性分别损失0.13、0.21岁;与2011年相比,2017年男性、女性及总人群归因于豆类摄入不足的期望寿命损失均上升。结论豆类摄入不足已成为影响南京市居民死亡和期望寿命的饮食危险因素之一,应积极倡导合理膳食,增加居民豆类摄入水平,从而减少心血管疾病负担。