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Clinical nutrition
Churchill Livingstone
Clinical nutrition

Churchill Livingstone

0261-5614

Clinical nutrition/Journal Clinical nutritionSCIISTPAHCI
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    Impact of body fat and muscle quantity on short- and long-term outcome after gastrectomy for cancer

    Uchida, TsuneyukiSekine, RyuichiMatsuo, KenichiKigawa, Gaku...
    8页
    查看更多>>摘要：Background & aims: Preoperative low skeletal muscle mass and obesity have been identified as poor prognostic factors after gastrectomy for cancer, but the predictive value of combined quantitation of skeletal muscle mass and obesity remains unclear. This study examined the impact of combined body compositions on outcomes after gastrectomy for cancer. Methods: 518 patients who had undergone gastric resection for cancer between 2004 and 2017 were analyzed retrospectively. Skeletal muscle mass (skeletal muscle mass index (SMI)) and visceral obesity (visceral fat area) were measured in preoperative computed tomographic images to categorize patients as outlined below. Impacts of these body compositions on outcomes after gastrectomy were investigated. Results: Body composition was classified as high SMI without obesity in 231 patients (45%), high SMI with obesity in 202 (39%), low SMI without obesity in 55 (11%), and low SMI with obesity in 30 (6%). Postoperative complications developed in 128 patients (25%). Multivariate analysis identified low SMI with obesity as an independent risk factor for postoperative complications (odds ratio, 3.27; P = 0.010). Moreover, patients with low SMI without obesity had lower 5-year overall survival rates than patients with high SMI without obesity (64.4% vs. 88.0%; P < 0.001) and worse 5-year relapse-free survival rates (61.3% vs. 81.3%; P = 0.002). Multivariate analysis identified low SMI without obesity as a significant risk factor for overall survival (hazard ratio, 3.033; P < 0.001) and relapse-free survival (hazard ratio, 2.144; P = 0.008) after gastrectomy. Conclusion: Preoperative low SMI with obesity was an independent risk factor for postoperative complications, while low SMI without obesity was an independent risk factor for overall and relapse-free survival following gastrectomy for cancer. (c) 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The joint association of malnutrition and activities of daily living dependence with adverse health outcomes among patients initiating maintenance dialysis

    Jiang, HongliWei, MengWei, LiminGao, Fanfan...
    8页
    查看更多>>摘要：Background: While prior work has examined activities of daily living (ADL) dependence and malnutrition separately, the additive effects of these conditions remain uncertain. Therefore, the purpose of this study was to evaluate the joint association of malnutrition and ADL dependence with poor health outcomes in incident dialysis patients. Methods: 1457 patients from the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis database were identified for inclusion in this longitudinal study. The geriatric nutritional risk index and Barthel index were used as the evaluation tool for nutritional status and functional ability. Combined classifications of malnutrition and ADL dependence were generated with four subgroups derived. As-sociations between these exposures and health outcomes, including all-cause mortality, major adverse cardiovascular events (MACE), and infection-related death were investigated using Cox-proportional hazard models and competing risk survival models, respectively. Results: 39.5% of the participants were not malnourished nor ADL dependent (normal), 30.3% were malnourished, 10.5% ADL dependent and 19.8% as having both malnutrition and ADL dependence. During 4752 person-years of follow-up, 367 (25.2%) died and 650 (4 4.6%) patients suffered a MACE. Compared with the reference group (ADL dependency and no-malnutrition), the combination malnourished/ADL dependent showed the strongest association with all cause death (fully-adjusted HR 2.64, 95% CI 1.79-3.89), mortality from infection (fully-adjusted HR 4.41, 95% CI 1.88-10.40), and MACE incidence (fully-adjusted HR 1.81, 95% CI 1.36-2.42). This relationship remained credible and robust in several subgroup and sensitivity analyses. Additionally, we identified this associations were higher in patients aged 75 and older. Conclusion: The concurrent presence of malnutrition and ADL dependence at the time of dialysis initi-ation has significant detrimental impacts. (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    Relationship between the consumption of wholegrain and nonalcoholic fatty liver disease: The TCLSIH cohort study

    Wu, HanzhangHe, XiaoluLi, QianZheng, Yunliang...
    8页
    查看更多>>摘要：Background & aims: Wholegrain contributes a range of beneficial nutrients and is considered to play a role in the prevention of chronic diseases, but evidence of their influence on nonalcoholic fatty liver disease (NAFLD) is limited. We conducted this study to investigate the prospective association between daily wholegrain consumption and NAFLD in the general population. Methods: This prospective cohort study included a total of 14,968 (42.2% men) inhabitants living in Tianjin, China. Participants without a history of CVD, cancer, alcoholic fatty liver disease, other liver diseases, or NAFLD were followed up for 1-6 years with a median follow-up duration of 4.2 years. Wholegrain consumption was assessed using a validated self-administered food frequency questionnaire. NAFLD was diagnosed with the results of liver ultrasonography without significant alcohol consumption and other causes of liver disease. Cox proportional hazards regression models were used to estimate the association between wholegrain consumption and NAFLD. Results: A total of 3505 (2171 men) first incident cases of NAFLD occurred during 53,303 person-years of follow-up (median follow-up of 4.2 years). After adjusting for several potential confounders and setting "almost never" as the control group, the multivariable hazard ratios (95% confidence intervals) of the NAFLD were 0.82 (0.73, 0.92) when they consuming <1 time/week, 0.78 (0.69, 0.88) when they consuming 2-6 time/week and 0.77 (0.66, 0.90) when they consuming >1 time/day (p for trend <0.001). Conclusion: The results from our prospective study demonstrated that the higher consumption of wholegrain is associated with a decreased risk of NAFLD in Chinese adults. (c) 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Differences in the gut microbiome and reduced fecal butyrate in elders with low skeletal muscle mass

    Wang, Tyng-GueyHan, Der-ShengWu, Wei-KaiLiu, Po-Yu...
    10页
    查看更多>>摘要：Background and aims: Despite animal studies revealing a causal link between the gut microbiota and skeletal muscle mass, the role of the gut microbiome and its metabolites in humans having low muscle mass remains unclear. Methods: Eighty-eight subjects older than 65 years were measured for sarcopenia-related parameters, including body composition, grip strength, gait speed and flexibility. Participants were divided into normal muscle mass group (NM, n = 52) and low muscle mass group (LM, n = 36) and fresh fecal samples were collected for metagenome and short chain fatty acids (SCFAs) analysis. Results: The richness and evenness of gut microbiota diversity were significantly decreased in the subjects with low muscle mass, including observed ASVs, Shannon and Chao 1 index. A significant difference of gut microbiota profile was noted between NM group and LM group. The Firmicutes/ Bacteroidetes ratio was significantly reduced in the LM group. A significant decrease in the abundance of a SCFA-producer, Marvinbryantia spp., whereas a remarkable enrichment of a flavonoid degrader, Flavonifractor spp., was observed in the LM elders. Comparing with the NM group, the fecal butyrate significantly diminished in the LM group and correlated with skeletal muscle mass index. Conclusions: This is the first study that demonstrates the reduced fecal butyrate in elders with low muscle mass and highlights the associated gut microbiome changes. The identified gut microbial features and fecal butyrate level may serve as potential biomarkers for early detection of sarcopenic patients. (c) 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Prevalence of micronutrient deficiency and its impact on the outcome of childhood cancer: A prospective cohort study

    Bansal, Priyanka GuptaGonmei, ZaozianlungliuToteja, Gurdayal SinghDhawan, Deepa...
    11页
    查看更多>>摘要：Background & aims: Impact of micronutrient deficiency on childhood malignancy is unexplored. We estimated the prevalence of baseline micronutrient deficiency in children with cancer and its impact on event-free survival (EFS) and overall survival (OS). Methods: A longitudinal cohort study was conducted at a tertiary cancer centre in India. Children ( 18 years) with de novo malignancy were enrolled between October 2012 and May 2014. Baseline levels of vitamin B12, folate, zinc, selenium, copper, and iron were measured and values below 150 pmol/L, 6 ng/ mL, International Zinc Nutrition Collaborative Group cut-off, 0.5 mmol/L, 10 mmol/L, and 50 mg/dL, respectively, indicated deficiency. Results: Total 535 children [326 (60.9%) haematological and 209 (39.1%) solid malignancies] were enrolled with median follow-up of 66 months. Vitamin B12, folate, zinc, selenium, copper and iron deficiencies were found in 209 (39.1%), 89 (16.6%), 173 (32.3%), 39 (7.3%), 12 (2.2%), and 231 (43.2%) children, respectively. Selenium deficiency independently predicted poor EFS (hazard ratio [HR] = 1.56; p = 0.038) and OS (HR = 1.65; p = 0.027) in the cohort. In haematological malignancies, selenium deficiency predicted poor EFS (HR = 1.81; p = 0.023) and OS (HR = 2.12; p = 0.004). In solid malignancies, vitamin B12 (HR = 1.55; p = 0.028) and zinc (HR = 1.74; p = 0.009) deficiencies predicted poor EFS, and zinc deficiency predicted poor OS (HR = 1.77; p = 0.009). Multiple micronutrient ( 3) deficiencies also predicted poor EFS (HR = 1.69; p = 0.001) and OS (HR = 1.83; p < 0.001) in the whole cohort. Conclusions: Selenium deficiency was independently predictive of adverse outcomes in childhood cancer, particularly in haematological malignancies. Zinc deficiency adversely affected solid tumours. The adjunct use of micronutrient supplementation in paediatric malignancies should be explored. 0 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    L-arginine supplementation improved neonatal outcomes in pregnancies with hypertensive disorder or intrauterine growth restriction: A systematic review and meta-analysis of randomized controlled trials

    Xu, LianbinWang, XinhuiWang, ChaochenLi, Wenyuan...
    11页
    查看更多>>摘要：Background & aims: Previous research established that the availability of L-arginine affects placental vascular development and fetal growth. However, practical details associated with the effects of L-arginine supplementation on the neonatal outcomes of hypertensive disorder (HD) and intrauterine growth restriction (IUGR) pregnancies are limited. Methods: The PubMed, ScienceDirect, and Web of Science databases were searched for peer-reviewed literature published by September 30, 2021 to investigate the operational details of L-arginine supplementation in improving neonatal outcomes in complicated pregnancies. Standardized mean difference (SMD) and weighted mean difference (WMD) of continuous variables, as well as the risk ratio (RR) for categorical variables were pooled by random-effects models. Results: The results indicated that L-arginine supplementation increased the plasma nitric oxide (NO) concentrations in IUGR pregnancies (SMD: 0.71; 95% CI: 0.45, 0.97; I-2 = 0%), but decreased the risk of preeclampsia in HD mothers (RR: 0.49; 95% CI: 0.31, 0.76; I-2 = 0%). Administration with L-arginine elevated birth weights both in hypertensive and IUGR pregnant women, with WMDs of 194.70 g (95% CI: 58.21, 331.20; I-2 = 44.2%) and 134.00 g (95% CI: 43.53, 224.46; I-2 = 42.4%), respectively. However, the intervention had no effect on gestational age except in HD pregnancies (WMD: 7.05 d; 95% CI: 3.16, 10.95; I-2 = 36.5%). L-arginine administration during pregnancy significantly reduced the small for gestational age (SGA) risk of fetus both in HD (RR: 0.51; 95% CI: 0.31, 0.83; I-2 = 0.0%) and IUGR mothers (RR: 0.46; 95% CI: 0.25, 0.88; I-2 = 0.0%). Subgroup analyses revealed that L-arginine supplementation at <4 g/ d dosage or for >1-month duration or in the third trimester had a greater effect on birth weights in HD women without proteinuria, but a higher L-arginine dosage was more beneficial for extending gestational age and reducing the risk of SGA in older pregnancies. Additionally, intravenous infusion of L-arginine, but not oral administration, significantly increased birth weight in IUGR pregnancies with elevated NO concentrations, although the recommended amount should be confined to <4 g/d. Conclusions: These findings provide practical guidelines for L-arginine supplementation to improve the birth outcomes of complicated pregnancies. Registry number: CRD42021246290 (https://www.crd.york.ac.uk/PROSPERO). (C) 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Dietary patterns and the risks of metabolic syndrome and insulin resistance among young adults: Evidence from a longitudinal study

    Wang, William Y. S.Williams, Gail M.Whiting, Susan J.Najman, Jake M....
    9页
    查看更多>>摘要：Background and aims: Whether early young adulthood dietary patterns predict the risk of metabolic syndrome (MetS) and diabetes-related endpoints prior to middle age remains unknown. We examined the prospective associations of dietary patterns in early young adulthood with MetS and diabetes-related endpoints at later young adulthood. Methods: We used data of young adults from a long running birth cohort in Australia. The Western dietary pattern rich in meats, refined grains, processed and fried foods and the prudent dietary pattern rich in fruits and vegetables, whole grains and legumes were derived using principal component analysis at the 21-year follow-up from dietary data obtained by a food frequency questionnaire. Fasting blood samples at 30 years were collected from each participant and their blood biomarkers, anthropometric and blood pressure were measured. MetS, insulin resistance, and prediabetes were based on clinical cutoffs; increased b-cell function and insulin resistance were based on upper quartiles. Log-binomial models were used to estimate diet-related risks of each outcome adjusting for potential confounders. Results: Greater adherence to the Western pattern predicted higher risks of MetS (RR: 2.32; 95% CI: 1.34, 4.00), increased insulin resistance (1.69; 1.07, 2.65), high b-cell function (1.60; 1.10, 2.31) and less likelihood of increased insulin sensitivity (0.57; 0.39, 0.84) in adjusted models. Conversely, adhering more to the prudent pattern predicted lower risks of MetS (RR: 0.47; 95% CI: 0.29, 0.75), increased insulin resistance (0.57; 0.39, 0.82), high b-cell function (0.69; 0.50, 0.93) and a greater likelihood of increased insulin sensitivity (1.84; 1.30, 2.60). Conclusion: This prospective study of young adults indicates greater adherence to unhealthy Western diet predicted higher risks of MetS and increased insulin resistance, whereas healthy prudent diet predicted lower risks. Optimizing diets to improve later cardiometabolic health needs to occur in early adulthood.
      原文链接:
    • NSTL
    • Elsevier

    Effects of vitamin D supplementation during pregnancy on offspring health at birth: A meta-analysis of randomized controlled trails

    Tu, WenjunChen, YajunLiu, YakunDing, Cailin...
    9页
    查看更多>>摘要：Background & aims: Vitamin D deficiency during pregnancy is common across the world. The effects of maternal vitamin D supplementation on offspring health were contradict from previous studies. This study was conducted to update the effects of vitamin D supplementation during pregnancy on offspring health with new evidence. Methods: A systematic search of Medline, Embase, the Cochrane Database of Systematic Reviews, ClinicalTrials.gov and ChiCTR.org.cn through July 2021 were conducted. Studies were included if they reported randomized clinical trials comparing vitamin D supplementation with placebo, no supple-mentation (400 IU/day or less) during pregnancy, and included birth outcomes. Pooled analyses were performed using random-effects models. Results: Forty-two RCTs recruiting 11,082 participants were included. Vitamin D supplementation during pregnancy was associated with a lower risk of intrauterine or neonatal death (RR, 0.69; 95% CI, 0.48-0.99) in 13 RCTs with 6238 participants. We also found prenatal vitamin D supplementation was associated with an increased offspring length at birth (MD, 0.27 cm; 95% CI, 0.02-0.51), increased neonatal vitamin D con-centration (MD, 27.72 nmol/L; 95% CI, 20.51-34.92), and reduced risk of vitamin D insufficiency (RR of 0.51; 95% CI, 0.38-0.67), but not associated with birth weight (MD, 37.07 g; 95% CI,-9.67 to 83.80), head circumference (MD, 0.15 cm; 95% CI,-0.02 to 0.32), preterm birth (RR, 0.93; 95% CI, 0.79-1.09), or low birth weight (RR, 0.90; 95% CI, 0.66-1.24). Supplementation initiated before the 20th week of gestation was associated with a decreased risk of small for gestational age (RR, 0.46; 95% CI, 0.24-0.90). Conclusions: Vitamin D supplementation during pregnancy was associated with improved offspring vitamin D sufficiency status, improved fetal linear growth, and reduced fetal or neonatal mortality. No effect was demonstrated for vitamin D supplementation on birth weight, risk of low birth weight, and risk of preterm birth. (c) 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Food consumption based on the nutrient profile system underlying the Nutri-Score and renal function in older adults

    Guallar-Castillon, PilarBanegas, Jose R.Akesson, AgnetaRodriguez-Artalejo, Fernando...
    8页
    查看更多>>摘要：Background: The impact of the Nutri-Score labelling system on renal function is unknown. Objective: To assess the association between food consumption based on the nutrient profile system underlying the Nutri-Score and renal function decline in older adults. Methods: We used data from the Spain-based Seniors-ENRICA cohort, a study with 1312 communitydwelling adults aged >60 years recruited during 2008-2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. Based on their nutritional quality, foods consumed were categorized into five labels (A/Green-best quality, B, C, D, E/Red-worst quality) using the established Nutri-Score algorithm. For each participant, a Nutri-Score dietary index (DI) was calculated in g/ day/kg of weight. At baseline and at follow-up, measured serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were obtained, and time changes were calculated. A combined outcome for renal decline was defined as: any increase in SCr or any decrease in eGFR beyond expectedfor-age. Statistical analyses were performed with logistic regression adjusting for socioeconomic, lifestyle, total energy intake, fresh foods, and comorbidity confounders. Results: A total of 183 cases of renal-function decline occurred over a mean 6-year follow-up. Participants with a higher (less favorable) Nutri-Score DI (interquartile range (IQR)13.2-17.7 (g/day/kg of weight); 46 cases) had higher probability of renal decline than those with a lower Nutri-Score DI (IQR 36.6-46.2; 44 cases); the corresponding odds ratios (95% confidence interval) across increasing quartiles of Nutri-Score DI were 1 (reference), 1.26 (0.78-2.04), 1.55 (0.92-2.62), and 1.82 (1.01-3.30), P-trend 1/4 0.045. Per each 10point increase in the Nutri-Score DI the odds of renal decline increased by 27% (6%-52%). Conclusions: Higher Nutri-Score DI, reflecting the consumption of foods with less favourable Nutri-Score rating, was associated with higher kidney function decline in older adults. Consequently, Nutri-Score labeling might be a useful policy tool for preventing kidney function decline, adding to the potential health benefits of this front-of-pack labelling system. 0 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    A nutritionally focused program for community-living older adults resulted in improved health and well-being

    Gomez, GabrielBotero-Rodriguez, FelipeMisas, Juan DiegoGarcia-Cifuentes, Elkin...
    8页
    查看更多>>摘要：Objectives: Among older adults, malnutrition is common and is associated with increased risk for impaired health and functionality, conditions further associated with poorer quality of life. In this study of community-living older adults, our objective was to quantify outcome changes following identification and treatment of malnutrition or its risk. Design: Our intervention was a nutritional quality improvement program (QIP). The nutritional QIP included: (i) education of participants about the importance of complete and balanced macro- and micronutrient intake plus physical exercise, (ii) nutritional intervention with dietary counseling; and (iii) provision of oral nutritional supplements (ONS) for daily intake over 60 days. Follow-up measurements took place 30 days after ONS treatment ended, i.e., 90 days after start of intervention. Setting and participants: We recruited 618 transitional-care, chronically ill, older adults ( 60 years) with malnutrition/risk (per Mini Nutrition Assessment-Short Form, MNA-SF) from the outpatient clinic of Hospital Universitario San Ignacio, in Bogota???, Colombia. Methods: For pre-post comparisons, we examined cognition (Mini-Mental State Exam, MMSE), physical abilities (Barthel Activities of Daily Living, ADL; Short Physical Performance Battery, SPPB), affective disorder status (Global Depression Scale, GDS), and quality of life (QoL; EuroQoL-5D-3L, EQ-5D-3L; EuroQoL-Visual Analog Scale, EQ-VAS). Results: Participants were mean age 74.1 ?? 8.7 y, female majority (69.4%), and had an average of 2.6 comorbidities with cardiovascular and respiratory diseases predominant (28.5%). QIP-based nutritional intervention led to significant improvements in cognitive (MMSE) and physical functions (ADL and SPPB), affective disorder status (GDS), and health-related quality of life (EQ-VAS); all differences (P < 0.001). Self-reported QoL (EQ-5D-3L) also improved. Conclusions and implications: Over 90 days, the nutritional QIP led to improvements in all measured outcomes, thus highlighting the importance of addressing malnutrition or its risk among communityliving older adults. From a patient's perspective, maintaining mental and physical function are important and further linked with quality of life.
      原文链接:
    • NSTL
    • Elsevier