Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study

Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REE_IC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REE_IC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REE_IC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.     

Relationships between Pre-Stroke SARC-F Scores,Disability, and Risk of Malnutrition and Functional Outcomes after Stroke—A Prospective Cohort Study

SARC-F is a screening tool for sarcopenia; however, it has not yet been established whether SARC-F scores predict functional outcomes. Therefore, we herein investigated the relationship between SARC-F scores and functional outcomes in stroke patients. The primary outcome in the present study was the modified Rankin Scale (mRS) 3 months after stroke. The relationship between SARC-F scores and poor functional outcomes was examined using a logistic regression analysis. Furthermore, the applicability of SARC-F scores to the assessment of poor functional outcomes was analyzed based on the area under the receiver operating curve (ROC). Eighty-one out of the 324 patients enrolled in the present study (25%) had poor functional outcomes (mRS ≥ 4). The results of the multivariate analysis revealed a correlation between SARC-F scores (OR = 1.29, 95% CI = 1.05–1.59, p = 0.02) and poor functional outcomes. A cut-off SARC-F score ≥ 4 had low-to-moderate sensitivity (47.4%) and high specificity (87.3%). The present results suggest that the measurement of pre-stroke SARC-F scores is useful for predicting the outcomes of stroke patients.     

Telomere Length and Mitochondrial DNA Copy Number Variations in Patients with Obesity: Effect of Diet-Induced Weight Loss—A Pilot Study

Background: Telomere length (TL) and mitochondrial DNA (mtDNA) copy number shifts are linked to metabolic abnormalities, and possible modifications by diet-induced weight loss are poorly explored. We investigated the variations before (T0) and after a 1-year (T12) lifestyle intervention (diet + physical activity) in a group of outpatients with obesity. Methods: Patients aged 25–70 years with BMI ≥ 30 kg/m² were enrolled. Clinical and biochemical assessments (including a blood sample for TL, mtDNA copy number and total antioxidant capacity, and TAC determinations) were performed at T0 and T12. Results: The change in TL and the mtDNA copy number was heterogeneous and not significantly different at T12. Patients were then divided by baseline TL values into lower than median TL (L-TL) and higher than median TL (H-TL) groups. The two groups did not differ at baseline for anthropometric, clinical, and laboratory characteristics. At T12, the L-TL group when compared to H-TL showed TL elongation (respectively, +0.57 ± 1.23 vs. −2.15 ± 1.13 kbp, p = 0.04), higher mtDNA copy number (+111.5 ± 478.5 vs. −2314.8 ± 724.2, respectively, p < 0.001), greater weight loss (−8.1 ± 2.7 vs. −6.1 ± 4.6 Kg, respectively, p = 0.03), fat mass reduction (−1.42 ± 1.3 vs. −1.22 ± 1.5%, respectively, p = 0.04), and increased fat-free mass (+57.8 ± 6.5 vs. +54.9 ± 5.3%, respectively, p = 0.04) and TAC levels (+58.5 ± 18.6 vs. +36.4 ± 24.1 µM/L, respectively, p = 0.04). Conclusions: TL and the mtDNA copy number significantly increased in patients with obesity and with lower baseline TL values after a 1-year lifestyle intervention. Larger longitudinal studies are needed to confirm the results of this pilot study.     

Length of Hospital Stay and Survival of Hospitalized COVID-19 Patients During the Second Wave of the Pandemic: A Single Centre Retrospective Study from Slovenia

BackgroundAs of writing, there are no publications pertaining to the prediction of COVID-19-related outcomes and length of stay in patients from Slovene hospitals.ObjectivesTo evaluate the length of regular ward and ICU stays and assess the survival of COVID-19 patients to develop better prediction models to forecast hospital capacity and staffing demands in possible further pandemic peaks.MethodsIn this retrospective, single-site study we analysed the length of stay and survival of all patients, hospitalized due to the novel coronavirus (COVID-19) at the peak of the second wave, between November 18th 2020 and January 27th 2021 at the University Clinic Golnik, Slovenia.ResultsOut of 407 included patients, 59% were male. The median length of stay on regular wards was 7.5 (IQR 5–13) days, and the median ICU length of stay was 6 (IQR 4–11) days. Age, male sex, and ICU stay were significantly associated with a higher risk of death. The probability of dying in 21 days at the regular ward was 14.4% (95% CI [10.9–18%]) and at the ICU it was 43.6% (95% CI [19.3-51.8%]).ConclusionThe survival of COVID-19 is strongly affected by age, sex, and the fact that a patient had to be admitted to ICU, while the length of hospital bed occupancy is very similar across different demographic groups. Knowing the length of stay and admission rate to ICU is important for proper planning of resources during an epidemic.     

Associations between Taste and Smell Sensitivity,Preference and Quality of Life in Healthy Aging—The NutriAct Family Study Examinations (NFSE) Cohort

Taste and smell function decline with age, with robust impairment in the very old. Much less is known about taste and smell function in young and middle aged. We investigated taste and smell sensitivity via thresholds in a sub-sample of the NutriAct Family Study (NFS), the NFS Examinations cohort (NFSE; N = 251, age M = 62.5 years). We examined different aspects relating to taste and smell function: the degree to which taste and smell sensitivity relate to another and to taste and smell preferences, the role of gender and age, as well as effects on Quality of Life (QoL). Taste thresholds were highly correlated, but no correlation was observed between taste and smell thresholds and between thresholds and preference. Women were more sensitive for both taste and smell than men. We found no effect of age on sensitivity and no effect of sensitivity on QoL. All null findings were complemented by Bayesian statistics. Together our results indicate the independence of taste and smell despite their overlap during sensorial experiences. We found no evidence for age-related sensory decline, which could be due to our sample’s characteristics of non-clinical volunteers with good dental health and 93% non-smokers.     

Comparative Analysis of Length of Stay, Total Costs, and Treatment Success between Intravenous Moxifloxacin 400 mg and Levofloxacin 750 mg among Hospitalized Patients with Community-Acquired Pneumonia

Objective:  This study aimed to evaluate the length of stay (LOS), costs, and treatment consistency among patients hospitalized with community-acquired pneumonia (CAP) initially treated with intravenous (IV) moxifloxacin 400 mg or IV levofloxacin 750 mg.
Methods:  Adults with CAP receiving IV moxifloxacin or IV levofloxacin for ≥3 days were identified in the Premier Perspective comparative database. Primary outcomes were LOS and costs. Secondary outcomes included treatment consistency, which was defined as 1) no additional IV moxifloxacin or levofloxacin after ≥1 day off study drug; 2) no switch to another IV antibiotic; and 3) no addition of another IV antibiotic.
Results:  A total of 7720 patients met inclusion criteria (6040 receiving moxifloxacin; 1680 receiving levofloxacin). Propensity matching created two cohorts (1300 patients each) well matched for demographic, clinical, hospital, and payor characteristics. Before the patients were matched, mean LOS (5.87 vs. 5.46 days; P  = 0.0004) and total costs per patient ($7302 vs. $6362; P  < 0.0001) were significantly greater with moxifloxacin. After the patients were matched, mean LOS (5.63 vs. 5.51 days; P  = 0.462) and total costs ($6624 vs. $6473; P  = 0.476) were comparable in both cohorts. Treatment consistency was higher for moxifloxacin before (81.0% vs. 78.9%; P  = 0.048) and after matching (82.8% vs. 78.0%; P  = 0.002).
Conclusions:  In-hospital treatment of CAP with IV moxifloxacin 400 mg or IV levofloxacin 750 mg was associated with similar hospital LOS and costs in propensity-matched cohorts.     

Diet Quality and Cognitive Performance in Australian Adults Aged 55–85 Years: A Cross-Sectional Analysis of the Hunter Community Study Cohort

There is a lack of evidence to determine if diet quality is associated with cognitive performance in older adults. Therefore, the aim of this study was to examine whether diet quality is associated with cognitive performance among older adults. A cross-sectional, secondary analysis of baseline data from the Hunter Community Study (HCS), comparing diet quality, measured using the Australian Recommended Food Score (ARFS), along with validated cognitive performance instruments the Audio Recorded Cognitive Screen (ARCS) and the Mini-Mental State Examination (MMSE) were undertaken in adults aged 55–85 years, living in Newcastle, NSW, Australia. Adjusted linear regression analyses showed that, compared with the lowest ARFS quintile, those in the highest quintile had an ARCS score 5.883 units greater (p < 0.001; R² = 0.0098). Furthermore, when quintiles of ARFS score were tested against each ARCS sub-scale score, statistically significant associations were observed with the greatest effect for the Memory (β = 4.055; p = 0.001; R² = 0.0065) and Attention (β = 4.136; p = 0.002; R² = 0.0047) domains. No statistically significant associations were observed between quintiles of ARFS and MMSE score in the adjusted linear regression analyses. In conclusion, a positive association was observed between diet quality and cognitive performance within this sample of older Australian adults. Further investigation of the above association over time, when follow-up data becomes available, in longitudinal analysis is recommended.     

铜、赖氨酰氧化酶与胎膜早破

胎膜早破为一个常见的产科并发症 ,其病因和发病机制尚不清楚 ,但胎膜本身结构的改变可能是最主要的因素。铜是人体必需的微量元素之一 ,是胎膜中胶原纤维发育成熟的关键酶赖氨酰氧化酶的活性辅基。当体内铜缺乏时 ,赖氨酰氧化酶活性下降 ,胶原发育成熟障碍 ,羊膜变薄 ,使胎膜弹性及韧性下降而易于发生破裂     

Global,Regional, and National Burden of Protein–Energy Malnutrition: A Systematic Analysis for the Global Burden of Disease Study

Background: Statistical data on the prevalence, mortality, and disability-adjusted life years (DALYs) of protein–energy malnutrition are valuable for health resource planning and policy-making. We aimed to estimate protein–energy malnutrition burdens worldwide according to gender, age, and sociodemographic index (SDI) between 1990 and 2019. Methods: Detailed data on protein–energy malnutrition from 1990 to 2019 was extracted from the Global Burden of Disease (GBD) database. The global prevalence, deaths, and DALYs attributable to protein–energy malnutrition and the corresponding age-standardized rates (ASRs) were analyzed. Results: In 2019, the global prevalence of protein–energy malnutrition increased to 14,767,275 cases. The age-standardized prevalence rate (ASPR) showed an increasing trend between 1990 and 2019, while the age-standardized deaths rate (ASDR) and age-standardized DALYs rate presented a significantly decreasing trend in the same period. Meanwhile, there was a clearly ASPR, ASDR, and age-standardized DALYs rate downtrend of the prediction curve when the SDI went up. Conclusions: PEM still has a relatively serious disease burden in the world, especially in children and the elderly. At the same time, this phenomenon will be more obvious due to the aging of the world’s population. Effective prevention measures should be strengthened to continuously improve public health conditions.     

Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein,Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study

Background: Serious morbidity may elevate nutrient requirements and affect adherence to feeding guidelines for very low birth weight (VLBW) infants. An understanding of factors affecting nutrient intakes of VLBW infants will facilitate development of strategies to improve nutrient provision. Our aim was to examine the impact of neonatal morbidity count on achieving recommended nutrient intakes in VLBW infants. Methods: VLBW infants enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes trial (ISRCTN35317141, n = 363) were included. Serious morbidities and daily parenteral and enteral intakes were collected prospectively. Results: Median intakes of infants with and without ≥1 morbidity met protein recommendations (3.5–4.5 g/kg/d) by week 2, although not maintained after week 4. Infants with ≥1 morbidity (vs without) were 2 weeks slower in achieving lipid (4.8–6.6 g/kg/d; week 4 vs 2) and energy (110–130 kcal/kg/d; week 5 vs 3) and 1 week slower in achieving carbohydrate recommendations (11.6–13.2 g/kg/d; week 4 vs 3). Adjusted hazard ratios of first achieving recommendations on any given day in infants with any 1 or 2 morbidities were 0.6 (95% confidence interval [CI], 0.5–0.9) and 0.6 (0.4–0.9), respectively, for protein; 0.5 (0.4–0.7) and 0.3 (0.2–0.5) for lipid; and 0.5 (0.4–0.7) and 0.3 (0.2–0.4) for energy. Conclusion: Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.     

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

Background: A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. Methods: We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). Conclusion: The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the “lipid paradox”. Higher BMI results were related to a lower risk of death, which may indicate the “obesity paradox”.     

Levels of metabolites of organophosphate pesticides, phthalates, and bisphenol A in pooled urine specimens from pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa)

Concerns about reproductive and developmental health risks of exposure to organophosphate (OP) pesticides, phthalates, and bisphenol A (BPA) among the general population are increasing. Six dialkyl phosphate (DAP) metabolites, 3,5,6-trichloro-2-pyridinol (TCPy), BPA, and fourteen phthalate metabolites were measured in 10 pooled urine samples representing 110 pregnant women who participated in the Norwegian Mother and Child Birth Cohort (MoBa) study in 2004. Daily intakes were estimated from urinary data and compared with reference doses (RfDs) and daily tolerable intakes (TDIs). The MoBa women had a higher mean BPA concentration (4.50 μg/L) than the pregnant women in the Generation R Study (Generation R) in the Netherlands and the National Health and Nutrition Examination Survey (NHANES) in the United States. The mean concentration of total DAP metabolites (24.20 μg/L) in MoBa women was higher than that in NHANES women but lower than that in Generation R women. The diethyl phthalate metabolite mono-ethyl phthalate (MEP) was the dominant phthalate metabolite in all three studies, with the mean concentrations of greater than 300 μg/L. The MoBa and Generation R women had higher mean concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP) than the NHANES women. The estimated average daily intakes of BPA, chlorpyrifos/chlorpyrifos-methyl and phthalates in MoBa (and the other two studies) were below the RfDs and TDIs. The higher levels of metabolites in the MoBa participants may have been from intake via pesticide residues in food (organophosphates), consumption of canned food, especially fish/seafood (BPA), and use of personal care products (selected phthalates).     

激活素A、瘦素与妊娠肝内胆汁淤积症关系的初步研究

目的:探讨激活素A(activinA,ACTA)、瘦素(leptin)与妊娠期肝内胆汁淤积症(intrahepatic cholcstasis ofPregnancy,ICP)的发病关系。方法:采用酶联免疫吸附试验(ELISA)和放射免疫吸附试验(R IA)测定30例ICP孕妇和20例正常孕妇产前、产后及新生儿脐血血清ACTA、瘦素水平,同时检测肝功能指标(TB IL、TBA、GLB),并分析ACTA、瘦素与之互相关系。结果:ICP患者产前血清ACTA、瘦素水平明显高于对照组孕妇,两组比较差异显著(P<0.01)。两组孕妇产后血清及新生儿脐血ACTA、瘦素水平无明显差异(P>0.05),ICP患者血清ACTA、瘦素水平与肝功能指标(TB IL、TBA、GLB)呈正相关(P<0.05或P<0.01)。与肝功能损害程度呈正相关,依次为C级>B级>A级。结论:ICP患者血清ACTA、瘦素水平明显高于正常孕妇,提示ACTA、瘦素在ICP发病机制中具有重要作用。     

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care,aggressive treatments,opioids, and place of death. A retrospective cohort study

Supportive and palliative care at the end of life (EOL) is a core component of health systems. Providing care at the EOL may require the interaction of several care providers working in different settings including nursing homes, home care, hospices, and hospitals. This work aims to (a) provide evidence on the performance of EOL care for cancer patients across healthcare organizations, with a focus on the place of care, aggressive treatments, opioids, and the place of death and (b) analyze factors associated with dying in hospital. A population‐based retrospective study was performed using administrative data from Tuscany region (Italy). Thirteen thousand sixty‐six cancer patients who died in 2016 were considered. There is a marked variability in EOL care within regional areas, with the multilevel logistic regression highlighting a greater likelihood of dying in hospital for patients who were admitted to intensive care units or previously hospitalized. There is a lower probability of dying in acute care setting for patients assisted in hospices and in both hospital and hospices/home care and for patients treated with opioids. This intraregional variation highlights the need to improve EOL planning and rethink the delivery of supportive/palliative care. Further investigations on the preferences of patients may lead to more understanding.