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Consumption and sources of added sugar in Thailand: a review

Background and Objectives: The present review examined the best available evidence regarding consumption levels and sources of added sugar in different population groups in Thailand. Methods and Study Design: Information was extracted from food balance sheets, household expenditure surveys, food consumption surveys, government reports, published and unpublished studies. Results: A total of 24 references were obtained, comprising 8 nationally representative reports and 16 individual studies. Results were inconsistent. The National Statistical Office reported an available supply of 83 g sugar per capita per day in 2010. The 2009 Food Consumption Survey of Thai Population showed median intake of sugar and sweeteners for all age groups ranging from 2.0 to 20.0 g per day among males and from 2.0 to 15.7 g per day among females (below the Thai recommendation of 40 to 55 g/day). Studies on children suggested intake levels between 25 to 50 g/day, while studies on adults were inconsistent. Frequently consumed sources were table sugar, sweetened beverages, and sweet snacks (traditional desserts, baked products, crispy snacks). Conclusions: Insufficient evidence exists regarding intake levels and sources of added sugar in Thailand. Limitations were the use of food frequency questionnaires or a single 24-h recall to assess intake, and outdated studies with small sample sizes. An updated nationally representative survey using improved methods is needed to determine the levels and sources of sugar intake in different population groups. These include biomarkers to establish levels of consumption and multiple 24-h recalls (at least two) to identify food sources that contribute significantly to excess sugar intake.

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Selenium in infant formula milk

Formula-based animal milk is an alternative source of infant nutrition in many cases when breastfeeding is unacceptable or inaccessible; however, these replacements often have low selenium levels. The composition of infant formula milk should be as close as possible to that of human breast milk, both in content and chemical speciation. Selenium is an essential trace element for infants. Generally, human breast milk is the ideal food to ensure adequate infant Se intake. However, to date, sodium selenite or sodium selenate has been used as selenium supplementation in infant formula milk in most countries. This inorganic Se, which is not a natural component of food, may not be the optimal speciation for Se supplementation in infant formula milk. Advances in speciation in foods, especially in animal milk, suggest that future proposals for selenium speciation in human breast milk can lead to discussions regarding the most favorable methods of selenium supplementation in infant formula milk.

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Associations of postprandial lipemia with trunk/leg fat ratio in young normal weight women independently of fat mass and insulin resistance

Background and Objectives: To determine whether postprandial lipemia is associated with fat distribution even in young, normal weight women independently of fat mass, adipokines, insulin resistance and systemic inflammation. Methods and Study Design: Female college students (ages 21-24, n=35) underwent dual-energy X-ray absorptiometry and a standardized breakfast providing 17 g triglycerides (TG). Serum lipids, lipoproteins, apolipoproteins, adipokines and markers of insulin resistance and inflammation were measured in fasting blood samples. Results: In crude analyses, postprandial lipemia, as assessed by 0-2 h area under the curve of serum TG (TG-AUC), was positively associated with fasting TG, trunk/leg fat ratio, apolipoprotein B, leptin/adiponectin ratio and log high-sensitivity CRP. Multiple linear regression analysis with these 5 variables as independent variables revealed that fasting TG (p＜0.001) and trunk/ leg fat ratio (p=0.001), were independent positive predictors of TG-AUC (R^2=0.923). Women with high compared to low TG-AUC were characterized by higher trunk/leg fat ratio, elevated apolipoprotein B and leptin/adiponectin ratio. Conclusion: Trunk/leg fat ratio, a marker of central adiposity, is a significant predictor of postprandial lipemia even in young women who are normal weight and insulin- sensitive, suggesting a modifiable pathway to postprandial hypertriglyceridemia, a cardiometabolic risk factor. These findings should be confirmed in studies employing more participants.

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Relevance of the Mini Nutritional Assessment in cirrhotic liver disease patients

Background and Objectives: Malnutrition is an important prognostic factor for patients with liver disease and a novel nutritional assessment tool is required for these patients. The aim of this study was to validate the Mini Nutritional Assessment (MNA) as a nutritional screening tool for patients with liver disease, by comparing MNA scores with other nutrition-related parameters. Methods and Study Design: Patients who were hospitalized at the gastroenterology division of Kyushu and Beppu Medical Center were enrolled. The study included 77 patients with liver disease (male/female, 46/31; mean±SD age, 68.5±10.7 years; liver cirrhosis, 64.9%; liver cancer, 61.0%). Correlations of MNA score at hospital admission with anthropometric parameters and blood test data were evaluated. Results: In patients with liver disease, MNA scores demonstrated that 18 (23.4%) had normal nutritional status, 41 (53.2%) were at risk of malnutrition, and 18 (23.4%) were malnourished, indicating that up to 76.6% of the liver disease group were malnourished. Especially, patients with liver cirrhosis had lower scores of nutritional markers and MNA. The MNA score in liver cirrhotic patients correlated with the following parameters: % arm circumference, % triceps skinfolds, ratio of % maximum grasp strength and arm circumference, maximum grasp strength, arm muscle circumference, calf circumference, serum albumin levels, the controlling nutritional status score, and Onodera's prognostic index, while patients without liver cirrhosis did not show such correlation. Conclusions: MNA scores correlated with nutrition-related data in patients with liver cirrhosis. The MNA is an appropriate tool for nutritional screening assessment in these cirrhotic patients of any etiology.

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The efficacy of parenteral fish oil in critical illness patients with sepsis: a prospective, non-randomized, observational study

Background and Objectives: To investigate the clinical outcomes in septic patients receiving parenteral fish oil. Methods and Study Design: A prospective, non-randomized, observational clinical study was carried out in 112 patients with sepsis from March, 2013 to May, 2015 in the surgical intensive care unit (SICU) of a tertiary-referral hospital. The patients were put into one of two groups; either the control or the study group. Patients received the standard treatment of sepsis based on guidelines in the control group. In the study group, patients received parenteral nutrition (PN) containing fish oil. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the length of ICU and hospital stay, duration of mechanical ventilation, mortality, and readmission into the ICU were recorded. Tumor necrosis factor (TNF)-α and procalcitonin (PCT) levels were also evaluated. Results: The study group showed a significant reduction for all-cause mortality (20.0% vs 10.0% in study and control groups, p=0.034) and APACHE II score on day 5 (p=0.015), day 7 (p=0.036) and day out of SICU (p= 0.045) compared with the control group. The study group tended to show a shortened length of stay in the ICU compared to the control group. However, TNF-α and PCT level, 28 d mortality, the length of hospital stay and the duration of mechanical ventilation did not show statistical differences between the two groups. There were no drug-related adverse effects shown during the study. Conclusions: PN with fish oil is probably safe and may improve clinical outcome in critical ill patients with sepsis.

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Continuous tube feeding versus intermittent oral feeding for intermediate position enterostomy in infants

Background and Objectives: The stoma of intermediate position enterostomy (IPE) often leads to high output, which is related to electrolyte abnormalities, and prolongs patient recovery post-operatively. The continuous nasogastric tube feeding method has the advantage of reducing the risk of feeding intolerance, and improves nutrient absorption. In the current study, we review our experience with continuous tube feeding and compare the clinical outcomes with intermittent oral feeding in patients with an IPE post-operatively. Methods and Study Design: This was a retrospective review of 118 infants with IPEs in our hospital. The infants were categorized into two groups (intermittent oral feeding [OF] group [n=68 infants, 1-14 days of age] and continuous tube feeding [TF] group [n=50 infants, 1-14 days of age]). Differences in stool volume, daily intravenous fluid infusion, weight gain, nutrition indices, and post-operative complications were reviewed. Results: The stool volume and intravenous fluid infusion in the TF group were less than the OF group from week 2. The weight gain was higher in the TF group than the OF group from week 3. The pre-albumin and retinol binding protein levels were significantly higher in the TF group than the OF group in weeks 3-4 post-operatively. The incidence of cholestasis and water-electrolyte disturbances in the TF group was significantly lower than the OF group, and the incidence of intestinal obstruction was lower than the control group, but the differences were not significant. Conclusions: Continuous tube feeding had better clinical outcomes than intermittent oral feeding in IPE patients.

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Contributors to nutritional status in continuous ambulatory peritoneal dialysis as practised in Henan Province, China

Background and Objectives: To investigate the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and the factors involved. Methods and Study Design: We used the Subjective Global Assessment (SGA) of nutritional status, a general questionnaire, dietary records, and laboratory parameters from 3 consecutive days to develop a NS assessment with it, we assessed 240 patients undergoing CAPD at a dialysis center in Henan Province. Results: In this setting, the prevalence of malnutrition in patients undergoing CAPD was 11.7%. Univariate analysis showed that patient characteristics related to NS included energy and protein intakes, weight and BMI, dialysis duration, urinary creatinine, and total creatinine clearance rate. Multiple linear regression analysis revealed that dialysis duration (p＜0.001) and energy intake (p=0.01) were the principal predictors of nutritional status and allowed 81% of the variance in nutritional status to be explained. Conclusions: Effective collaboration between nutritionists and other health care workers to minimise dialysis duration and optimize energy intake should improve the nutritionally-related quality of life and well-being among CAPD patients.

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Effects of eating frequency on respiratory quotient in patients with liver cirrhosis: a randomized controlled trial

Background and Objectives: Respiratory quotient (RQ) is a good marker of substrate oxidation. Low RQ is frequently found in patients with liver cirrhosis and is associated with poor outcome. The purpose of this study was to demonstrate the effects of eating frequency on RQ in patients with cirrhosis. Methods and Study Design: We performed a randomized controlled trial to assess the effects of eating frequency on RQ in patients with cirrhosis. Seventy patients and 30 healthy controls were enrolled, and patients were further randomized to receive either normal eating frequency (NEF) meals at 08:00, 12:00 and 18:00 h, or high eating frequency (HEF) meals at 08:00, 10:00, 12:00, 15:00, 18:00 and 20:00 h. The two groups had equivalent energy intake. Fasting RQ was measured at 07:30 h and daytime RQ was measured at 11:30 and 17:30 h. Disease severity was evaluated using the Child- Turcotte-Pugh (CTP) classification. Results: Fasting RQ and daytime RQ were significantly lower in patients with cirrhosis than in healthy controls. Patients in the HEF group had a higher RQ than patients in the NEF group at three time points. In patients with CTP-A, no significant differences in daytime RQ were observed between the two groups. However, in CTP-C patients, daytime RQ was significantly higher in the HEF group than in the NEF group. Serum free fatty acid levels were significantly decreased and albumin was significantly increased after HEF intervention. Conclusions: HEF strategy is effective in improvement of RQ and is beneficial to patients with cirrhosis.

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Refeeding hypophosphataemia after enteral nutrition in a Malaysian intensive care unit: risk factors and outcome

Background and Objectives: Refeeding hypophosphataemia (RH) is characterized by an acute electrolyte derangement following nutrition therapy. Complications associated include heart failure, respiratory failure, paraesthesia, seizure and death. We aim to assess its incidence, risk factors, and outcome in our local intensive care unit (ICU). Methods and Study Design: A prospective observational cohort study was conducted at the mixed medical- surgical of a tertiary ICU in Kuantan, Malaysia. The study was registered under the National Medical Research Register (NMRR-14-803-19813) and has received ethical approval. Inclusion criteria include adult admission longer than 48 hours who were started on enteral feeding. Chronic renal failure patients and those receiving dialysis were excluded. RH was defined as plasma phosphate less than 0.65 mmol/L and a drop of more than 0.16 mmol/L following feeding. Results: A total of 109 patients were recruited, of which 44 (42.6%) had RH. Patients with RH had higher SOFA score compared to those without (p=0.04). There were no differences in the APACHE II and NUTRIC scores. Serum albumin was lower in those with RH (p=0.04). After refeeding, patients with RH had lower serum phosphate, magnesium and albumin, and higher supplementation of phosphate, potassium and calcium. There were no differences in mortality, length of hospital or ICU stay. Conclusions: Refeeding hypophosphataemia occurs in almost half of ICU admission. Risk factors for refeeding include high organ failure score and low albumin. Refeeding was associated with imbalances in phosphate, magnesium, potassium and calcium. Future larger study may further investigate these risk factors and long-term outcomes.

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Effects of grass jelly on glycemic control: hydrocolloids may inhibit gut carbohydrase

Background and Objectives: The aim of this study was to investigate (1) the hydrocolloid properties of grass jelly on reducing glycaemic response, (2) the impact of phenolic compounds in Mesona chinensis L. on glycaemic response. Methods and Study Design: A total of 15 healthy Chinese men were recruited to this study. On each visit, subjects consumed one of the following three treatments, i.e. glucose solution (T1), grass jelly (Mesona chinensis L.) solution with glucose (T2) or grass jelly gel with glucose (T3). Capillary blood glucose and venous plasma insulin were analysed over a period of 180 min. Results: The incremental area under the curve for capillary glucose and venous plasma insulin for glucose group, grass jelly solution group and grass jelly gel was found to be statistically not significant (p＞0.05). In a previous study the co-ingestion of grass jelly with complex carbohydrate was found to reduce glycaemic response. The key difference between the two studies was the use of monosaccharide glucose in the present study, compared to complex carbohydrates in the other. The present study suggests that the glycaemic lowering effect of grass jelly may be dependent on the inhibition of carbohydrase enzymes. Conclusions: The co-ingestion of Mesona chinensis L. appears to reduce glycaemic response of only complex carbohydrates through the inhibition of carbohydrase. This conclusion was arrived at by the lack of any effect of Mesona chinensis L. on the monosaccharide glucose.