Relationship Between the Comprehensive Nutritional Index and the EORTC QLQ-H&N35 in Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiation Therapy

This study aimed to explore the relationship between the comprehensive nutritional index (CNI) and quality of life in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiation therapy (IMRT). The nutritional index, which includes total lymphocyte count, hemoglobin and albumin levels, body mass index, and usual body weight percentage, was evaluated pre-treatment and post-treatment in patients who underwent IMRT. The quality of life of NPC patients was measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) at four time points: pre-treatment, post-treatment, and 3 and 6 mo after IMRT. A comprehensive nutritional model was used to assess the correlation with QLQ-H&N35. The nutritional index decreased significantly post-treatment. The CNI was associated with immunotherapy; the International Union Against Cancer (UICC) stage; concurrent chemotherapy; speech problems, trouble with social contact, feeling ill and having dental problems at pre-treatment; sexuality at 3 mos post-treatment; and sensory problems and xerostomia at 6 mo post-treatment (P < 0.05). The nutritional status and QLQ-H&N35 scores in NPC patients decreased during IMRT. Our study provides an alternative measure of the CNI to improve the QLQ-H&N35 evaluation system for patients with NPC.     

Nutritional status and dietary intake of outpatients with chronic obstructive pulmonary disease

Aim: To determine, in Australian chronic obstructive pulmonary disease (COPD) outpatients, the prevalence of nutritional depletion, adequacy of dietary intake and relationship between nutritional depletion and clinical indicators. Methods: Cross‐sectional study of 66 stable COPD outpatients (mean forced expiratory volume in one second (FEV₁) of 60% predicted (95% confidence interval 54, 67) ). Nutritional status was assessed using body mass index (BMI) and fat‐free mass index (FFMI). Four‐day estimated food records were compared with the new Australian Nutrient Reference Values. Clinical indicators included respiratory function and quality of life (QoL) using the St George Respiratory Questionnaire. Results: Thirty per cent of subjects (n = 20) were nutritionally depleted (BMI < 20 kg/m² and/or FFMI < 16.7 kg/m² (male) or <14.6 kg/m² (female) ). Low FFMI despite normal/high BMI was present in 20% of subjects (n = 13). Many subjects were not meeting estimated requirements for energy (n = 43 of 57), calcium (n = 47), fibre (n = 47), folate (n = 37), magnesium (n = 28) and zinc (n = 14). Nutritionally depleted subjects had significantly lower respiratory function (FEV₁ (% predicted) (P = 0.003) and FEV₁/forced vital capacity (%) (P = 0.038) ), while QoL scores were not significantly different. Conclusion: While nutritional depletion is a recognised complication of COPD that is predictive of early mortality, this is the first nutritional analysis of stable ambulatory COPD patients in Australia. One‐third of this sample was nutritionally depleted, characterised particularly by low fat‐free mass. Intake of energy and several nutrients was also inadequate. Prompt diagnosis and treatment of nutritional depletion are required, as it is highly prevalent in this population and associated with poorer outcomes.     

Relationship of sleep quality and quality of life in children with monosymptomatic enuresis

Background Health‐related quality of life (QoL) in children with monosymptomatic nocturnal enuresis might be influenced by impaired quality of sleep. The aim of this study was to evaluate possible deteriorations in QoL and sleep quality and the association between these parameters in children with monosymptomatic nocturnal enuresis. Methods The study consisted of 44 children with monosymptomatic nocturnal enuresis and 27 healthy controls aged 6–15 years. KINDL QoL and Pittsburgh Sleep Quality Index (PSQI) were applied to all children. Results Mean total KINDL scores in enuresis and control groups were 65.1 ± 11.0 vs. 67.4 ± 13.7, respectively (P = 0.44). PSQI scores were not significantly different between the groups (P > 0.05l). In the enuresis group, age showed significant negative correlation with self‐esteem domain of KINDL (r = ?0.39, P = 0.01) and positive correlation with sleep duration sub‐score of the PSQI (r = 0.37, P = 0.03). Duration of enuresis showed significantly negative correlation with total KINDL score and self‐esteem domain (r = ?0.32 and r = ?0.39, P = 0.04 and P = 0.01, respectively). There was significant correlation between physical well‐being sub‐score of KINDL with daytime dysfunction and total scores of PSQI (r = ?0.53, P = 0.001 and r = ?0.41, P = 0.02, respectively). Daytime dysfunction sub‐score of PSQI was significantly correlated with friends sub‐score of KINDL (r = ?0.33, P = 0.04). Conclusions As age of the child and duration of enuresis increase, self‐esteem domain of QoL worsens. Moreover, there is a significant correlation of physical well‐being and friends domains of QoL score and total and daytime dysfunction scores of PSQI. These findings necessitate global evaluation of QoL and sleep quality in children with monosymptomatic nocturnal enuresis to increase efficacy of health care.     

Mini Nutritional Assessment in patients with Parkinson's disease: correlation between worsening of the malnutrition and increasing number of disease-years

Abstract

Objective: To monitor the nutritional status of patients with Parkinson's disease using the Mini Nutritional Assessment (MNA) questionnaire.

Patients and methods: This was a 3-year longitudinal study conducted in a national referral centre for Parkinson's disease and other movement disorders. The cohort included 61 Parkinson's disease patients, 37 men and 24 women, mean age of 70.5 ± 5.5 years, mean duration of disease 9 ± 6.3 years; 35 patients were followed-up after 3 years.

Results: MNA score diminished from 24.9 ± 1.6 to 24 ± 2.5 (P = 0.02); the proportion of patients at risk of malnutrition increased from 22.9% to 34.3%. A linear correlation was observed between MNA score and the duration of disease (P = 0.0096). The dietary assessment subscore significantly diminished (8.6 versus 8.1; P = 0.0009) as did body mass index (25.9 ± 3.5 kg/m² versus 27.1 ± 3.1 kg/m²; P = 0.001).

Conclusions: The evaluation of nutritional status should be part of the routine work-up of a Parkinson's disease patient. Dietary education should be included amongst the therapeutic measures designed to improve the general conditions in Parkinson's disease.     

Nutritional predictors of cognitive impairment severity in demented elderly patients: The key role of BMI

Introduction

The body mass index (BMI) is commonly used to assess nutritional status and the Mini Mental State Examination (MMSE) is a validated tool for assessing cognitive status in elderly people. Nutritional and cognitive aspects are closely related in dementia.

Objectives

To establish whether BMI predicts cognitive decline in demented patients and whether an ??alarm?? BMI cut-off exists for declining MMSE scores.

Subjects and methods

82 elderly demented patients underwent clinical, bio-chemical and functional assessment.

Design

Transversal study.

Results

The mean BMI was 26.08±4.48 kg/m₂ and the mean MMSE 18.68±5.38. Patients with BMI<25 kg/m₂ had significantly lower MMSE scores (16.5±5.53 vs 20.38±4.64; p 0.001), fat-free mass (FFM; 27.76±8.99 vs 37.38±10.58 kg; p<0.001), fat-free mass index (FFMI; 11.52±3.03 vs 14.67±2.89 kg/m₂; p<0.001), and fat mass (FM; 24.90±6.89 vs 36.86±6.77 kg; p<0.001), as well as lower Mini Nutritional Assessment (MNA) scores (23.80±2.50 vs 25.00±2.29; p=0.03) and higher vitamin B12 levels (460.95±289.80 vs 332.43±82.07 pg/ml; p=0.01). In the sample as a whole, MMSE scores significantly correlated with scores for MNA (r=0.27, p=0.01), FFM (r=0.27, p=0.01), BMI (r=0.19, p=0.05), ADL (r=0.28, p=0.01) and instrumental activities of daily living (IADL; r=0.34, p=0.002). On multiple logistic regression, BMI<25 kg/m₂ was independently associated with the risk of moderate-severe cognitive impairment (OR=2.96; 95% CI; 1.16?C7.55) and female gender was independently associated with severity of dementia (OR=3.14; 95% CI; 1.09?C9.03).

Conclusion

BMI seems to indicate global health status in elderly demented people and a BMI of 25 kg/m² can be considered an ??alarm?? cutoff, lower values coinciding with a worse cognitive status based on MMSE scores.     

基于不同量表探讨慢性肝炎患者生命质量的内涵及健康改善研究

摘要 目的 分析慢性肝炎患者的生命质量状况并探讨不同量表在生命质量测量中的内涵差异及健康改善途径。方法 分别采用EQ-5D-5L、ICECAP-A和EBQoL量表测量240例慢性肝炎患者的生命质量，同时采用因子分析、Bland-Altman分析和Spearman相关分析探讨测量结果的内涵、一致性及相关性。结果EQ-5D-5L、ICECAP-A和EBQoL量表测量的受访者生命质量总体得分分别为（89.15±13.84）分、（71.10±18.32）分和（65.17±17.93）分，各测量结果间有一定的正相关性（r=0.173~0.435，P＜0.01），且一致性较高。三类量表的测量结果主要加载于4个公因子，分别主要反映影响生命质量的生理健康、与个人生活环境和条件密切相关的心理健康、与社会环境相关的心理健康以及自然环境因素。结论 慢性肝炎患者总体的生命质量水平不高，对其进行健康改善除了应关注个人生理及心理健康外，还需同时关注患者所处的宏观外界社会环境和生存条件。     

Vitamin B12 status,dietary protein intake and proton pump inhibitor use in geriatric rehabilitation subjects

Aim: To compare the dietary intake and nutritional status of users and non‐users of proton pump inhibitor medications. Methods: Cross‐sectional study of subacute rehabilitation inpatients. Forty‐nine patients (nine men and 40 women) without dementia fulfilled the study criteria. Information was collected on admission and included medical history, duration of proton pump inhibitor medication use, nutritional status and cognitive scores. Dietary data were collected by food frequency questionnaire and blood samples were analysed for vitamin B₁₂, homocysteine and methylmalonic acid concentrations. Results: Age was 80.4 ± 7.7 (mean ± SD) years and body mass index was 26 ± 6.7 kg/m². Twenty‐one (of 49) subjects had subclinical vitamin B₁₂ deficiency, which was defined as serum vitamin B₁₂ <148 pmol/L or 148–258 pmol/L and methylmalonic acid >0.30 µmol/L or tHcy >13 µmol/L (women) and >15 µmol/L (men). Subjects were stratified according to proton pump inhibitor use and vitamin B₁₂ status. The presence of subclinical deficiency was similar between the groups (χ²‐test P= 0.17). Proton pump inhibitor users had higher dietary protein and calcium intakes (but not supplement calcium intakes) compared with non‐users (93 vs 81 g/day, P= 0.002 and 968 vs 742 mg/day, P= 0.038, respectively). Conclusions: Subjects using proton pump inhibitor medications did not have lower vitamin B₁₂ status, but had higher dietary protein intakes suggesting higher intakes of meats, eggs and dairy foods may reduce the risk of developing vitamin B₁₂ deficiency whilst taking proton pump inhibitor medications.     

The Impact of the Disease Trend on the Macro and Micro-Nutrients Intake in Patients with Gastric Cancer

Abstract

Background: Disease-related malnutrition, as a major cause of morbidity and mortality in cancer patients, is very common in patients with gastric cancer (GC). Malnutrition in cancer patients was reported to have important adverse effects, including a decreased response and tolerance to treatment, a decrease of performance, shorter survival, and lower quality of life. The treatment approaches involving chemotherapy is known to develop various acute and chronic symptoms that restrict eating and, thereby, exert a profound impact on nutritional status.

Method: In this study, 82 patients with GC with an average age of 48.33?±?10.74 were enrolled. Patients were followed up for 6 months without any nutritional intervention and/or education. A 168 item semi-quantities food frequency questioner was completed by a trained nutritionist at the beginning of the study and six months after the start of chemotherapy.

Results: Intake of vitamin A (T₀:585.52?±?203.34 vs. T₆:529.48?±?138.91, t?=?2.96), Thiamin (T₀:2.09?±?0.76 vs. T₆:1.80?±?0.72, t?=?2.81), vitamin B6 (T₀:2.03?±?0.53 vs. T₆:2.29?±?0.73, t?=?2.56), and vitamin B12 (T₀:5.79?±?3.96 vs. T₆:4.48?±?2.20, t?=?2.43) significantly decreased after 6 months of receiving chemotherapy. On the other intake of beef (T0:17.79?±?25.48 vs. T6:12.58?±?16.66, t?=?2.06), low-fat milk (T0:52.57?±?69.80 vs. T6:29.18?±?45.89, t?=?2.95), cream (T0:2.42?±?4.16 vs. T6:1.06?±?1.68, t?=?2.88), and raw vegetable (T0:6.54?±?9.55 vs. T6:3.85?±?5.23, t?=?2.54) significantly decreased.

Conclusion: Nutritional deterioration is an important part of the pathogenesis of cancer and its treatment that can occur at any point in the timeline of cancer diagnosis, treatment or support. Therefore nutritional counseling and supportive services are needed for cancer patients, especially when their disease is diagnosed.     

Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

BackgroundMalnutrition in patients with chronic obstructive pulmonary disease (COPD) is common and associated with poor prognosis. Nutrition interventions are necessary, but there is a lack of evidence regarding the effectiveness of tailored nutrition advice.ObjectiveThis study investigated whether tailored nutrition counseling could improve dietary intake, nutritional status, functional outcomes, and health-related quality of life (QoL) of malnourished outpatients with COPD.DesignWe conducted a randomized controlled trial in which participants were randomly assigned to either the intervention group (IG) or the control group (CG).Participants/settingOne hundred and twenty malnourished outpatients with COPD participated in the study between May and November 2017 at the National Lung Hospital, Hanoi, Vietnam.InterventionThe IG received tailored nutrition counseling once per month for 3 months based on a specifically developed written nutrition resource for COPD. The CG received the same educational resource at baseline without any discussion.Main outcome measuresThe main outcome measures were energy and protein intakes, body weight change, nutritional status (Subjective Global Assessment score), muscle strength, and QoL.Statistical analysesDifferences between groups before and after the intervention were assessed using two-way repeated measures analysis of variance. Generalized estimating equation modeling was used to investigate the differences between groups over time.ResultsAt baseline, there were no significant differences in outcomes of interest between the two groups. After 3 months of intervention, time–intervention interactions for energy intake, protein intake, and body weight change were significant (945 kcal/day, 95% CI 792 to 1,099 kcal/day, P<0.001; 50.0 g protein/day, 95% CI 43.9 to 56.1 g protein/day, P<0.001; and 1.0 kg, 95% CI 0.5 to 1.5 kg, P<0.001, respectively). Subjective Global Assessment scores improved in the IG and worsened in the CG. Significant improvements were found in inspiratory muscle strength in the IG (5.4 cmH₂O, 95% CI 2.3 to 8.6 cmH₂O, P=0.001) and significant decreases in handgrip strength were found in the CG after 3 months of the intervention (1.4 kg, 95% CI 0.4 to 2.4 kg, P=0.007). There was a significant interaction effect for all QoL scores (analysis of variance two-way repeated, P≤0.003). The IG also significantly improved all QoL scores from baseline to 3 months (P<0.004).ConclusionsTailored nutritional counseling has the potential to improve dietary intakes, nutritional status, functional outcomes, and QoL in malnourished outpatients with COPD.     

Nutritional,immunological and antioxidant defense status of outpatients diagnosed with colorectal cancer – a case–control study of the little-studied population

Abstract

This cross-sectional study was conducted to investigate nutritional and immunological status of colorectal cancer (CRC) patients in a little-studied population from developing country, Pakistan. Data on 81 CRC patients and 37 healthy controls (HCs) were collected on nutritional status, nutrient intake, percent body fat (%BF), selected immunological parameters, phytochemical index (PI), healthy eating index (HEI), and prognostic nutrition index (PNI). Blood samples were used for immunological and antiradical defense potential (expressed as 50% hemolysis time; HT₅₀). Results show 40/81 (49.4%) patients reported weight loss in past 3–6?mo, Significant differences were found in HEI values between patients vs. HCs, and between patients in low vs. high PNI groups (P, for all trends <0.05). Patients in the higher PNI group were heavier, had higher % BF, higher energy intake, and higher PI score as compared to patients in the low PNI group (P?<?0.05). Low PNI was positively associated with non-significantly lower CD4:CD8 ratios, higher B-cells and NK cells (P, for all trends >0.05), but with significantly higher hs-CRP levels, and lower HT₅₀ values (P, for all trends <0.001). In conclusion, CRC patients in a little-studied population have compromised nutritional and immunological health with lower HEI and PNI scores.     

Nutritional Status of Hematological Patients before Hematopoietic Stem Cell Transplantation and in Early Posttransplantation Period

Hematopoietic stem cell transplantation (HSCT) is an aggressive method of treatment affecting patient's homeostasis. The aim of the study was to evaluate the initial nutritional status of HSCT patients and nutritional status in early posttransplantation period. The prospective study included 100 consecutive patients with hematological malignancies subjected to HSCT. The nutritional status evaluation was made using the nutritional screening scales, anthropometric and biochemical parameters, as well. On the day +7 following HSCT significant decrease in concentration of total protein (5.8 g/dl), albumin (3.6 g/dl) and transferrin (165 mg/dl) were observed (P < 0.001), although the mean body mass/BMI were within the normal range. On the day +14, the biochemical parameters of the nutritional status were even lower (P < 0.001). Poorer nutritional status was associated with worse performance status and mucositis escalation. The adequate nutritional support plan is important element of the whole transplantation procedure.     

Relationships between appetite and quality of life in hemodialysis patients

The aim of this paper was to investigate the association between appetite and kidney-disease specific quality of life in maintenance hemodialysis patients. Quality of life (QoL) was measured using the kidney disease quality of life survey. Appetite was measured using self-reported categories and a visual analog scale. Other nutritional parameters included Patient-Generated Subjective Global Assessment (PGSGA), dietary intake, body mass index and biochemical markers C-reactive protein and albumin. Even in this well nourished sample (n=62) of hemodialysis patients, PGSGA score (r=-0.629), subjective hunger sensations (r=0.420) and body mass index (r=-0.409) were all significantly associated with the physical health domain of QoL. As self-reported appetite declined, QoL was significantly lower in nine domains which were mostly in the SF36 component and covered social functioning and physical domains. Appetite and other nutritional parameters were not as strongly associated with the Mental Health domain and Kidney Disease Component Summary Domains. Nutritional parameters, especially PGSGA score and appetite, appear to be important components of the physical health domain of QoL. As even small reductions in nutritional status were associated with significantly lower QoL scores, monitoring appetite and nutritional status is an important component of care for hemodialysis patients.     

衰弱指数模型在老年人综合评估中的初步应用

目的 探讨基于老年人综合评估的衰弱指数模型(FI-CGA)在中国老年人群中的适用性,及其评估老年人的衰弱状况。方法 对118例参加体检的老年人进行综合评估,并计算衰弱指数;同时采用临床衰弱量表(CFS)-09的9级分级法进行衰弱测评,比较两种衰弱评估方法的相关性。结果 118例老年人FI-CGA均值为0.19±0.07,平均CFS分级为3.11±1.46;5例老年女性FI-CGA均值为0.20±0.02、CFS分级均值为3.40±0.55;113例老年男性FI-CGA均值为0.19±0.07、CFS分级均值为3.10±1.48,女性高于男性,但差异均无统计学意义(t=0.270、0.452,P=0.788、0.652)。随着年龄增加老年人FI-CGA值和CFS衰弱分级均增加(F=10.437、5.651,P=0.000、0.001);且FI-CGA值与CFS衰弱分级水平呈正相关(r=0.615,P=0.000)。结论 FI-CGA可为中国老年患者准确定量评估病情,应在老年医学临床中推广应用。     

Breakfast eating pattern and its association with dietary quality indices and anthropometric measurements in young women in Isfahan

ObjectiveTo assess the association between consuming or skipping breakfast and dietary quality indices such as the Healthy Eating Index (HEI), the Dietary Diversity Score (DDS), diversity scores of different food groups, and anthropometric measurements in young Isfahanian women.MethodsWomen 18 to 28 y old were selected randomly from among university students (n = 411) in Isfahan, Iran. A validated semiquantitative questionnaire was used to assess dietary intake. Five food groups of the Food Guide Pyramid were considered for calculating the DDS and diversity score of the food groups. Subjects were categorized based on consuming or skipping breakfast. The HEI was calculated based on 10 components including the five food groups, different fat and sodium intakes, and the DDS.ResultsBreakfast consumers versus skippers had higher scores for the HEI (66 ± 13 versus 47 ± 13, P = 0.001), the DDS (6.8 ± 1.2 versus 4.9 ± 0.7, P = 0.001), and the DDSs for fruits (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001), vegetables (1.6 ± 0.2 versus 1.2 ± 0.1, P = 0.001), and whole grains (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001). Also, eating breakfast was associated with lower values for dietary energy density (0.96 ± 0.25 versus 1.04 ± 0.40, P = 0.01), the body mass index (20.0 ± 1.8 versus 23.3 ± 2.7, P = 0.001), and waist circumference (69.2 ± 7.6 versus 72.5 ± 8.7, P = 0.001). There was a higher prevalence of breakfast consumers in the third tertiles of the HEI and DDS. However, there was a smaller percentage of breakfast consumers in the third tertiles of the body mass index and waist circumference.ConclusionsBreakfast consumption was associated with higher scores of the dietary quality indices and lower values for the body mass index and waist circumference in young Isfahanian women. Further studies should be performed to determine the relation between the kind of breakfast consumed and the dietary quality indices.     

Nutritional Status and Related Factors in Elderly Nursing Home Residents: Comparative Cross-Sectional Study in Migrants and Native Germans

Former guest workers in Germany who stayed on after retirement are now older than 70 years. Nursing homes (NH) are broadening their offer to meet specific requirements of this population. The nutritional status and related problems of the older ethnic minority group living in German NH has so far not been investigated. The aim of this study was, thus, to compare the nutritional situation of older migrants to that of native residents in two “multicultural” NH (cross-sectional study). All residents 65 years and older with a migration background were enrolled and compared to nonmigrants using frequency matching for age and gender. Nutritional status was assessed using body mass index (BMI; cut-off for undernourishment: BMI < 22 kg/m²) and calf circumference (CC; CC < 31 cm). Care staff completed a questionnaire on residents' health. Consecutive 3-day food records were evaluated to analyze the intake of energy, macro-, and micronutrients.

Participants were n = 23 migrants (76 ± 6 years, 52% female) and n = 37 nonmigrants (78 ± 7 years, 59% female). Undernourishment was more prevalent in migrants according to BMI (39 vs. 11%; P < 0.05) and CC (57 vs. 22%; P < 0.05). Main nutritional problems in both groups were “loss of appetite” (56 vs. 19%; P < 0.05) and “refusal to eat” (56 vs. 25%; P < 0.05). Energy intake was low (6.4 ± 1.4, 6.8 ± 1.6 MJ/d). More than 50% of participants fell below recommended values for vitamin C, B₁, B₆, D, folate, calcium, and iron; 61% of the migrants had a low vitamin B₁₂ intake. Migrant NH residents were more often undernourished than German NH residents.     

High-protein meals may benefit fat oxidation and energy expenditure in individuals with higher body fat

Aim: Fat oxidation is impaired in obesity. The aim of the present study was to determine if fat oxidation, seen in a high‐protein meal response, was influenced by body composition. Methods: Subjects were provided with control (14% protein, glycaemic index, GI 65), high‐protein high‐GI (33% protein, GI 74) and high‐protein low‐GI (35% protein, GI 45) meals. Substrate oxidation and energy expenditure were measured in room calorimeters over eight hours in 18 subjects. Results were compared using a repeated‐measures anova with a customised post‐hoc analysis (to compare the protein diets averaged vs control and to compare the low‐ and high‐GI diets) and covariates in a linear model of the form: y = α + β₁ × fat‐free mass (kg) + β₂ × log_e fat mass (kg). Results: The full model found significant meal effects on fat oxidation (0.21 ± 0.21 kcal/minute high‐protein high‐GI, 0.34 ± 0.11 kcal/minute high‐protein low‐GI, 0.55 ± 0.2 kcal/minute control, F = 3.50, P = 0.007). The effect on energy expenditure (1.67 ± 0.07 kcal/minute high‐protein high‐GI, 1.61 ± 0.08 kcal/minute high‐protein low‐GI, 1.67 ± 0.08 kcal/minute control) approached significance (F = 2.45, P = 0.070). Post‐hoc analysis revealed a protein effect (P = 0.004 for fat oxidation and P = 0.030 for energy expenditure). Significant interactions indicated that meal response was influenced by body composition. The high‐protein meals eliminated the negative relationship between body fat and fat oxidation (α = ?4.7, β₂ = 2.23, P < 0.01) and between body fat and energy expenditure, which were evident in the control meal (α = ?1.5, β₂ = 0.63, P < 0.05). No effect of GI was evident. Conclusion: High‐protein intakes may ameliorate an obesity‐induced decline in fat oxidation.     

Nutritional status and oxidative stress in an elderly Sardinian population

Weight loss and overweight/obesity-frequent consequences of malnutrition-may impair functional status and worsen concomitant morbidities in the elderly, often through changes in oxidative balance. In order to verify the relationships between these factors, a group of elderly people living on the island of Sardinia (Italy) underwent health and nutritional status assessment and oxidative balance evaluation. The elderly subjects had significantly higher d-ROMs test and body mass index (BMI) values than controls (d-ROMs 325.4 ± 66.3 vs. 295.4 vs 58-9 CARR U, p = 0.006; BMI 28.0 ± 4.6 vs. 21.7 ± 1.4 kg/m², p < 0.0001). The risk of malnutrition in the elderly subjects was evaluated with the Mini Nutritional Assessment (MNA), which showed that 32 of the 111 elderly subjects (28.8%) were at risk of malnutrition, of whom 11 (34%) were overweight and 10 (31-2%) obese. Oxidative stress was negatively and significantly correlated with nutritional status. Oxidative stress may precede malnutrition, even in the absence of weight loss. Routine evaluation of nutritional status and oxidative balance in the elderly may help identify an early risk of malnutrition so that treatment can be personalized.     

Randomized,double-blind,placebo-controlled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure

ObjectiveTo assess whether a ketodiet, a combination of ketoanalogs of essential amino acids (KAs) and a very low-protein diet, retards progression of chronic renal failure and maintains nutritional status.DesignA prospective, randomized, double-blind, placebo-controlled trial.SettingNephrology outpatient department in Northern Railways Central Hospital, New Delhi, India.PatientsThirty-four patients in predialytic stages of chronic renal failure (CRF), randomized to 2 comparable groups in terms of age, sex distribution, blood pressure control, etiology, use of angiotensin converting enzyme inhibitors, serum creatinine, glomerular filtration rate (GFR), and body mass index (BMI).InterventionSubjects randomly received either 0.6 g/kg/d protein plus placebo (n = 16) or 0.3 g/kg/d protein plus tablets of KAs (Ketosteril; Fresenius Kabi, Germany) (n = 18) for 9 months. A dietician administered the diet as well as the KAs or the placebo to the patients.Outcome measuresChanges in GFR and renal and nutritional parameters were measured.ResultsMean (± SD) GFR measured by the ^99mTc-DTPA (99 m technetium diethylenetri-aminepenta-aceticacid) plasma sample method was unchanged in the ketodiet group: 28.1 ± 8.8 (before) and 27.6 ± 10.1 mL/min/1.73 m² (after the study) (P = .72). However, it significantly decreased from 28.6 ± 17.6 to 22.5 ± 15.9 mL/min/1.73 m² in the placebo group (P = .015). Serum creatinine before and after the study in the ketodiet group was 2.26 ± 1.03 mg/dL and 2.07 ± 0.8 mg/dL (P = .90) and in the placebo group was 2.37 ± 0.85 and 3.52 ± 2.9 mg/dL (P = .066), respectively. In both groups the mean BMI did not change from 25.4 ± 4.2 to 24.5 ± 4.2 kg/m² (P = .46) for ketodiet and from 25.0 ± 6.8 to 23.9 ± 4.1 kg/m² (P = .39) for the placebo group. Serum total proteins decreased significantly (P = .038) in the placebo group, and serum albumin showed a trend (P = .061) toward reduction, whereas both of these parameters were maintained in the ketodiet group.ConclusionOver a 9-month period, very low-protein diet supplemented with ketoanalogs helped CRF patients to preserve GFR and maintain BMI. KAs were safe and efficacious in retarding the progression of renal failure and preserving the nutritional status of CRF patients.     

Factors associated with knowledge of genetics and nutritional genomics among dietitians

Introduction Knowledge of genetics and nutritional genomics is important for dietitians in the prevention and management of disease. The present study aimed to analyse data from a nationwide postal questionnaire survey in order to investigate the factors associated with knowledge of genetics and nutritional genomics among dietitians in the UK. Methods A nationwide postal questionnaire survey was conducted in a random sample of 600 dietitians in the UK. The questionnaire measured dietitians’ knowledge using 12 multiple choice questions relating to genetics and nutritional genomics. Factors that may impact upon such knowledge were also recorded. Knowledge scores were calculated and compared between dietitians using comparative statistics and univariate analysis of variance. Results A total of 389 (64.8%) usable questionnaires were returned. Overall, the mean ± SD total knowledge score was low at 41 ± 19%. Highest qualification (F_2,372 = 9.1, P < 0.001), the genetics content of university education (F_2,372 = 7.1, P = 0.001) and reading literature or attending a conference relating to genetics or nutritional genomics within the last year (F_1,372 = 11.9, P = 0.001) were all associated with higher total knowledge scores. Conclusion Knowledge of genetics and nutritional genomics among dietitians is currently low, and better knowledge is associated with exposure to these in university education and continuing professional development.     

Effect of chemoradiotherapy on nutrition status of patients with nasopharyngeal cancer

We aimed to assess the effect of chemoradiotherapy on the nutritional status of patients with nasopharyngeal cancer (NPC) and to detect the risk factors for poor nutrition status in NPC patients after radiotherapy. A total of 104 NPC patients participated in this clinical observational study. Psychological distress and nutritional indicators were measured prior to chemoradiotherapy. During the course of radiation therapy, side effect symptoms were assessed weekly. At the end of radiotherapy, nutritional indicators were measured again. Logistic regression was used to identify the risk factors for poor nutritional status after radiotherapy. The values of the 9 nutritional indicators were significantly lower after radiotherapy (P < 0.001) than the initial values before treatment. After radiotherapy, 20.19% of patients had more than 10% weight loss. At a significance level of α = 0.05, the risk factors for poor nutritional status were old age (P = 0.042), female gender (P < 0.001), late stage of the disease (P = 0.013), depression (P = 0.024), high side effect score (P = 0.007), and moderate nutritional status before radiotherapy (P = 0.015). Radiotherapy affects the nutritional status of NPC patients. To prevent malnutrition during radiotherapy, nutritional assessment and intervention should be an integral part of treatment.