Impact of SARS-CoV-2 Lockdown on the Preoperative Care Program of Patients Scheduled for Bariatric Surgery

Objectives: To evaluate the effect of the SARS-CoV-2 lockdown on dietary habits, body weight, left hepatic lobe volume, use of micronutrient supplements, micronutrient status, frequency of physical activity, and evolution of comorbidities in patients undergoing preoperative care for BS. Materials and Methods: We prospectively evaluated the dietary habits (including use of micronutrient supplements and frequency of physical activity) of 36 patients who were candidates for BS from March to May 2020; 7-day food dietary records, body weight, left hepatic lobe volume by ultrasound, micronutrient status, and evolution of comorbidities were assessed. Results: All patients completed the study. Of the participants, 44.4% (16/36), 47.2% (17/36), and 27.8% (10/36) followed the preoperative indications for vegetables, fruits, and legumes, respectively, whereas over 50% did not. Furthermore, 30.6% (11/36) and 55.6% (20/36) of participants followed the prescribed recommendations for carbohydrates/sweets products and alcohol, respectively. A total of 61.1% (22/36) of participants experienced new foods and new culinary preparations. In addition, at the time of the study, we found that only 11.1% (4/36) were engaged in prescribed physical activity and only 36.1% (13/36) were taking prescribed micronutrient supplements. Compared to the initial weight, we observed an increased body weight and body mass index (+4.9%, p = 0.115; +1.89%, p = 0.0692, respectively), and no improvement in left hepatic lobe volume, micronutrient status, or comorbidities was recorded for any patient in the anamnesis. Conclusions: Lockdown determined by the SARS-CoV-2 pandemic has negatively affected the preoperative program of BS candidates, resulting in a postponement to the resumption of bariatric surgical activity.     

Implementing micronutrient fortification programs as a potential practical contribution to achieving sustainable diets

Due to sustainability concerns related to current diets and environmental challenges, it is crucial to have sound policies to protect human and planetary health. It is proposed that sustainable diets will improve public health and food security and decrease the food system's effect on the environment. Micronutrient deficiencies are a well-known major public health concern. One-third to half of the world's population suffers from nutrient deficiencies, which have a negative impact on society in terms of unrealised potential and lost economic productivity. Large-scale fortification with different micronutrients has been found to be a useful strategy to improve public health. As a cost-effective strategy to improve micronutrient deficiency, this review explores the role of micronutrient fortification programmes in ensuring the nutritional quality (and affordability) of diets that are adjusted to help ensure environmental sustainability in the face of climate change, for example by replacing some animal-sourced foods with nutrient-dense, plant-sourced foods fortified with the micronutrients commonly supplied by animal-sourced foods. Additionally, micronutrient fortification considers food preferences based on the dimensions of a culturally sustainable diet. Thus, we conclude that investing in micronutrient fortification could play a significant role in preventing and controlling micronutrient deficiencies, improving diets and being environmentally, culturally and economically sustainable.     

Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

We investigated the association between dietary micronutrient intakes and the risk of chronic kidney disease (CKD) in the Ansan-Ansung study of the Korean Genome and Epidemiologic Study (KoGES), a population-based prospective cohort study. Of 9079 cohort participants with a baseline estimate glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m² and a urine albumin to creatinine ratio (UACR) <300 mg/g and who were not diagnosed with CKD, we ascertained 1392 new CKD cases over 12 year follow-up periods. The risk of CKD according to dietary micronutrient intakes was presented using hazard ratios (HRs) and 95% confidence intervals (95% CIs) in a full multivariable Cox proportional hazard models, adjusted for multiple micronutrients and important clinico-epidemiological risk factors. Low dietary intakes of phosphorus (<400 mg/day), vitamin B2 (<0.7 mg/day) and high dietary intake of vitamin B6 (≥1.6 mg/day) and C (≥100 mg/day) were associated with an increased risk of CKD stage 3B and over, compared with the intake at recommended levels (HR = 6.78 [95%CI = 2.18–21.11]; HR = 2.90 [95%CI = 1.01–8.33]; HR = 2.71 [95%CI = 1.26–5.81]; HR = 1.83 [95%CI = 1.00–3.33], respectively). In the restricted population, excluding new CKD cases defined within 2 years, an additional association with low folate levels (<100 µg/day) in higher risk of CKD stage 3B and over was observed (HR = 6.72 [95%CI = 1.40–32.16]). None of the micronutrients showed a significant association with the risk of developing CKD stage 3A. Adequate intake of micronutrients may lower the risk of CKD stage 3B and over, suggesting that dietary guidelines are needed in the general population to prevent CKD.     

Highlights from the International Symposium on Understanding the Double Burden of Malnutrition for Effective Interventions: A focus on stable isotope techniques in nutrition

The International Symposium on Understanding the Double Burden of Malnutrition for Effective Interventions was held at the International Atomic Energy Agency (IAEA) headquarters in Vienna, Austria, from 10 to 13 December 2018. The Symposium was hosted by the IAEA in cooperation with the World Health Organization and United Nations Children's Fund. The double burden of malnutrition (DBM) is a complex situation characterised by the co‐existence of overweight/obesity, underweight and/or undernutrition, and can occur at the individual, household and population levels across the lifespan. Currently, one in three individuals worldwide suffer from at least one form of malnutrition. The objective of the meeting was to strengthen understanding of how to tackle the DBM by sharing research findings, ideas and issues with the implementation of relevant interventions, programmes and policies. In particular, the Symposium highlighted the crucial roles stable isotopes play in the assessment and monitoring of the DBM and in measuring the impact of programmes designed to address this issue. The range of stable isotope applications considered at the meeting is discussed in this paper and includes the assessment of body composition, total energy expenditure, breastfeeding practices and micronutrient bioavailability.     

Immunobiology of mild micronutrient deficiencies

Nutrition is a critical determinant of the outcome of host microbe interactions through a modulation of the immune response. Besides macronutrient malnutrition, deficiencies of several macronutrients also influence immune homeostasis and thus affect infection-related morbidity and mortality. Deficiencies of micronutrients like vitamin A, iron and zinc are widely prevalent among populations living in developing countries. Besides their severe deficiencies, subclinical deficiencies are known to impair biological functions in the host, immune function being one of them. The effects of these micronutrients on various immune mechanisms are briefly reviewed in this article.     

Impact of Micronutrients on Hypertension: Evidence from Clinical Trials with a Special Focus on Meta-Analysis

Hypertension (HT) is one of the pivotal risk factors for various detrimental diseases like cardiovascular diseases (CVDs), cerebrovascular disease, and renal dysfunction. Currently, many researchers are paying immense attention to various diet formula (dietary approach) with a special focus on micro and macronutrients along with modified lifestyle and standard anti-hypertensive drugs. Micronutrients (minerals/vitamins) play a central role in the regulation of blood pressure (BP) as they aid the function of macronutrients and also improve the anti-hypertensive functions of some anti-hypertensive agents. Even though several studies have demonstrated the beneficial effects of micronutrients on controlling BP, still some ambiguity exists among the nutritionists/doctors, which combination or individual mineral (dietary approach) contributes to better BP regulation. Therefore, this critical review article was attempted to delineate the underlying role of micronutrients (minerals and vitamins) for the management and prevention or delaying of HT and their related complications with strong affirmation from clinical trials as well as its mechanism of controlling BP. Moreover, the major source and recommended daily allowance (RDA) of various micronutrients are included in this review for guiding common readers (especially HT subjects) and dieticians to choose/recommend a better micronutrient and their combinations (other nutrients and standard anti-hypertensive drugs) for lowering the risk of HT and its related co-morbid conditions like CVDs.     

Limitations of current indicators of micronutrient status

Assessment of micronutrient status is a major concern in public health nutrition, yet there are serious limitations to the indicators currently available. This paper presents the merits of these indicators along with their drawbacks, which include cost, lack of congruence between cutoffs denoting deficiency and adverse functional consequences, and inconsistent methods of evaluating the confounding effects of infections on micronutrient status indicators. Methods for assessing the functional consequences of micronutrient deficiencies are even less well developed; their usefulness would be enhanced by a greater focus on outcomes known to be influenced by deficiencies. Although there have been notable breakthroughs, further improvements in methods to assess micronutrient status are urgently needed.     

胆道闭锁患儿微量营养素缺乏及防治研究进展

胆道闭锁是新生儿胆汁淤积的常见原因,也是儿童肝移植最主要的原发病,若不及时治疗,预后不良。而因胆道梗阻,导致消化吸收及代谢等多方面障碍,此类患儿常伴有营养不良,其中微量营养素,特别是脂溶性维生素的缺乏不仅会导致病情加重,还可能并发其他临床症状。本文通过查阅相关文献,就胆道闭锁患儿的微量营养素缺乏现状、相关机制及支持方案等进行综述,为临床改善患儿营养状况及预后提供参考和帮助。     

Co-Occurrence of Overweight/Obesity,Anemia and Micronutrient Deficiencies among Non-Pregnant Women of Reproductive Age in Ghana: Results from a Nationally Representative Survey

Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.     

INTRODUCTORY OBSERVATIONS: THE REGION,NUTRITION, AND HEALTH

Geography and culture only loosely define the Middle East and there are differing opinions as to which countries should be included in the region. International agencies also use the terms “Near East,” “Eastern Mediterranean,” and “West Asia and North Africa” each with a somewhat different definition. The region has shown a greater than average increase in food availability in recent years and projections for 2010 show these trends progressing. Significant differences, however, exist between the individual countries since they range from some of the poorest in the world to some of the richest. As a consequence the nutritional and health conditions found, vary from those associated with poverty to those associated with affluence. Nutritionally related chronic diseases such as heart disease, diabetes mellitus, hypertension, and osteo-arthritis are now major contributors to morbidity and mortality in the industrialized world. However, in many countries of the Middle East, micronutrient malnutrition, especially iron, iodine, and vitamin A deficiencies as well as general child undernutrition coexist with the newer diet related chronic diseases. The papers in this volume, originating from Egypt, Kuwait, Lebanon, Saudi Arabia, and Syria reflect our desire to highlight these twin sets of problems in the region.     

肥胖儿童体液免疫功能及其相关因素分析

【目的】探讨单纯性肥胖症儿童的体液免疫功能及可能的影响因素。【方法】对符合诊断标准的40例单纯性肥胖儿童测定其腹围、身高、体重,计算体质指数(body mass index,BMI)。运用散射比浊法测定其免疫球蛋白IgG、IgAI、gMI、gE及补体C3、C4,同时测定空腹血糖、血脂、胰岛素与30例正常儿童相比较,并调查一些相关因素。【结果】肥胖组的IgG、补体C3值明显低于正常儿童,并与肥胖儿童的血甘油三酯(TG)、BMI、腹围、肥胖年数、胰岛素抵抗指数(HO-MA-IR)和胰岛β细胞功能指数(HBCI)密切相关。经多因素回归分析,影响体液免疫功能的因素有肥胖年数、BMI、血脂等因素。【结论】单纯性肥胖症患儿存在体液免疫功能受损。免疫功能受损与肥胖体块指数、血脂及肥胖年数有关。     

β淀粉样蛋白处理大鼠认知和微量营养素状况的变化

目的观察认知功能损伤大鼠体内几种主要维生素和微量元素含量的改变。方法30只雄性SD大鼠随机分为正常对照组、β淀粉样蛋白(Aβ)组和生理盐水组,每组10只。正常对照组不作任何处理,Aβ组双侧海马内注射Aβ(每侧10μg),生理盐水组海马内注射等体积生理盐水。实验周期两周。通过水迷宫试验、避暗试验检测大鼠认知功能;采用原子吸收分光光度法、微量荧光法等方法检测动物血清维生素A、维生素E、维生素C、维生素B2、维生素B6、叶酸及微量元素铜、锌、铁的含量。结果海马内注射Aβ使大鼠认知功能有下降趋势;与正常对照组及生理盐水组比较,Aβ组大鼠水迷宫试验及避暗试验潜伏期均延长,且血清维生素C及铁含量明显下降(P<0.05);各组大鼠其余指标差异均无显著性。结论海马内注射Aβ可导致大鼠认知功能损伤以及血清维生素C、铁含量降低。     

INTRODUCTORY OBSERVATIONS: THE REGION, NUTRITION, AND HEALTH

Geography and culture only loosely define the Middle East and there are differing opinions as to which countries should be included in the region. International agencies also use the terms “Near East,” “Eastern Mediterranean,” and “West Asia and North Africa” each with a somewhat different definition. The region has shown a greater than average increase in food availability in recent years and projections for 2010 show these trends progressing. Significant differences, however, exist between the individual countries since they range from some of the poorest in the world to some of the richest. As a consequence the nutritional and health conditions found, vary from those associated with poverty to those associated with affluence. Nutritionally related chronic diseases such as heart disease, diabetes mellitus, hypertension, and osteo-arthritis are now major contributors to morbidity and mortality in the industrialized world. However, in many countries of the Middle East, micronutrient malnutrition, especially iron, iodine, and vitamin A deficiencies as well as general child undernutrition coexist with the newer diet related chronic diseases. The papers in this volume, originating from Egypt, Kuwait, Lebanon, Saudi Arabia, and Syria reflect our desire to highlight these twin sets of problems in the region.     

复合微量营养素对C57BL糖尿病小鼠Th1、Th2型细胞因子表达的调控作用

目的通过研究复合微量营养素(MC)对C57BL糖尿病小鼠Th1、Th2型细胞因子抗原表达的影响,探讨AM拮抗糖尿病的分子作用机制。方法应用小剂量多次注射STZ的方法(multiplelowdoseofstreptozotocin,MLDS)制备小鼠IDDM模型,经灌胃联合投予硒(Se)、维生素E(VE)、钒(V)、铬(Cr),应用流式细胞术观察表达Th1型细胞因子(TNFα、IFNγ)和Th2型细胞因子(IL4、IL10)抗原的淋巴细胞数百分比。结果IDDM小鼠外周血表达TNFα、IFNγ抗原的淋巴细胞数百分比明显升高(P<001),而外周血、脾组织表达IL10抗原的淋巴细胞数百分比明显降低(P<001);应用MC可显著降低IDDM小鼠外周血淋巴细胞TNFα的表达(P<001),显著升高外周血淋巴细胞IL10、脾淋巴细胞IL4的表达(P<001,P<005)。结论MC可通过下调Th1型细胞因子、上调Th2型细胞因子的基因表达,来调节IDDM时的免疫失衡,减轻胰岛自身免疫性损害,拮抗糖尿病的发生发展。     

Impact of obesity on influenza compared to pneumonia hospitalization outcomes

ObjectivesPrevious literature has suggested that obesity impacts mortality risk differently in bacterial versus viral infections. This study sought to further elucidate this association in pneumonia versus influenza.DesignRetrospective cohort study.Setting and participantsData were collected from the US Nationwide Readmission Database from 2013 to 2014.MethodsPatients were categorized into three weight groups: normal weight (BMI 18.5–25.0 kg/m²), obese (BMI 30–40.0 kg/m²), and morbidly obese (BMI ≥ 40 kg/m²). To minimize confounding, we excluded patients with a history of smoking, alcoholism, or chronic wasting conditions, as suggested by the Global BMI Mortality Collaboration. To further isolate obesity from baseline differences across cohorts, we performed a three-way propensity matching analysis. The association between body weight and in-hospital all-cause 30-day mortality was assessed using Cox proportional hazard regression analysis.Results132,965 influenza and 34,177 pneumonia hospitalizations were identified. For patients with influenza, obesity (hazard ratio [HR]: 1.51; 95% CI: 1.01–2.26) and morbid obesity (HR: 1.64; 95% CI: 1.10–2.44) were associated with higher in-hospital 30-day mortality compared to normal weight. For pneumonia, obesity (HR, 0.41; 95% CI, 0.20–0.84) and morbid obesity (HR, 0.49; 95% CI, 0.25–0.96) were associated with reduced 30-day mortality compared to normal weight.Conclusions and implicationsObesity may increase 30-day mortality risk during influenza hospitalization but provide mortality benefit in pneumonia, a divergent effect not adequately explained by lower admission threshold.     

Complementary Feeding and Malnutrition among Infants and Young Children Aged 6–23 Months in Rural Areas of China

This study investigated the nutrition and complementary feeding (CF) of infants and young children (IYC) aged 6–23 months in rural areas of China in 2018 and explored the relationship between CF and nutritional status. We measured the length and weight, calculated the z-scores, and detected micronutrients in the hair. The status of CF was obtained from the respondents by a 24-h dietary recall. IYC were classified into clusters using a two-step cluster analysis. The CF and nutritional status of each cluster were analyzed and compared. The prevalence of stunting, wasting, and overweight in the IYC in rural Chinese areas was 7.1%, 3.0%, and 3.7%, respectively. The median levels of Ca, Fe, and Zn in hair were 550.10 µg/g, 62.94 µg/g, and 132.86 µg/g, respectively. The prevalence of meeting the requirements of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) was 68.9%, 77.9%, and 46.4%, respectively. IYC with a higher prevalence of MDD, MMF, and MAD were more inclined to maintain a healthy status. The prevalence of undernutrition and overweight of 6- to 23-month-old IYC in rural areas of China was low. However, lack of trace elements was evident, and MAD prevalence remained low.     

Meeting the challenges of micronutrient deficiencies in emergency-affected populations

Micronutrient deficiencies occur frequently in refugee and displaced populations. These deficiency diseases include, in addition to the most common Fe and vitamin A deficiencies, scurvy (vitamin C deficiency), pellagra (niacin and/or tryptophan deficiency) and beriberi (thiamin deficiency), which are not seen frequently in non-emergency-affected populations. The main causes of the outbreaks have been inadequate food rations given to populations dependent on food aid. There is no universal solution to the problem of micronutrient deficiencies, and not all interventions to prevent the deficiency diseases are feasible in every emergency setting. The preferred way of preventing these micronutrient deficiencies would be by securing dietary diversification through the provision of vegetables, fruit and pulses, which may not be a feasible strategy, especially in the initial phase of a relief operation. The one basic emergency strategy has been to include a fortified blended cereal in the ration of all food-aid-dependent populations (United Nations High Commissioner for Refugees/World Food Programme, 1997). In situations where the emergency-affected population has access to markets, recommendations have been to increase the general ration to encourage the sale and/or barter of a portion of the ration in exchange for locally-available fruit and vegetables (World Health Organization, 1999a,b, 2000). Promotion of home gardens as well as promotion of local trading are recommended longer-term options aiming at the self-sufficiency of emergency-affected households. The provision of fortified blended foods in the general ration has successfully prevented and controlled micronutrient deficiencies in various emergency settings. However, the strategy of relying only on fortified blended foods to prevent micronutrient deficiencies should be reviewed in the light of recurring evidence that provision of adequate supplies of these foods is often problematic. Donor policies on the bartering or exchange of food aid should also be clarified. Furthermore, the establishment of micronutrient surveillance systems, including standardized micronutrient deficiency diagnostic criteria, are vital for the control of micronutrient deficiency diseases.     

贵州省农村地区儿童微量元素补充现状、影响因素及对生长发育迟缓效果预测研究

目的 探索通过儿童微量元素补充降低贵州省农村地区儿童生长发育迟缓的效果和策略。方法 根据入户调查数据, 描述2008-2012年贵州省调查地区的儿童VitA补充率及锌补充率, 利用Logistic回归分析影响当地儿童微量元素补充的因素, 利用生命挽救工具预测将儿童VitA补充率及锌补充率逐步提高至2020年99.9%水平对降低儿童生长发育迟缓的效果。结果 2012年贵州省调查地区儿童VitA补充率和锌补充率分别是50.9%与31.7%, 影响儿童微量元素补充的主要因素是母亲文化程度和民族, 2020年将儿童VitA覆盖与锌覆盖提升至99.9%, 可将当地儿童生长发育迟缓率降低1.26%。结论 应主要通过加强对文化程度较低及非汉族母亲群体的干预, 提高儿童微量元素补充覆盖率, 有效降低未来贵州省农村地区的儿童生长发育迟缓率。