Clinical Nutrition - Articles in Press

The 2008 ESPEN Sir David Cuthbertson lecture: Fatty acids and inflammation – From the membrane to the nucleus and from the laboratory bench to the clinic - Corrected Proof

Philip C. Calder — 2009-11-12

Summary: Many chronic conditions involve excessive inflammation that is damaging to host tissues. Excessive or inappropriate inflammation and immunosuppression are components of the response to surgery, trauma, injury and infection in some individuals and these can lead, progressively, to sepsis and septic shock. Hyperinflammation is characterised by the production of inflammatory cytokines, eicosanoids and other inflammatory mediators, while the immunosuppression is characterised by impairment of antigen presentation and of certain T cell responses. N-6 fatty acids may contribute to the hyperinflammed and immunosuppressed states. N-3 fatty acids from fish oil decrease the production of inflammatory cytokines and eicosanoids. They act both directly (by replacing arachidonic acid as an eicosanoid precursor) and indirectly (by altering the expression of inflammatory genes through effects on transcription factor activation). Thus, these fatty acids are potentially useful anti-inflammatory agents and may be of benefit in patients with chronic inflammatory diseases or at risk of hyperinflammation and sepsis. An emerging application of n-3 fatty acids is in surgical or critically ill patients where they may be added to parenteral or enteral formulas. Studies to date are suggestive of clinical benefits from these approaches, although more robust data are needed especially in critically ill patients.

Restrictive diets in the elderly: Never say never again? - Accepted Manuscript

2009-11-11

Abstract: Restrictive diets have long been an essential part of standard nutritional therapy for a wide range of diseases like obesity, diabetes, hyperlipidaemia, arterial hypertension and chronic renal failure. Although a relevant number of studies has been published in this field, most of these have concentrated on adults below age 65. Data on the effects of restrictive diets in older persons are still scarce. With increasing age, restrictive diets seem to be less effective with regard to relevant study endpoints like morbidity, quality of life and mortality. This applies in particular to chronic indications which are in most cases associated with additional co-morbidities. Here the focus shifts towards providing adequate nutritional intake rich in macro- and especially micronutrients and a diet that is also highly palatable as older individuals are at increased risk of becoming malnourished and sarcopenic. In this context, nutritional prevention and therapy are of utmost importance for maintaining quality of life. This review summarizes the present evidence for the application of restrictive diets in older persons and balances it against potential risks.

Long-chain saturated fatty acids induce pro-inflammatory responses and impact endothelial cell growth - Corrected Proof

2009-11-09

Summary: Background & aims: Saturated fatty acids (SFAs), significant components of enteral and parenteral formulations, have been linked to cardiovascular complications. However, the effect of SFAs upon vascular inflammation is less clear. Endothelial cells (EC) play an important role in the acute inflammatory responses. We, therefore, evaluated the acute effects of different chain-length SFAs upon EC functions.Methods: Endothelial cells were cultured with various SFAs. Growth and cytotoxicity were determined by WST-1 assay. Apoptosis and pro-inflammatory adhesion molecule (ICAM-1) expression was assayed using flow cytometry. Activation of NF-κB was analyzed using western blot analysis.Results: Long-chain SFAs (C14:0-C20:0) inhibited EC growth in a chain-length dependent manner. Medium-chain SFAs (C6:0-C12:0) did not significantly affect EC growth. In contrast, the short-chain SFA (C4:0) stimulated cellular growth. Stearic acid induced significantly more EC apoptosis and necrosis than palmitic acid or myristic acids. Stearic acid (>10μM) treatment also significantly increased ICAM-1 expression. Stearic acid's pro-inflammatory response was confirmed by phosphorylation of IκB-α and NF-κB in a dose dependent manner.Conclusions: Long-chain SFAs can induce pro-inflammatory responses and significantly impact growth and viability of EC. Our data suggest that the presence of long-chain SFAs in parenteral formulations may have harmful effects on the vascular system.

Paediatric parenteral nutrition and lipid usage in the UK – a Pick N’ Mix situation? - Accepted Manuscript

2009-11-09

Abstract: Background and aims: Parenteral nutrition (PN) is an important treatment for children with intestinal failure. However, soya based lipids which are traditionally used are associated with complications including intestinal failureassociated liver disease (IFALD). Lipid preparations containing MCT and/or fish oil have been developed but their usage in the UK is unknown.Methods: We carried out a nationwide audit of current lipid prescribing practise in children receiving PN in the UK from Sept 2008-March 2009 utilising paediatric gastroenterologists collaboratoring with the British Intestinal Failure Survey (BIFS.)Results: 25/32 participating paediatric centres responded.Most centres use Intralipid as their first line lipid. Maximum lipid dosages were fairly standard across the UK. However, practise was highly variable between centres when patients developed jaundice:19/25 centres reduce exposure to lipids by cycled dosaging and in 10/19 the total lipid dose per week was also reduced. An alternative (second line) lipid was used in 20/25 centres containing MCT and/or fish oil.Conclusions: Intralipid remains the predominant lipid prescribed for children and infants in the UK. However, the considerable variation in practise highlights the need for a lipid prescribing algorithm and for a randomised controlled trial comparing alternative lipid preparations to current practise in children.

Anthropometry and body composition analysis in children with cerebral palsy - Corrected Proof

Hoda Y. Tomoum, Nagia B. Badawy, Nayera E. Hassan, Khadija M. Alian — 2009-11-09

Summary: Background & aims: This study was undertaken to describe anthropometry, body composition parameters and assess serum levels of leptin and other biochemical markers of the nutritional status in a sample of Egyptian children with cerebral palsy(CP).Methods: Anthropometric measurements (body weight, knee height, head, mid-upper arm, waist and hip circumferences, triceps and subscapular skin-fold thickness) were taken. Using the bioelectrical impedance technique, total body water(TBW), fat-free mass, fat mass, fat percentage and basal metabolic rate(BMR) were calculated. Serum levels of total proteins, albumin, ferritin and leptin were measured. Results were compared to that of healthy controls.Results: Patients had significantly lower anthropometric measurements than controls, except for mid-upper arm and hip circumferences, and subscapular skin-fold thickness which were not different in both groups. Fat mass, fat free mass, fat percentage, TBW and BMR were lower in the patients. Serum protein and leptin levels were not different in patients and controls, though other biochemical markers were reduced in the patients. Patients with more severe motor handicap had lower skin-fold thickness, fat percentage and serum ferritin than those with milder affection.Conclusion: Parameters of growth, body composition analysis and nutritional status are significantly altered in CP patients especially those with severe motor handicap and oromotor dysfunction.

Resting energy expenditure in stroke patients who are dependent on tube feeding: A pilot study - Corrected Proof

Ashley Leone, Paul B. Pencharz — 2009-11-02

Summary: Background & aims: Energy requirements of chronic stroke patients are not known. The purpose was to determine the energy requirements of stable stroke patients who are tube fed.Methods: Resting energy expenditure was measured in tube fed, chronic stroke patients (n=10) using indirect calorimetry. Fat free mass was then measured using bioelectrical impedance to determine the relationship between fat free mass and resting energy expenditure. The results were compared to a healthy control group (n=57), using multivariate analysis of variance (MANOVA).Results: Fat free mass was significantly lower in the stroke group (42.2±2.3kg) than the controls (51.0±1.5kg) (p<0.02). Adjustment of resting energy expenditure for fat free mass brought the mean resting energy expenditure of the stroke group (5439±235kJ/d) closer to that of the controls (6336±149kJ/d) than the original measured values. However, adjusted resting energy expenditure remained significantly lower for the stroke group than for the control group (p<0.02).Conclusions: Resting energy expenditure and hence energy needs of chronically tube fed stroke survivors appear to be reduced.

One day of moderate energy deficit reduces fasting and postprandial triacylglycerolemia in women: The role of calorie restriction and exercise - Corrected Proof

2009-11-02

Summary: Background & aims: Fasting and postprandial hypertriacylglycerolemia are important cardiovascular risk factors in women. We sought to examine the effects of acute (1 day), moderate (∼2 MJ) energy deficit induced by calorie restriction, exercise, or combination of both on fasting and postprandial triacylglycerol (TAG) metabolism in women.Methods: Six healthy premenopausal women performed four oral fat tolerance tests in the morning after a day of a) rest (control), b) calorie restriction (∼2 MJ), c) exercise (net deficit of ∼2 MJ) and d) calorie restriction-plus-exercise (total energy deficit of ∼2 MJ).Results: All energy deficit trials significantly reduced fasting and postprandial total plasma TAG concentrations by 15–23% and 12–23%, respectively, and triacylglycerol-rich lipoprotein TAG concentrations by 37–43% and 25–39%, respectively, compared with the control condition (P<0.05). Postprandial, but not fasting, total TAG concentrations were ∼12% lower after exercise compared with diet-induced energy deficit (P=0.05).Conclusions: Acute, moderate energy deficit independently of its origin (i.e. diet or exercise or combination of both) reduces fasting and postprandial triacylglycerolemia in women. Exercise elicits a somewhat greater effect than calorie restriction in the postprandial state. The acute effect of diet and exercise should be taken into account when studying the long-term effects of weight loss and exercise training on TAG metabolism.

Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial - Corrected Proof

2009-10-30

Summary: Background & aims: Continuous pump feeding is often used to reduce aspiration risk in older patients on tube feeding, but its effectiveness in preventing aspiration pneumonia is unproven. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients.Methods: One hundred and seventy eight elderly patients from three convalescence hospitals and one infirmary, on nasogastric tube feeding, were randomly assigned to have intermittent bolus (bolus) or continuous pump (pump) feeding for 4weeks. The primary outcome was the incidence of pneumonia. The secondary outcome was mortality.Results: Eighty five subjects were randomized into the pump group and 93 in the bolus group. The groups were comparable in age, nutritional and functional status, co-morbidities and history of pneumonia, except that there were more women in the pump group. Within 4weeks, 15 subjects (17.6%) in the pump group and 18 (19.4%) in the bolus group developed pneumonia. Seven subjects (8.2%) in pump group and 13 subjects (14.0%) in bolus group died. There was no significant difference in either pneumonia or death rates between the two groups.Conclusion: Continuous pump feeding did not significantly affect the rates of pneumonia or mortality in tube-fed older hospital patients when compared with intermittent bolus feeding.

The European fight against malnutrition - Corrected Proof

Olle Ljungqvist, Andre van Gossum, Miguel Leon Sanz, Frank de Man — 2009-10-30

The Fight against Malnutrition is a European-wide, concerted campaign to improve nutritional care in all types of care facilities, such as hospitals, care homes as well as the community. The campaign aims to engage all professionals in the medical field, managers of hospitals and care facilities, administrators of health care and social care, along with their governing politicians, insurance companies, patient organizations and other stakeholders in medicine and care.

Reporting of dietary control frameworks in studies on simvastatin efficacy - Corrected Proof

Shawn M. Somerset — 2009-10-30

Summary: Background & aims: HMG-Co reductase inhibitors (e.g. simvastatin) are important coronary heart disease (CHD) risk-reduction agents. Prescription protocols recommend low-fat diets in conjunction with simvastatin prescription. Simvastatin efficacy studies were reviewed to define dietary contexts within which simvastatin is most efficacious.Methods: Randomised controlled trials of simvastatin were identified by a literature search of Medline Databases (1992–2006), English-language journals, and reference lists of original articles, reviews and metanalyses. Studies involving both genders, sample size >30, were assessed for published details on dietary advice, dietary intervention duration, dietary adherence measures, and dietary data analysis.Results: Review of 18 selected studies revealed an absence of transparency of dietary control frameworks and analysis. Even where a specific diet was integral to study design, information was scant on diet-related outcomes or methods applied to assure dietary adherence.Conclusions: The absence of published details on dietary methodology reveals substantial gaps in understanding the context within which simvastatin is most efficacious. Further, these studies provide little scope for post hoc analysis for effects of specific dietary factors on simvastatin efficacy. Since dietary advice is often given in conjunction with prescription of many drugs, more rigorous attention to reporting dietary methodology is warranted.

Appetite and gastrointestinal motility: Role of ghrelin-family peptides - Accepted Manuscript

Simona Perboni, Akio Inui — 2009-10-26

Abstract: Eating disorders, obesity and cachexia endanger the lives of millions of people worldwide. Fortunately, in last decade, there has been a rapid and substantial progress toward uncovering the molecular and neural mechanisms by which energy imbalance develops. In 1999, ghrelin was identified as the first orexigenic gut-derived peptide. It stimulates appetite and controls the gastric motility and the acid secretion through the activation of the growth-hormone secretagogue-receptor. After the discovery of ghrelin, other forms of ghrelin-related proteins were isolated from the rat stomach. The unmodified des-n-octanoyl form (des-acyl ghrelin) and the recent obestatin act through distinct receptors and contrarily to acyl ghrelin, show an anorexigenic activity. The finding that these three peptide hormones derive from the same precursor exert opposing physiological actions, highlights the importance of posttranslational regulatory mechanisms. Further investigations are required to highlight the complexity of ghrelin physiology in order to better understand the mechanisms regulating the energy balance and provide a successful treatment of eating disorders, obesity and cachexia.

Green tea extract decreases muscle pathology and NF-κB immunostaining in regenerating muscle fibers of mdx mice - Corrected Proof

2009-10-26

Summary: Background & aims: Duchenne muscular dystrophy is a debilitating genetic disorder characterized by severe muscle wasting and early death in afflicted boys. The primary cause of this disease is mutations in the dystrophin gene resulting in massive muscle degeneration and inflammation. The purpose of this study was to determine if dystrophic muscle pathology and inflammation were decreased by pre-natal and early dietary intervention with green tea extract.Methods: Mdx breeder mice and pups were fed diets containing 0.25% or 0.5% green tea extract and compared to untreated mdx and C57BL/6J mice. Serum creatine kinase was assessed as a systemic indicator of muscle damage. Quantitative histopathological and immunohistochemical techniques were used to determine muscle pathology, macrophage infiltration, and NF-κB localization.Results: Early treatment of mdx mice with green tea extract significantly decreased serum creatine kinase by ∼85% at age 42 days (P≤0.05). In these mice, the area of normal fiber morphology was increased by as much as ∼32% (P≤0.05). The primary histopathological change was a ∼21% decrease in the area of regenerating fibers (P≤0.05). NF-κB staining in regenerating muscle fibers was also significantly decreased in green tea extract-treated mdx mice when compared to untreated mdx mice (P≤0.05).Conclusion: Early treatment with green tea extract decreases dystrophic muscle pathology potentially by regulating NF-κB activity in regenerating muscle fibers.

Short chain fatty acids exchange: Is the cirrhotic, dysfunctional liver still able to clear them? - Corrected Proof

2009-10-26

Summary: Background & aims: Prebiotics are increasingly used to improve gut integrity. A presumed mechanism of their beneficial action is the synthesis of short chain fatty acids (SCFA: acetate, propionate and butyrate). High systemic concentrations of propionate and butyrate are toxic and can adversely affect the patient. In physiological situations the liver uses propionate and butyrate for energy metabolism. The aim of the present study was to investigate to which extent patients with liver cirrhosis are still able to metabolize portal derived SCFA in the liver.Methods: Twelve patients with liver cirrhosis and an intrahepatic portosystemic shunt (TIPSS) were studied. Blood was sampled from the femoral artery, portal and hepatic vein. Organ plasma flow was measured. Net release or uptake was calculated by multiplying the arteriovenous differences by plasma flow. SCFA plasma concentrations were measured using LC-MS.Results: Arterial concentrations were 124±12, 8±1 and 10±1μmol/l for acetate, propionate and butyrate, respectively. The gut produced 32.5±13.0, 4.8±1.3 and 6.2±2.1μmolkgbw−1h−1 of acetate, propionate and butyrate, respectively. Assuming 70% portosystemic shunting, hepatic uptake of propionate and butyrate was 3.1±0.9 and 5.2±1.4μmolkgbw−1h−1. Hepatic uptake of acetate was non significant (12.1±12.3μmolkgbw−1min−1). As a consequence of shunting, part of total acetate escaped from the splanchnic bed, which equalled 34.9±14.7μmolkgbw−1h−1.Conclusion: The liver of patients with stable cirrhosis is able to use butyrate and propionate, most likely preventing increased systemic concentrations. This suggests that prebiotics can be administered safely, but monitoring butyrate levels may be advisable in patients with diminished liver function.

Validity of predictive equations for resting energy expenditure in Belgian normal weight to morbid obese women - Corrected Proof

Peter J.M. Weijs, Greet A.A.M. Vansant — 2009-10-08

Summary: Background & aims: Individual energy requirements of overweight and obese adults can often not be measured by indirect calorimetry, mainly due to the time-consuming procedure and the high costs. To analyze which resting energy expenditure (REE) predictive equation is the best alternative for indirect calorimetry in Belgian normal weight to morbid obese women.Methods: Predictive equations were included when based on weight, height, gender, age, fat free mass and fat mass. REE was measured with indirect calorimetry. Accuracy of equations was evaluated by the percentage of subjects predicted within 10% of REE measured, the root mean squared prediction error (RMSE) and the mean percentage difference (bias) between predicted and measured REE.Results: Twenty-seven predictive equations (of which 9 based on FFM) were included. Validation was based on 536 F (18–71 year). Most accurate and precise for the Belgian women were the Huang, Siervo, Muller (FFM), Harris–Benedict (HB), and the Mifflin equation with 71%, 71%, 70%, 69%, and 68% accurate predictions, respectively; bias −1.7, −0.5, +1.1, +2.2, and −1.8%, RMSE 168, 170, 163, 167, and 173kcal/d. The equations of HB and Mifflin are most widely used in clinical practice and both provide accurate predictions across a wide range of BMI groups. In an already overweight group the underpredicting Mifflin equation might be preferred. Above BMI 45kg/m2, the Siervo equation performed best, while the FAO/WHO/UNU or Schofield equation should not be used in this extremely obese group.Conclusions: In Belgian women, the original Harris–Benedict or the Mifflin equation is a reliable tool to predict REE across a wide variety of body weight (BMI 18.5–50). Estimations for the BMI range between 30 and 40kg/m2, however, should be improved.

Inactivity-mediated insulin resistance is associated with upregulated pro-inflammatory fatty acids in human cell membranes - Corrected Proof

Sara Mazzucco, Francesco Agostini, Gianni Biolo — 2009-10-05

Summary: Background & aims: Low-grade systemic inflammation and pro-inflammatory pattern of cell membrane fatty acid composition characterize patients affected by type 2 diabetes and metabolic syndrome. We hypothesize that inactivity-induced insulin resistance could affect levels of pro-inflammatory fatty acids in cell membranes.Methods: Thirty healthy, male, young volunteers were investigated before and after 35-day experimental bed rest. Diet composition was adapted to previous dietary habits. Fatty acid composition of erythrocyte membranes was analyzed by gas-chromatography using flame ionization detector.Results: Following bed rest, the HOMA index of insulin resistance significantly increased by +51±11% (P<0.01). Bed rest was associated with increased n-6 polyunsaturated (+4.7±2.2%; P<0.01) and decreased monounsaturated (−4.8±1.5%; P<0.01) fatty acid content in erythrocyte membranes. Fractional content of arachidonic acid increased by +14±12% (P=0.01) following inactivity. Δ5 and Δ9 desaturase indexes, as estimated from product-to-precursor ratios, significantly diminished following bed rest from 9.6±0.4 to 8.4±0.3 (P<0.001) and from 0.72±0.02 to 0.69±0.01 (P<0.05), respectively. The n-3 fatty acids, α-linolenic and eicosapentaenoic, were decreased (P=0.05) following inactivity by 4.7±13.2% and 3.8±5.2%, respectively.Conclusions: Inactivity-mediated insulin resistance was associated with altered Δ5 and Δ9 desaturase indexes and with pro-inflammatory fatty acid pattern in erythrocyte membranes. These abnormalities could contribute to the low-grade inflammation associated to inactivity.

The S-100B substudy of the GLUTAMICS trial: Glutamate infusion not associated with sustained elevation of plasma S-100B after coronary surgery - Corrected Proof

2009-10-05

Summary: Background & aims: Concerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion.Methods: Sixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day.Results: S-100B in the glutamate group and the control group were 0.079±0.034μg/L and 0.090±0.042μg/L respectively (p=0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132±0.047vs 0.081±0.036μg/L; p=0.003). Overall, 21 patients had S-100B above reference level (≥0.10μg/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning.Conclusions: Intravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.

Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial - Corrected Proof

2009-10-05

Summary: Background & aims: The aim of our study was to investigate the role of Lactobacillus GG (LGG) in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers.Methods: We conducted a randomized, double-blind, placebo-controlled trial in 281 children who attend day care centers. They were randomly allocated to receive LGG at a dose of 109 colony-forming units in 100ml of a fermented milk product (LGG group, n=139) or placebo that was the same post-pasteurized fermented milk product without LGG (placebo group, n=142) during the 3-month intervention period.Results: Compared to the placebo group, children in the LGG group had a significantly reduced risk of upper respiratory tract infections (RR 0.66, 95% CI 0.52 to 0.82, NNT 5, 95% CI 4 to 10), a reduced risk of respiratory tract infections lasting longer than 3 days (RR 0.57, 95% CI 0.41 to 0.78, NNT 5, 95% CI 4 to 11), and a significantly lower number of days with respiratory symptoms (p<0.001). There was no risk reduction in regard to lower respiratory tract infections (RR 0.82, 95% CI 0.24 to 2.76). Compared with the placebo group, children in the LGG group had no significant reduction in the risk of gastrointestinal infections (RR 0.63, 95% CI 0.38 to 1.06), vomiting episodes (RR 0.60, 95% CI 0.29 to 1.24), and diarrheal episodes (RR 0.63, 95% CI 0.35 to 1.11) as well as no reduction in the number of days with gastrointestinal symptoms (p=0.063).Conclusion: LGG administration can be recommended as a valid measure for decreasing the risk of upper respiratory tract infections in children attending day care centers.

The perception that beer improves sleep onset might be a motivation for some to drink heavily. Is it only melatonin that matters? Reply to Dr. Molfino - Corrected Proof

Maria D. Maldonado, J.R. Calvo — 2009-09-24

I am writing in response to Dr. Molfino's letter to you, regarding my paper which was published in Clinical Nutrition 2009, 28:188–191. In first place, I would like to thank to the team of Dr. Molfino his vigilance and interest in our work.

Sleep-inducing effect of beer: A melatonin- or alcohol-mediated effect? - Corrected Proof

Alessio Molfino, Alessandro Laviano, Filippo Rossi Fanelli — 2009-09-24

We read with interest the paper by Maldonado MD et al. which demonstrates that melatonin is a significant component of beer, and exerts clinically relevant effects by increasing the levels of melatonin and antioxidant capacity of the human serum. Authors concluded that melatonin in beer contributes to the total antioxidative capability in healthy volunteers' serum, and indicated that moderate beer consumption may protect organism from overall oxidative stress.

Effects of powdered fertilized eggs on the stress response - Corrected Proof

Johannes Schult, Torsten Hero, Juliane Hellhammer — 2009-09-23

Summary: Background & aims: Effects of nutritional supplements on psychological wellbeing receive increasing attention. This double-blind placebo-controlled study investigated effects of a four week intake of powder of fertilized eggs (Young Tissue Extract; YTE™) in a laboratory protocol (Trier Social Stress Test; TSST).Methods: Aside the laboratory stress test, we examined differential effects on subjects with high and low levels of chronic stress. Thus, subjects were further divided into two subgroups with scores for chronic stress scores below and above average, respectively.Results: Compared to placebo, a four week intake of YTE™ did not result in superior effects on general wellbeing. However, beneficial effects of YTE™ were observed in subjects with enhanced levels of chronic stress. When compared to placebo these subjects showed an improvement of both the psychological and endocrine stress response.Conclusions: Group differences suggest that YTE™ selectively improves adaptation to acute stress by normalizing the endocrine and the subjective stress response. Subjects with less chronic stress also reported less subjective stress but did not show beneficial effects on the endocrine stress response.

Body density estimates from upper-body skinfold thicknesses compared to air-displacement plethysmography - Corrected Proof

Kimberly J. Shafer, William A. Siders, LuAnn K. Johnson, Henry C. Lukaski — 2009-09-22

Summary: Background & aims: Determine the accuracy of body density (Db) estimated with upper-body skinfold thickness (SFT) measurements compared to air-displacement plethysmography (ADP) and ascertain whether body mass index (BMI) impacts the accuracy of SFT to assess Db.Methods: We estimated Db with SFT and ADP in 131 healthy men and women with normal (N; 18.5–24.9kg/m2), overweight (OW; 25–29.9kg/m2), and obese (OB; 30–39.9kg/m2) BMI.Results: Compared with ADP, SFT overestimated (p<0.05) Db in OW and OB females and in OB males (−0.0047, −0.0164 and −0.0119g/cc, respectively), and underestimated (p<0.05) Db in N females and males (0.0050 and 0.0068g/cc, respectively) but did not differently estimate Db in OW males. The gender by BMI group interaction was not significant. SFT underestimated (p<0.05; 0.0058g/cc) Db in the N and overestimated (p<0.05; 0.0113g/cc) Db in the OB BMI groups. The error in predicting Db did not change significantly over the range of Db within the N (r=0.239, p=0.06) and OB (r=0.160, p=0.934) BMI groups. Limits of agreement were −0.0165 to 0.0284g/cc and −0.0365 to 0.0085g/cc for the N and OB BMI groups, respectively. The error of estimating Db with SFT was correlated with mean Db in the aggregate sample (r=0.495, p<0.0001) and the OW group (r=0.394, p<0.009). The regression-based limits of agreement were ±0.0226g/cc in the total group and ±0.0168g/cc in the OW group.Conclusions: Although SFT offer practical advantages, the validity of SFT to estimate Db among individuals with N and OB BMI is adversely affected.

Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake - Corrected Proof

Willem F. Nieuwenhuizen, Hugo Weenen, Paul Rigby, Marion M. Hetherington — 2009-09-22

Summary: Background & aims: Many older adults and patients do not achieve sufficient nutritional intake to support their minimal needs and are at risk of, or are suffering from, (protein-energy) malnutrition. Better understanding of current treatment options and factors determining nutritional intake, may help design new strategies to solve this multifactorial problem.Methods: Medline, Science Citation Index, ScienceDirect and Google databases (until December 2008) were searched with the keywords malnutrition, elderly, older adults, food intake, energy density, variety, taste, satiety, and appetite.Results: 37 Factors affecting nutritional intake were identified and divided in three categories; those related to the environment, the person, and the food. For older adults in nursing homes, encouragement by carers and an appropriate ambiance seem particularly important. Meal fortification, offering variety, providing frequent small meals, snacks and particularly Oral Nutritional Supplements (ONS) between meals are other possibilities for this group. Product factors that stimulate intake include palatability, high energy density, low volume, and liquid format.Conclusion: The current review gives a comprehensive overview of factors affecting nutritional intake and may help carers to improve nutritional intake in their patients. The product factors identified here suggest that especially small volume, energy and nutrient dense ONS can be effective to improve nutritional intake.

Protein and energy metabolism in type 1 diabetes - Corrected Proof

Sadie L. Hebert, K. Sreekumaran Nair — 2009-09-14

Summary: Profound metabolic changes occur in people with type 1 diabetes mellitus during insulin deprivation. These include an increase in basal energy expenditure and reduced mitochondrial function. In addition, protein metabolism is significantly affected during insulin deprivation. A greater increase in whole-body protein breakdown than protein synthesis occurs resulting in a net protein loss. During insulin deprivation the splanchnic bed has a net protein accretion which accounts for the total increase in whole-body protein synthesis while muscle is in a net catabolic state.

Knowledge and attitudes of surgical trainees towards nutritional support: Food for thought - Corrected Proof

Sherif Awad, Philip J.J. Herrod, Ewan Forbes, Dileep N. Lobo — 2009-09-07

Summary: Background & aims: Up to 40% of patients admitted to UK hospitals are malnourished and appropriate nutritional intervention can improve outcomes. We investigated the knowledge and attitudes of UK surgical trainees towards nutritional support and compared their responses with dieticians.Methods: Trainee surgeons and qualified dieticians were asked to complete a multiple choice question test derived from topics relating to nutritional support, followed by a questionnaire on their attitudes towards nutrition. Participants were unaware that they would be tested.Results: The test was administered to 63 doctors and 25 dieticians. There were 19 newly qualified doctors (foundation year 1 [FY1]), 21 junior surgeons (speciality-training years 1 and 2 [ST1–2]) and 23 senior surgeons (speciality-training years 3 and above [ST3+]). Mean [SE] test scores were lower for doctors compared to dieticians (14.0 [0.64] versus 26.4 [0.22], p<0.001). The respective test scores for FY1, ST1–2, ST3+ doctors were 9.8 [0.78], 14.3 [1.10] and 17.3 [0.76]. Only 47% of doctors felt they had adequate knowledge of this subject and 65% stated that they regularly made decisions on nutritional support. Furthermore, only 25% stated they could calculate daily energy and nutritional requirements.Conclusion: Despite making decisions related to nutritional support regularly, surgical doctors in the UK demonstrated less knowledge of the fundamental principles of nutritional support than dieticians.

Prospective study of self-reported usual snacking and weight gain in a Mediterranean cohort: The SUN project - Corrected Proof

2009-09-07

Summary: Background & aims: It has been hypothesized that snacking could be a major factor in the development of obesity. However, the relationship between snacking and the increment in body weight remains controversial. Moreover, longitudinal studies about this issue are scarce. Thus, our objective was to prospectively assess the relationship between snacking and weight gain and obesity in a middle-aged free-living population.Methods: Longitudinal prospective Spanish dynamic cohort (10,162 university graduates; mean age: 39 years) followed-up for an average of 4.6 years. Dietary habits were ascertained through a validated 136-item food-frequency questionnaire. Usual snackers were defined as those participants who answered affirmatively when asked in the baseline assessment if they usually eat between meals. Validated self-reported weight and body mass index were collected at baseline and during follow-up.Results: After adjusting for potential confounders, self-reported between-meal snacking was significantly associated with a higher risk of substantial weight gain (≥3kg/year; p<0.001;≥5kg/year, p<0.001;≥10% baseline weight, p<0.001). Among participants with a baseline body mass index lower than 30kg/m2 (n: 9709) we observed 258 new cases of obesity. Usual snackers presented an adjusted 69% higher risk of becoming obese during follow-up (Hazard Ratio: 1.69; 95% confidence interval: 1.30–2.20).Conclusion: Our results support the hypothesis that self-reported between-meal snacking can be a potential risk factor for obesity.

Inhibition of JNK along with activation of ERK1/2 MAPK pathways improve steatohepatitis among the rats - Corrected Proof

Safiyeh Aghazadeh, Razieh Yazdanparast — 2009-09-02

Summary: Background & aims: Oxidative stress-induced hepatocyte apoptosis is implicated in the onset of non-alcoholic steatohepatitis (NASH). Regarding the pronounced roles of mitogen activated protein kinases (MAPKs) in oxidative stress-induced cellular damages and the development of NASH, we evaluated the effect of Teucrium polium ethyl acetate (EtoAc) extract on rats with NASH and on the modulation of MAPKs activities.Methods: To induce NASH, a methionine choline deficient diet (MCD) was given to N-Mary rats. These animals were then compared to the control group receiving normal diet and/or MCD diet plus EtoAc extract (0.5g/kg/day). After 8 weeks, liver histopathology, malondialdehyde (MDA) and immunoblot analyses of caspase-3 cleavage, ERK/pERK and JNK/pJNK were examined.Results: Simultaneous treatments with MCD diet and the EtoAc extract resulted in pronounced improvements in liver steatosis, ballooning degeneration and inflammation. Elevated MDA and caspase-3 levels among MCD-fed rats were also markedly decreased. In addition, the EtoAc extract treatments caused significant reduction in the phosphorylated form of JNK along with an increase in the phosphorylated level of ERK1/2.Conclusion: These results indicate that the anti-apoptotic effect of T. polium extract is mediated through inhibition of ROS generation. Moreover, the inhibitory effect of T. polium on the development and progression of NASH is apparently governed by the attenuation of JNK activation and augmentation of ERK1/2 activity through phosphorylation.

Adductor pollicis muscle: Reference values of its thickness in a healthy population - Corrected Proof

M. Cristina Gonzalez, Rodrigo R.P. Duarte, Michele B. Budziareck — 2009-09-01

Summary: Background & aims: Adductor pollicis muscle is the only muscle which could be directly assessed, and its thickness could be useful in muscle mass assessment. Our objective is to determine values of adductor pollicis muscle thickness (APMT) in healthy subjects.Methods: APMT was obtained using a skinfold caliper in 300 healthy subjects, grouped by age and gender, in dominant (DAPMT) and non-dominant (NDAPMT) sides. All patients were assessed by Subjective Global Assessment (SGA). General characteristics of the subjects were obtained by a questionnaire.Results: One hundred and fifty men and one hundred and fifty women were evaluated. Their mean age was 44.9±18.5 years and they were all well nourished. DAPMT mean values found in men were 26.1±4.4mm and in women, 19.8±3.3mm, respectively. NDAPMT mean values found in men and women were 25.1±4.4mm and 18.7±3.1, respectively. Reference values for each gender and age group were created and values below the 5th percentile were considered as limit of normality.Conclusions: This study presents APMT reference values from a healthy population. New studies may demonstrate its role in the evaluation of muscle mass and its association with nutritional status.

The relationship between the insulin-like growth factor-1 axis, weight loss, an inflammation-based score and survival in patients with inoperable non-small cell lung cancer - Corrected Proof

Claire L. Meek, A. Michael Wallace, Lynn M. Forrest, Donald C. McMillan — 2009-09-01

Summary: Background & aims: The involvement of a systemic inflammatory response, as evidenced by the Glasgow Prognostic Score (GPS), is associated with weight loss and poor outcome in patients with non-small cell lung cancer. There is good evidence that nutritional and functional decline in patients with advanced malignant disease is associated with catabolic changes in metabolism. However, defects in anabolism may also contribute towards nutritional decline in patients with cancer. The aim of the present study was to examine the relationship between IGF-1 and IGFBP-3, performance status, mGPS and survival in patients with inoperable NSCLC.Methods: 56 patients with inoperable NSCLC were studied. The plasma concentrations of IGF-1, IGFBP-3 and leptin were measured using ELISA and RIA.Results: The patients were predominantly male (61%), over 60 years old (80%), with advanced (stage III or IV) disease (98%), with a BMI≥20 (84%), an ECOG-ps of 0 or 1 (79%), a haemoglobin (59%) and white cell count (79%) in the reference range. On follow-up 43 patients died of their cancer. On univariate analysis, BMI (p<0.05), Stage (p<0.05), ECOG-ps (p<0.05), haemoglobin (p<0.05), white cell count (p<0.05) and mGPS (p<0.05) were associated with cancer specific survival. There was no association between age, sex, treatment, IGF-1, IGFBP-3, IGF-1:IGFBP-3 ratio, or leptin and cancer specific survival. With an increasing mGPS concentrations of haemoglobin (p<0.005) and IGFBP-3 (p<0.05) decreased. mGPS was not associated with either IGF-1(p>0.20), or leptin (p>0.20).Conclusions: In summary, the results of this study suggest that anabolism (IGF-1 axis) does not play a significant role in the relationship between nutritional and functional decline, systemic inflammation and poor survival in patients with inoperable NSCLC.

Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure - Corrected Proof

2009-08-25

Abstract: Background & aims: Small bowel disruption is often complicated by acute intestinal failure and can be corrected by chyme reinfusion (CR). Plasma citrulline ([Cit]) is a biomarker of the enterocyte mass. Our aim was to determine whether [Cit] could be a marker of absorptive intestinal mass or function by assessing whether CR could affect intestinal absorptive function and [Cit].Methods: Twenty-six patients with small bowel disruption and double enterostomy were treated with CR. Fecal wet weight, nitrogen and fat absorption, parenteral nutrition delivery and [Cit] were measured before and after the initiation of CR with a median follow-up of 30 days.Results: CR decreased the intestinal wet weight output (median±IQ, 2384±969 vs. 216±242mLd−1, P<0.0001) and parenteral nutrition dependence (65% vs. 8%, P<0.01). CR was associated with a rise in net nitrogen and fat digestive absorption and [Cit] (17.0±10.0 vs. 31.0±12.0μmolL−1, P=0.0001). Before the initiation of CR, [Cit] correlated positively with the absorptive post-duodenal small bowel length (r=0.39, P=0.04), but not with the total post-duodenal small bowel length (r=0.11, P=0.60).Conclusion: CR allows for a dramatic improvement of intestinal absorptive function and a near doubling in [Cit] level. [Cit] is not a marker of overall intestinal mass, but of the absorptive small bowel function.

Plantago ovata husks-supplemented diet ameliorates metabolic alterations in obese Zucker rats through activation of AMP-activated protein kinase. Comparative study with other dietary fibers - Corrected Proof

2009-08-25

Summary: Background & aims: Our aim was to compare the effects of intake of diets supplemented with different dietary fibers, namely cellulose, methylcellulose or Plantago ovata husks, (insoluble, soluble non-fermentable, and soluble fermentable fiber, respectively), on the abnormalities clustered in the metabolic syndrome.Methods: Adult obese Zucker rats were distributed in four groups which were fed respectively a standard, a cellulose-supplemented, a methylcellulose-supplemented or a P. ovata husks-supplemented diet, for ten weeks.Results: Increased body weight, hyperlipidemia, hyperinsulinemia and hyperleptinemia, increased TNF-α and reduced adiponectin secretion by adipose tissue found in obese Zucker rats were significantly improved in obese rats fed the P. ovata husks-supplemented diet, together with a lower hepatic lipid content which parallels activation of the signaling pathway of AMP-protein kinase in the liver. The methylcellulose-supplemented diet reduced body weight, hyperlipidemia, circulating free fatty acids concentration and ameliorated adipose tissue secretion of adiponectin and TNF-α. Feeding with the cellulose-supplemented diet only reduced free fatty acids circulating levels.Conclusions: The soluble dietary fibers essayed are more beneficial than insoluble fiber in the treatment of metabolic syndrome, being the soluble and fermentable the more efficient to improve metabolic alterations. Fermentation products of P. ovata husks must play an important role in such effects.

Effects of the PRo-active Interdisciplinary Self-MAnagement (PRISMA, Dutch DESMOND) program on dietary intake in type 2 diabetes outpatients: A pilot study - Corrected Proof

2009-08-21

Abstract: Background & aims: To investigate the effect on dietary intake of the PRo-active Interdisciplinary Self-MAnagement (PRISMA) program, developed analogous to DESMOND, in overweight type 2 diabetes patients.Methods: All type 2 diabetes patients referred to the Diabetes Outpatient Clinic of the VU University Medical Center Amsterdam with a BMI >25kg/m2, were eligible for inclusion to the PRISMA program. At baseline and after 3, 6 and 12 months of follow-up, macronutrient intake, anthropometric, biomedical and psychosocial measures were evaluated by using Generalized Estimation Equations.Results: Included into the study were 38 patients, of which 22 completed a 1-year follow-up. After 6 months energy and macronutrient intake were significantly decreased. Reductions after 12 months were still significant for protein, unsaturated fat and dietary fiber and borderline significant for energy and saturated fat intake. Patients positively evaluated the program, and most patients held the view that they had learned something from PRISMA.Conclusions: The PRISMA program reduced energy and macronutrient intake up to 6 months. After 6 months, attention should be paid to patients' food product choices. Follow-up counselling might further improve long-term outcome. This pilot study shows that the PRISMA program is promising in decreasing dietary intake in newly diagnosed and established overweight type 2 diabetes patients in secondary care.

Metabolic syndrome and its components after liver transplantation: Incidence, prevalence, risk factors, and implications - Corrected Proof

2009-08-20

Summary: Metabolic syndrome is defined as the mutual existence of obesity, impaired fasting glucose levels, insulin resistance, hypertension, and dyslipidemia. After liver transplantation, patients typically develop these disorders, and even though there has been minimal research focused on the chronic impact of this syndrome on post-liver transplant patients, studies point to an association with major vascular events and fibrosis. The aim of the current work is to review data on the incidence, prevalence, risk factors, and implications of metabolic syndrome and its components in patients who have undergone liver transplantation.

The bioelectrical impedance vector migration in healthy infants - Corrected Proof

2009-08-17

Summary: Background & aims: Detecting young children with high amount of body fat is important to intervene in the development of obesity. The aim of this study is to gain inside in the bioelectrical impedance vector analysis in healthy infants.Methods: Repeated measurements of whole body reactance and resistance were assessed, using a 50kHz frequency bioelectrical impedance analysis, in 51 boys and 62 girls during infancy. Bivariate vector analysis, which can be used to determine tissue hydration and soft tissue mass, was conducted. The 95% confidence intervals of the mean vectors for different age groups and the 95%, 75% and 50% tolerance intervals were plotted, using resistance and reactance components standardized by the participant's height.Results: During infancy impedance vectors changed significantly: A vector migration of the Xc/H of 8.50ohm/m and the R/H of −95.68ohm/m between the age of two months and eight to twelve months (p=0.0001) was observed. Bivariate, reference tolerance intervals of the impedance vectors for healthy infants at the age of two months are presented.Conclusion: Our results show a significant impedance vector migration during the first year of life. New reference tolerance intervals for the second month of life were constructed.

Before–after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position - Corrected Proof

2009-08-13

Summary: Backgrounds & aims: To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP).Methods: Eligible patients receiving EN and mechanical ventilation in PP were included within 48h after intubation in a before–after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250ml/6h or vomiting. In the before group (n=34), the EN rate was increased by 500ml every 24h up to 2000ml/24h; patients were flat when prone and received erythromycin (250mgIV/6h) to treat intolerance. In the intervention group (n=38), the EN rate was increased by 25ml/h every 6h to 85ml/h, 25° head elevation was used in PP, and prophylactic erythromycin was started at the first turn.Results: Compared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774ml [IQR 513–925] vs. 1170ml [IQR 736–1417]; P<0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia.Conclusion: An intervention including PP with 25° elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.

The effect of a very high daily plant stanol ester intake on serum lipids, carotenoids, and fat-soluble vitamins - Corrected Proof

Helena Gylling, Maarit Hallikainen, Markku J. Nissinen, Tatu A. Miettinen — 2009-08-13

Summary: Background & aims: Intake of 2–3g/d of plant stanols as esters lowers LDL cholesterol level, but there is no information about the efficacy and safety of a respective very high daily intake. We studied the effects of 8.8g/d of plant stanols as esters on serum lipids and safety variables in subjects with mild to moderate hypercholesterolemia.Methods: In a randomized, double-blind, placebo-controlled study the intervention (n=25) and control (n=24) groups consumed spread and drink enriched or not with plant stanol esters for 10 weeks.Results: Plant stanols reduced serum total and LDL cholesterol concentrations by 12.8 and 17.3% from baseline and by 12.0 and 17.1% from controls (P<0.01 for all). Liver enzymes, markers of hemolysis, and blood cells were unchanged. Serum vitamins A, D, and γ-tocopherol concentrations, and the ratios of α-tocopherol to cholesterol were unchanged. Serum β-carotene concentrations decreased significantly from baseline and were different from controls even when adjusted for cholesterol. Serum α-carotene concentration and α-carotene/cholesterol ratio were not different from controls.Conclusions: High intake of plant stanols reduced LDL cholesterol values without any other side effects than reduction of serum β-carotene concentration. However, the end product, serum vitamin A levels, were unchanged. The results suggest that plant stanol ester intake can be increased to induce a greater cholesterol lowering effect.

The costs arising from pressure ulcers attributable to malnutrition - Corrected Proof

Merrilyn D. Banks, Nicholas Graves, Judith D. Bauer, Susan Ash — 2009-08-13

Summary: Background & aims: To estimate the economic consequences of pressure ulcer attributable to malnutrition.Methods: Statistical models were developed to predict the number of cases of pressure ulcer, associated bed days lost and the dollar value of these losses in public hospitals in 2002/2003 in Queensland, Australia. The following input parameters were specified and appropriate probability distributions fitted.One thousand random re-samples were made and the results expressed as (output) probabilistic distributions.Results: The model predicts a mean 16,060 (SD 5671) bed days lost and corresponding mean economic cost of AU$12,968,668 (SD AU$4,924,148) (EUROS 6,925,268; SD 2,629,495) of pressure ulcer attributable to malnutrition in 2002/2003 in public hospitals in Queensland, Australia.Conclusion: The cost of pressure ulcer attributable to malnutrition in bed days and dollar terms are substantial. The model only considers costs of increased length of stay associated with pressure ulcer and not other factors associated with care.

Body weight change in women receiving adjuvant chemotherapy for breast cancer: A French prospective study - Corrected Proof

2009-08-12

Summary: Background & aims: Adjuvant chemotherapy has frequently been associated with weight gain after breast cancer diagnosis. We aimed to prospectively evaluate body weight variations in French patients with early breast cancer.Methods: This prospective observational study included 272 breast cancer patients who were candidates for adjuvant chemotherapy. Weight and body mass index were measured at baseline visit, then at 9 and 15 months from baseline (6 and 12-month post-chemotherapy). At baseline visit, information on the benefits of weight gain prevention and healthy diet was given by a dietician. Univariate logistic regression was performed to test the association between weight gain and potential predictive factors.Results: Thirty percent of patients gained weight during the year before diagnosis, 26% were overweight and 15% were obese. At one year, the mean weight change was +1.5kg (SD=4.1) and +2.3% (SD=6.0); 60% of the cohort had gained weight, with a median increase of 3.9kg (SD=3.0) and 5.9% (SD=4.4). Reported weight gain during the year before diagnosis appears to be the only factor associated with the absence of post-chemotherapy weight gain (OR=0.54, 95% CI [0.31–0.95], p=0.034).Conclusion: Body weight increased in the post-chemotherapy period in French breast cancer survivors, even when given dietary recommendations. Appropriate weight management interventions with nutritional follow-up and physical activity programs are needed.

Nutritional status in patients with chronic respiratory failure receiving home mechanical ventilation: Impact on survival - Corrected Proof

2009-08-07

Summary: Background & aims: In patients with chronic respiratory diseases body mass index (BMI) is a predictor of long-term survival, whereas the prognostic value of body composition, especially fat-free mass index (FFMI), is unknown.Methods: In a prospectively collected cohort of 131 patients (50 females, 81 males; 71% chronic obstructive pulmonary disease, 29% severe restrictive disorders) undergoing home mechanical ventilation (HMV) due to chronic hypercapnic respiratory failure (CHRF), the prognostic value of nutritional composition assessed by bioelectrical impedance analysis was evaluated during a 4-year follow-up and compared to that of BMI, anthropometrics, and functional parameters.Results: After follow-up, 53 patients (40.5%) had died. Regarding all-cause mortality cumulative survival percentages after 1, 2 and 3 years were 89.3, 76.3 and 67.9%, respectively. In univariate analyses, FFMI, BMI, sex, age, leukocyte number, FEV1 and 6-min walking distance were associated with survival (p<0.05). Multivariate analyses using the most significant percentiles identified by univariate analysis revealed FFMI (25th percentile; hazard ratio 0.338 [95% confidence interval: 0.189–0.605]), sex, leukocyte number (50th percentile) and FEV1 (50th percentile) as independent predictors of mortality.Conclusions: In patients with CHRF and HMV, body composition in terms of FFMI was an independent predictor of long-term survival. FFMI was superior to BMI and seems informative in the multidimensional assessment of these patients.

Serum concentration and dietary intake of vitamins A and E in low-income South African elderly - Corrected Proof

Wilna H. Oldewage-Theron, Folake O. Samuel, Roger D. Djoulde — 2009-08-06

Summary: Background & aims: Adequate dietary intake of antioxidants is vital for the promotion of health, well being and longevity of the elderly. This study assessed the prevalence of vitamin A (retinol) and vitamin E (alpha-tocopherol) deficiency in a population of low-income South African elderly.Methods: Serum vitamin A and vitamin E concentrations were determined in 235 persons aged 60–93 years in Sharpeville, South Africa. Dietary assessment was done using 24-h recall. Weight and height were measured to determine body mass index.Results: The mean and standard deviation of serum levels in the elderly were 1.41±1.4μmol/L for vitamin A and 2.1±1.1mg/l for vitamin E. The proportion with deficient serum vitamin A was 28.2% and 26.5% for men and women respectively and 20.5% and 20.9% respectively for deficient vitamin E concentrations. Almost one-third of the subjects consumed less than 100% of the Estimated Average Requirement for both vitamins. Mean vitamin A intake was 426±666μg in men and 368±811μg in women, mean vitamin E intake for men and women was 5.4±5.2μg and 4.0±0.5mg respectively. The predominant macronutrient consumed was carbohydrate. No relationship existed between biochemical and dietary intake parameters of vitamins A and E.Conclusions: These findings indicate poor dietary intake and high prevalence of vitamins A and E deficiency among this elderly population. Sustainable community-based interventions are needed to address this nutritional vulnerability in this community.

Resting VO2, maximal VO2 and metabolic equivalents in free-living healthy elderly women - Corrected Proof

2009-08-03

Summary: Background & aims: Maximal VO2 (VO2max) and metabolic equivalents (METs) decline with aging due to body composition and cardiovascular modifications. However, a detailed evaluation of these variables for this population has not been done. The aim of this study was to evaluate VO2max and METs in healthy elderly women, and to establish whether the calculated resting VO2 (3.5ml/min/kg) underestimates the true METs.Methods: 81 females over 65 years old attending a twice-weekly mild fitness program were studied. Body composition was measured by DEXA. VO2max and resting VO2 (VO2rest-meas) were measured by indirect calorimetry. METs were measured (METs-meas) using the VO2max/VO2rest-meas ratio, and calculated (METs-cal) from the ratio between measured VO2max and calculated resting VO2 (3.5ml/min/kg of body weight).Results: The VO2rest-meas and VO2max measured by indirect calorimetry were 2.9±0.4ml/min/kg and 17.5±2.8ml/min/kg, respectively. The METs-meas were higher than the METs-cal (6.1±1.2 vs 5.0±0.8; p<0.001). The 25th–75th percentile range of measured METs was 5.2–6.8.Conclusions: Our study confirmed that, in elderly women, METs values ranging between 5 and 7 are compatible with an acceptable physical activity. The estimated resting VO2 (3.5ml/min/kg) does not appear to be applicable to elderly women, because it underestimates the real METs in this population.

Validation of skinfold measurements and bioelectrical impedance analysis in children with severe cerebral palsy: A review - Corrected Proof

Rob Rieken, Elsbeth A.C. Calis, Dick Tibboel, Heleen M. Evenhuis, Corine Penning — 2009-07-31

Abstract: Background & aims: Accurately measuring nutritional status in children with severe cerebral palsy (CP) is a challenge. This review seeks to assess the validity of skinfold measurements and bioelectrical impedance analysis (BIA) for measuring body composition in children with severe CP.Methods: We executed a literature search on the validation of both methods in children with severe CP. To be eligible for inclusion, a study had to report on a statistical comparison between these two methods and any method of reference. The QUADAS tool was used for quality assessment.Results: The search strategy resulted in 1549 studies of which 5 studies eventually met the inclusion criteria. When comparing body composition outcomes of skinfold measurements to a reference method, correlation coefficients were found ranging from 0.406 to 0.988. Correlation coefficients between body composition data of BIA and a reference method ranged from 0.515 to 0.95.Conclusions: Although a number of authors found favorable agreement between skinfold measurements and BIA in comparison with reference methods, the small numbers studied, the lack of methodological quality measured by QUADAS, and the use of inappropriate analytical methods hamper solid conclusions.

Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immunity in severely burned mice - Corrected Proof

2009-07-27

Summary: Background: To investigate the effects of early enteral nutrition (EN) supplemented with Arginine (Arg) on intestinal mucosal immunity in severely burned mice.Methods: Forty-four mice were randomly assigned into four groups: a sham injury+EN group (n=10), a sham injury+EN+Arg group (n=10), a burn+EN group (n=12), and a burn+EN+Arg group (n=12) and the mice in two experimental groups received a 20% total body surface area (TBSA), full-thickness scald burn on the back. Then, the burned mice were given a 175kcal/kg body wt/day of conventional enteral nutrition or an isonitrogenous and isocaloric enteral nutrition supplemented with Arg by gastric gavage for 7 days. There was isonitrogenous and isocaloric intake in two experimental groups. The mice in two control groups received the same procedures as above, except for burn injury. On day 7 after injury, all mice among four groups were euthanized and the entire intestine was harvested. Intestinal immunoglobulin A (IgA) levels, total lymphocyte yield, and lymphocyte subpopulations in Peyer's patches were analyzed. Levels of IFN-γ, IL-2, IL-4 and IL-10 in gut homogenates were also measured by ELISA.Results: Total lymphocyte yield, numbers of lymphocyte subpopulations, and intestinal IgA levels in the EN+ARG group were higher than those in the EN group (p<0.05). Levels of gut tissue cytokines were significantly altered with enteral Arg supplementation: levels of IL-4 and IL-10 were increased, and levels of IFN-γ and IL-2 declined, when compared with the EN-fed mice (p<0.05).Conclusions: The results of this study suggested that enteral nutrition supplemented with Arg has changed the cytokine concentrations in intestinal homogenates from a pro- to an anti-inflammatory profile, increased sIgA levels and changed lymphocytes in severely burned mice.

Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: A comparison between fertile and infertile men - Corrected Proof

2009-07-27

SUMMARY: Background & aims: Fatty acid (FA) composition of the spermatozoa may be an important determinant of fertility. The aim was to evaluate polyunsaturated fatty acid (PUFA) composition of the blood plasma and spermatozoa in infertile men with idiopathic oligoasthenoteratozoospermia (OAT).Methods: Eighty-two infertile men with idiopathic OAT and seventy-eight fertile men defined according to semen concentration and proven fertility were enrolled in the study. The semen parameters were assessed according to World Health Organization criteria; three omega-3 fatty acids – α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and two omega-6 fatty acids – linoleic acid (LA) and arachidonic acid (AA) concentrations were measured in blood plasma and spermatozoa; and the seminal plasma enzymatic antioxidant levels of catalase, and superoxide dismutase (SOD) were also assessed.Results: Proven fertile men had higher blood and spermatozoa levels of omega-3 FAs compared with the infertile patients. The ratio of serum omega-6/omega-3 fatty acids was significantly higher in infertile (14.8±4.3) patients compared to fertile controls (6.3±2.2) (P=0.001). Additionally, levels of AA were higher and the omega-3 index (EPA+DHA) was lower in infertile subjects than in fertile controls (all P values<0.05). Infertile men had higher mean AA:DHA ratio and AA:EPA (6.4±2.9 and 12.0±4.9, respectively) than fertile men (3.3±1.8 and 6.7±2.6, respectively) (both P=0.001). A strong negative correlation was found between the AA:DHA and AA:EPA ratios and total sperm count (r=−0.62, P=0.001 and r=−0.64, P=0.001, respectively), sperm motility (r=−0.63, P=0.001 and r=−0.61, P=0.001, respectively), and sperm morphology (r=−0.61, P=0.001, and r=−0.59, P=0.002, respectively).Conclusions: Infertile men had lower concentrations of omega-3 FAs in spermatozoa than fertile men. These results suggest that research should be performed to assess the potential benefits of omega-3 FA supplementation as a therapeutic approach in infertile men with idiopathic OAT.

Serum albumin and total lymphocyte count as predictors of outcome in hip fractures - Corrected Proof

2009-07-27

Summary: Background & aims: Hip fractures are a significant cause of mortality and morbidity in the elderly. Malnutrition is a significant contributor to this, however no consensus exists as to the detection or management of this condition. We hypothesise that results of admission serum albumin and total lymphocyte count (TLC), as markers of Protein Energy Malnutrition (PEM) can help predict clinical outcome in hip fracture patients aged over 60 years.Methods: This retrospective study evaluated the nutritional status of patients with hip fractures using albumin and TLC assays and analysed their prognostic relevance. Clinical outcome parameters studied were delay to operation, duration of in-patient stay, re-admission and in-patient, 3- and 12-month mortality.Results: Four hundred and fifteen hip fracture patients were evaluated. Survival data were available for 377 patients at 12months. In-hospital mortality for PEM patients was 9.8%, compared with 0% for patients without. Patients with PEM had a higher 12-month mortality compared to patients who had normal values of both laboratory parameters (Odds Ratio 4.6; 95% CI: 1.0–21.3). Serum albumin (Hazard Ratio 0.932, 95% CI: 0.9–1.0) and age (Hazard Ratio 1.04, 95% CI: 1.0–1.1) were found to be significant independent prognostic factors of mortality by Cox regression analysis.Conclusions: These results highlight the relevance of assessing the nutritional status of patients with hip fractures at the time of admission and emphasises the correlation between PEM and outcome in these patients.

Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children - Corrected Proof

Jessie M. Hulst, Henrike Zwart, Wim C. Hop, Koen F.M. Joosten — 2009-07-27

Summary: Background & aims: Children admitted to the hospital are at risk of developing malnutrition. The aim of the present study was to investigate the feasibility and value of a new nutritional risk screening tool, called STRONGkids, in a nationwide study.Methods: A Prospective observational multi-centre study was performed in 44 Dutch hospitals (7 academic and 37 general), over three consecutive days during the month of November 2007.The STRONGkids screening tool consisted of 4 items: (1) subjective clinical assessment, (2) high risk disease, (3) nutritional intake, (4) weight loss. Measurements of weight and length were performed. SD-scores <−2 for weight-for-height and height-for-age were considered to indicate acute and chronic malnutrition respectively.Results: A total of 424 children were included. Median age was 3.5 years and median hospital stay was 2 days. Sixty-two percent of the children were classified “at risk” of developing malnutrition by the STRONGkids tool. Children at risk had significantly lower SD-scores for weight-for-height, a higher prevalence of acute malnutrition and a longer hospital stay compared to children with no nutritional risk.Conclusions: The nutritional risk screening tool STRONGkids was successfully applied to 98% of the children. Using this tool, a significant relationship was found between having a “high risk” score, a negative SD-score in weight-for-height and a prolonged hospital stay.

Preferential promotion of apoptosis of monocytes by Lactobacillus casei rhamnosus soluble factors - Corrected Proof

Yi-Han Chiu, Yi-Jen Hsieh, Kuang-Wen Liao, Kou-Cheng Peng — 2009-07-24

Summary: Background & aims: Inflammatory bowel disease (IBD) is characterized by dense infiltrates of and defective apoptosis by mucosal cell populations. Some probiotics inhibit monocytes' expansion, although mechanisms remain unknown. Supernatants of Lactobacillus strains were investigated for inducing apoptosis of monocytes.Methods: Secreted factors produced by Latobacillus strains were tested on human lymphocytes, monocytes and a human monocytic leukemia-cell line (THP-1). Cell death mechanisms were investigated by a variety of methods. Lipopolysaccharide (LPS)-induced proinflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and anti-inflammatory TGF-β1 were determined.Results: Soluble factor(s) from Lactobacillus casei rhamnosus strain supernatants (LcrS) effectively induced apoptosis of immune cells. These were mainly soluble proteins (MW 5–30kDa; LcrS5–30). For immune cells, but not human colonic epithelial carcinoma cells (HT-29), pretreatment with LcrS5–30 significantly promoted apoptosis via a mitochondrial pathway. LcrS5–30 suppressed pro-inflammatory cytokines and induced anti-inflammatory TGF-β1.Conclusions: Probiotic Lcr produced heat-stable molecules (MW range 5–30kDa) that promoted immune cell apoptosis without affecting intestinal epithelial cells. LcrS5–30 triggered apoptosis by a mitochondrial pathway, but not via TGF-β signaling pathway. LcrS5–30 also inhibited LPS-induced inflammatory cytokines by immune cells. Thus, LcrS5–30 promotes apoptosis of immune cells, and suggests probiotics-based regimens for prevention of IBD.

Early serum IGF-I response to oral protein supplements in elderly women with a recent hip fracture - Corrected Proof

Thierry Chevalley, Pierre Hoffmeyer, Jean-Philippe Bonjour, René Rizzoli — 2009-07-22

Summary: Background & aims: In patients with recent hip fracture, reduced serum IGF-I in relation to protein undernutrition is frequent. Elevation of circulating IGF-I in response to a daily oral supplement of 20g of casein was observed after 6 months. This study determined if the response to casein as compared to whey protein can be observed as early as after one week.Methods: 45 Women were randomized after recent hip fracture in 3 groups receiving a preparation of 20g of casein, an isocaloric supplement of 20g of whey protein or an isocaloric supplement of 15g of whey protein combined with 5g of essential amino acids (a.a.).Results: A similar significant elevation of serum IGF-I was already observed after 7 days for casein (+37.3μg/L), whey (+29.4) and for whey+a.a. (+34.3). From day 7–28, no further significant rise in IGF-I was recorded.Conclusion: After one week of protein supplementation, the percent increase of IGF-I was of similar magnitude to that previously observed after 6 months of protein supplementation. It suggests that in hip fracture patients, long-term effects of various protein preparations on IGF-I could be predicted from changes observed as early as 7 days after the onset of supplementation.

Levels of lipids in preterm infants fed breast milk - Corrected Proof

Niels Rochow, Sandra Möller, Gerhard Fusch, Tim Drogies, Christoph Fusch — 2009-07-22

Summary: Background: Actual recommendations in preterm infants limit parenteral fat intake to 3–4g/kg/d. This is based on clinical studies where fat administration was adjusted to achieve levels close to those recommended in adults for atherosclerosis prevention. Data about lipid profiles of breast fed preterm infants who may have fat intakes of up to 7g/kg/d and could serve as reference are not available.Objective: To establish full lipid profiles in healthy fully breast fed preterm infants and to test the hypothesis that breast milk fat intake leads to serum triglycerides higher than those achieved under full parenteral fat administration.Design: Serum triglycerides, cholesterol, VLDL, LDL, HDL (all pre- and postprandial), as well as triglycerides in breast milk were measured in 65 healthy, fully breast fed, stable growing preterm infants stratified in 500g intervals (mean gestational age: 31±4 weeks, birth weight: 1500±600g, age at study: 25±16d).Results: Median fat intake was 7.0g/kg/d (interquartile range: 5.8;8.1) and led to the following serum levels: triglycerides 0.9 (0.6;1.1), cholesterol 3.1 (2.6;3.5), VLDL 0.5 (0.3;0.6), LDL 1.3 (1.1;1.6), HDL 1.1 (0.8;1.4)mmol/L.Small for gestational age infants showed higher triglycerides (p=0.005). Triglycerides (r2=0.08, p=0.023), postprandial triglyceride increase (r2=0.21, p<0.001), cholesterol (r2=0.16, p<0.001) and HDL (r2=0.16, p<0.001) were correlated with weight at study.Conclusion: Though higher by a factor of two, fat intake by breast milk leads to considerably lower lipid levels when compared to published values obtained under parenteral fat intake. Results suggest that either fat absorption is reduced in preterm infants, or the composition of breast milk supports a lower profile of fat levels when compared to commercially available parenteral fat emulsions.

Fasting and postprandial relationships among plasma leptin, ghrelin, and insulin in prepubertal obese children - Corrected Proof

M. Gil-Campos, C.M. Aguilera, M.C. Ramirez-Tortosa, R. Cañete, A. Gil — 2009-07-21

Summary: Background: Leptin is involved in the long-term regulation of body weight and dietary intake, while ghrelin plays an essential role in appetite control. High levels of leptin have been associated with adiposity and the suppression of ghrelin levels with increased dietary intake.Aims: To evaluate fasting and postprandial concentrations of plasma leptin and ghrelin after intake of a standardised breakfast and to study the relationship of these hormones with adiposity and insulin resistance in obese prepubertal children.Methods: 34 obese and 20 normal-weight prepubertal children aged 6–12 years were selected. Plasma leptin and ghrelin were measured by ELISA and radioimmunoassay, respectively. The general linear model of variance, principal-component factor, and Pearson's analyses correlation were performed.Results: Baseline and postprandial leptin levels were higher in obese versus normal-weight children. In obese, ghrelin showed an altered pattern during the postprandial period, recovering to baseline levels at 3h after the intake. Insulin resistance was associated with leptin and independently with ghrelin.Conclusion: The association of ghrelin with insulin resistance provides further evidence on the regulation of ghrelin in glucose homeostasis in childhood obesity at the prepubertal age. Changes in ghrelin after dietary intake may be related to an earlier recovery of appetite in prepubertal obese children.

Resting energy expenditure and body composition in patients with newly detected cancer - Corrected Proof

2009-07-21

Summary: Background & aims: Elevated resting energy expenditure (REE) may be a major determinant in the development of cancer cachexia. The aim of the study was to evaluate REE and body composition in cancer patients and find out the relationship between energy expenditure and substrate utilization.Methods: Measured resting energy expenditure (mREE), carbohydrate oxidation (C-O), and fat oxidation (F-O) were measured by indirect calorimetry in 714 cancer patients and 642 controls. Extracellular fluid (ECF), intracellular fluid (ICF), and total water (TW) were measured by bioelectrical impedance appliance; fat mass (FM), fat free mass (FFM), and body cell mass (BCM) were further determined.Results: Compared with the controls, cancer patients showed no significant difference in mREE, but had higher mREE/FFM and mREE/pREE. 46.7% (n=333) of cancer patients were hypermetabolic, 43.5% (n=310) normometabolic, and 9.8% (n=71) hypometabolic; whereas 25.2% (n=162) of control subjects were hypermetabolic, 56.5% (n=363) normometabolic, and 18.3% (n=117) hypometabolic. Cancer patients showed an increase in F-O, ECF, TW/BW and ECF/BW; and a decrease in C-O, npRQ, ICF, ICF/BW. REE was correlated to substrate oxidation rate. Cancer patients exhibited an elevation in FM, FM/BW, FFM, and BCM, and a decrease in FFM/BW.Conclusions: 1. Cancer patients had elevated REE. Cancer type, pathological stage and duration of disease influenced REE. 2. Aberrations in substrate utilization may contribute to the elevated REE in cancer patients. 3. FM, FFM, and BCM diminished in cancer patients, which may be related to the elevated REE.