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Dietary education with customised dishware and food supplements can reduce frailty and improve mental well-being in elderly people: A single-blind randomized controlled study

Background and Objectives: The elderly population is increasing rapidly worldwide, and frailty is a common geriatric syndrome. Comprehensive dietary management strategies may have beneficial effects on frailty prevention and reversal. This 3-month single-blind, paralleled, randomized controlled trial compared the effects of micronutrients and/or protein supplements, and a personalised diet on frailty status in elderly individuals. Methods and Study Design: Between 2014 and 2015, 40 prefrail or frail subjects aged ≥65 years were recruited at Miaoli General Hospital, Taiwan. Of these, 37 completed the study, and 36 were included in the analysis. Participants were randomly assigned to one of four treatment groups: (1) the control (2) multiple micronutrient supplements, (3) multiple micronutrients plus isolated soy protein supplement, and (4) individualised nutrition education with customised dishware and food supplements (mixed nuts and skimmed milk powder). Dietary intake, protein biomarkers, frailty score, and geriatric depression score were assessed. Results: Individualised nutrition education with customised dishware and food supplements significantly increased the participants' intake of vegetables, dairy, and nuts, in addition to increasing the concentration of urinary urea nitrogen. It yielded a significant reduction in frailty score (p＜0.05) and a borderline reduction (p=0.063) in geriatric depression score. No significant beneficial changes were observed for the other two intervention groups. Conclusions: Our study indicated that a dietary approach with easy-to-comprehend dishware and food supplements to optimize the distribution of the consumption of six food groups improved frailty status and, potentially, psychological well-being in elderly people.

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Pro- and prebiotic effects on oxidative stress and inflammatory markers in non-alcoholic fatty liver disease

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is related to inflammation and oxidative stress. Probiotics and prebiotics are considered anti-inflammatory and antioxidative factors. In this study, we evaluated the effects of probiotic and/or prebiotic on oxidative stress and inflammatory markers in patients with NAFLD. Methods and Study Design: Seventy-five NAFLD subjects were divided into four groups. The first group received a pro-biotic capsule of Bifidobacterium longum (B.L) and Lactobacillus acidophilus (L.A) (2 × 10^7 CFU/day), the second group received prebiotic (10g/day inulin), the third group received pro-biotic and prebiotic, and the fourth group received placebo, for three months. Anthropometric, inflammatory and oxidative/ anti-oxidative indices were measured in all patients before and after the intervention. Results: We showed that consumption of pro- and/or prebiotic compared to placebo is able to significantly decrease body weight, body mass index, waist and hip circumferences, tumour necrosis factor-α and increase serum levels of total antioxidant capacity in patients with NAFLD (p＜0.01). There were not any significant differences between probiotic, prebiotic and co-administration of them on the mentioned parameters. Co-administration of pro- and prebiotic caused significant decrease of high-sensitive C-reactive protein (hs-CRP) compared to the placebo and other groups (p＜0.01). Interlekin-6 and malondialdehyde were not significantly different among groups at the end of study. Conclusions: Probiotic or/and prebiotic supplementation can be effective for improvement of some anthropometric, inflammatory and oxidative indices in patients with NAFLD. Co-administration of pro- and prebiotic is more effective than probiotic and prebiotic alone in modifying hs-CRP in patients with NAFLD.

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The influence of diet and behaviour on metabolic syndrome and the prevalence of metabolic syndrome according to different definitions in west China

Background and Objectives: This study investigated the updated prevalence of metabolic syndrome among adults in West China and the influence of diet and behaviour on metabolic syndrome. Methods and Study Design: A cross-sectional survey was conducted from 2013-2014, and multi-stage stratified clustering sampling was applied in 12 counties of Sichuan province. Data regarding metabolic syndrome and style risk factors were collected through interviewer-administered questionnaires, and physical measurements were recorded following a standardized protocol. Logistic regression models were used to explore the association between metabolic syndrome and its risk factors. Results: A total of 7,131 adults participated. The prevalence of metabolic syndrome was 16.9% and 23.8% according to the International Diabetes Federation criteria and the consensus definition, respectively. The International Diabetes Federation criteria failed to identify 28.8% of the participants identified by the consensus definition. The odds ratios (ORs) of suffering from Metabolic syndrome in people eating pork every week compared with at lower frequencies, people eating more than 100 g of red meat/day, people with more sedentary behaviour per day, and people consuming at least 20 cigarettes/day were 1.76 (1.09-2.84), 1.28 (1.01- 1.62), 1.03 (0.99-1.07), and 1.46 (1.12-1.92), respectively, according to the consensus definition, and 1.51 (1.09- 2.10), 1.4 (1.14-1.72), 1.07 (1.02-1.13), and 1.5 (1.16-1.94), respectively, based on the International Diabetes Federation criteria. Conclusions: The International Diabetes Federation criteria were less sensitive in identifying metabolic syndrome than the consensus definition. More sedentary behaviour, smoking ≥20 cigarettes per day, and a higher frequency of pork intake increased the risk of metabolic syndrome in this study.

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Dietary pattern and its association with blood pressure and blood lipid profiles among Japanese adults in the 2012 Japan National Health and Nutrition Survey

Background and Objectives: Little is known about the association between dietary patterns and cardiovascular disease risk factors among Japanese adults based on nationally representative data. This study aimed to explore the association between dietary patterns and hypertension or blood lipid profiles among Japanese people. Methods and Study Design: De-identified Japan National Health and Nutrition Survey (NHNS) 2012 data with a total of 8721 subjects (3524 men and 5197 women) aged 40-74 years were used. Dietary patterns were derived by principal component analysis (PCA). Generalized linear models and multivariate logistic regression analysis were used to assess the relationship between dietary patterns and blood pressure or lipid profiles. Results: We identified four dietary patterns: (a) traditional Japanese, (b) bread-dairy, (c) meat-fat, and (d) noodle patterns. Among these, the traditional Japanese pattern was significantly related to lower blood pressure, lower low-density lipoprotein (LDL)-cholesterol in men and lower high-density lipoprotein (HDL)-cholesterol in women. Bread-dairy pattern was associated with high total cholesterol in women and higher LDL cholesterol in both men and women. Noodle pattern was associated with higher total cholesterol and HDL-cholesterol in men. No significant association was observed between meat-fat pattern and blood pressure or lipid profiles. Conclusions: Our study showed that the traditional Japanese pattern with high intake of miso, soy-sauce, vegetables, beans, potatoes and mushroom conferred benefits on blood pressure. Our findings have indicated clearly that it is possible to provide useful information on healthy dietary pattern for health promotion from the one-day dietary records of the NHNS.

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Association between bone mineral density, muscle volume, walking ability, and geriatric nutritional risk index in hemodialysis patients

Background and Objectives: Hemodialysis patients are at risk for bone loss and sarcopenia, characterized by reduced muscle mass and limited mobility/function. Osteoporosis and sarcopenia both increase the risk of hospitalization and death in affected individuals. Malnutrition also occurs as a complication of hemodialysis and has been identified as a risk factor for osteoporosis and sarcopenia. In this study, we examined the relationship between osteoporosis, muscle volume, walking ability, and malnutrition in hemodialysis patients. Methods and Study Design: Forty-five hemodialysis patients were evaluated. Bone mineral density (BMD) and muscle volume were measured by dual-energy X-ray absorptiometry. Muscle volume and strength were evaluated using lean mass index (LMI), handgrip strength, and walking ability. The time required for a patient to walk 10 meters was measured to evaluate walking ability. The geriatric nutritional risk index (GNRI) was used to assess malnutrition. Results: Multiple linear regression analysis showed that older age, female sex, lower LMI, and higher total type I procollagen N-terminal propeptide were correlated with lower BMD of lumbar spine. Higher age and lower LMI were correlated with lower BMD of the femoral neck. Female sex and lower GNRI were correlated with lower LMI. Longer duration of hemodialysis was correlated with lower walking ability. Conclusions: Our findings suggest that muscle preservation is required to maintain both lumbar spine and femoral neck BMD. Similarly, nutritional management is necessary to maintain BMD via preservation of muscle volume. Complementary nutritional therapies are needed to improve osteoporosis and sarcopenia in high-risk hemodialysis patients.

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Untargeted metabolomics approach (UPLC-Q-TOF-MS) explores the biomarkers of serum and urine in overweight/obese young men

Background and Objectives: Obesity is linked to metabolic diseases characterized by insulin resistance, such as diabetes and cardiovascular disease. In this study, we investigated the metabolic disorders of uncomplicated obesity to identify early alterations in biological systems. Methods and Study Design: Metabolic differences between overweight/obese (n=36) and normal-weight (n=35) young Chinese men without known metabolic disorders were assessed. Metabolic profiling of the serum and urine was performed using ultra-performance liquid-chromatography quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS). Partial least squares discriminant analysis (PLS-DA) was undertaken to reveal and classify the differences between the two groups. Results: Compared to normal-weight men, obese men had higher levels of the serum metabolites phenylalanine, Phe-Phe, and L-tryptophan, whereas those of p-cresol sulfate and p-cresol were less in obesity. Urinary metabolites phenylacetamide, L-glutamine, phenylacetylglutamine, indoxyl sulfate, p-cresol, and p-cresol sulfate were greater in obese men. Conclusions: These findings indicate that disorders involving aromatic amino acids and the tricarboxylic acid cycle (TCA) have microbiomic involvement in the uncomplicated phase of obesity.

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Effect of increasing protein content at the evening meal followed by exercise on overnight nocturnal total energy expenditure, fat and carbohydrate oxidation in healthy young Indian men

Background and Objectives: Indians are more prone to develop diabetes at a younger age, with normal BMI, and this might partly be due to their higher body fat content. Increase in fat mass in the body might be because of the reduction in fat oxidizing capability. Given the fact that Indians consume high carbohydrate diets, effective fat oxidation is likely to be delayed. Simple preventive weight loss strategies like exercise or change in diet regimen are needed to reduce their body fat. This study investigated the effect of exercise with a high protein dinner on overnight thermogenesis and fat oxidation. Methods and Study Design: Nine healthy normal subjects aged 18 - 30 years participated in randomised cross over study. They underwent 6 sessions of overnight whole body indirect calorimetry on separate nights with the following experimental conditions: (i) standard (habitual) meal (ii) standard meal with exercise (iii) 20% protein meal (iv) 20% protein meal with exercise (v) 50% protein meal and (vi) 50% protein meal with exercise. Oxygen consumption (VO2) and carbon dioxide production (VCO_2) were measured overnight, from which energy expenditure, non-protein respiratory quotient (RQ), and fat oxidation were estimated. Results: The estimated marginal means of fat oxidation and energy expenditure were significantly different for protocols with exercise compared to those without exercise (p=0.02). There was no acute effect of protein on nocturnal fat or carbohydrate oxidation, with or without exercise. Conclusions: Post-dinner exercise increase nocturnal fat oxidation and energy expenditure in young active Indian men.

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Several problem nutrients are identified in the complementary diet of 6 to 11 month old breastfed children in Western Guatemala

Background and Objectives: The failure of infants in developing countries to meet nutrient intake recommendations is well documented. The objective of this study was to assess the nutritional adequacy and identify problem nutrients of the diets of Guatemalan infants with continued breastfeeding. Methods and Study Design: A single previous-day dietary recall was collected from a convenience sample of 94 mothers of infants aged 6-11 mo attending a public health clinic in the urban area of Quetzaltenango, Guatemala. Energy and nutrient content of complementary feeding (CF) and breastmilk, modelled by subtracting estimated energy intakes from CF from energy requirements, were calculated and nutrient adequacy of the diet was assessed. Nutrient densities and critical nutrient densities of CF were computed to identify ＂problem nutrients＂ and main food sources of these nutrients. Results: Complementary diets were adequate for protein, but likely to be inadequate for pantothenic acid and vitamins C, A, D, E, and K, as well as calcium, iron and zinc. In the worst-case scenario, i.e. for small girls with limited energy allowances, riboflavin, niacin, vitamin B-6 and magnesium were identified as ＂problem nutrients＂ as well. Formula milk, cow milk and Incaparina^® were main food sources of ＂problem nutrients＂. Conclusions: The intake of micronutrients during the first six months of the recommend CF period in Guatemala has a number of notable inadequacies, but the gaps are narrower than traditionally reported for this age group in low-income settings.

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A dietary and nutritional status survey among young children in five big cities of China

Background and Objectives: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. Methods and Study Design: A cross-sectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical examination, blood hemoglobin measurements and a 24 hour dietary recall questionnaire Results: The educational level of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient deficiencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6-11 and 12-23 month old children. 3.) An increased risk of overweight/obesity. Conclusions: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further improvements in the diet and nutrition of young children in these environments is likely require more specific education to parents and other significant carers such as grandparents. The relatively high educational level and socio- economic status of the population group is likely to facilitate the uptake of such measures in this population group.

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Analysis of dietary trends in Chinese adolescents from 1991 to 2011

Background and Objectives: To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 - 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey. Methods and Study Design: Individual level, consecutive 3 - day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces representing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size. Results: From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p＜0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p＜0.05). Sodium-potassium ratios decreased overall and across both sexes (p＜0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p＜0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p＜0.01). Conclusions: This suggests Chinese adolescents are transitioning to a low carbohydrate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodium-potassium ratios are primarily due to decreased sodium intake and require further reduction efforts.