• 期刊

Determining the predictive equation for height from ulnar length in the Vietnamese population

Background and Objectives: Height is an essential measurement in clinical medicine. It allows the calculation of body mass index, ideal body weight, basic energy requirements and tidal volumes. In many patient groups, such as the critically ill, height cannot be measured easily and surrogate anthropometric measures are used. Regression equations estimating height are specific to ethnicity. We aimed to develop the regression equation for Vietnamese men and women to predict height from ulna length and so improve prescription of life-saving treatment in the intensive care units. Methods and Study Design: A cross-sectional survey of patients and relatives at the National Hospital for Tropical Diseases was undertaken. Ulna length, standing height and weight were measured. The first two thirds of participants' data, stratified by sex and age, were allocated to a model training group, the subsequent participants entered the validation group. Linear regression equations were calculated for the model group by sex, then applied to the validation group and assessed for precision. Other international equations were also compared. Results: 498 males and 496 females were recruited. There was good correlation between ulna length and height in those aged 21-64, r=0.66, p＜0.001 in males and females. The regression equations were: male: height = 85.61 + (3.16 x ulna length), female: height = 85.80 + (2.97 x ulna length). Equations from other populations were less accurate. Conclusions: The regression equations calculated for men and women aged 21-64 showed good correlation and can be used to predict height in those where direct measurement is impossible.

• 期刊

Validation of summer and winter ELISA measurements of serum 25-hydroxyvitamin D concentrations in Mongolia

Background and Objectives: Assay cost, quality, and availability pose challenges for vitamin D surveys in limited resource settings. This study aimed to validate an inexpensive vitamin D assay (ELISA) under real-world conditions in Mongolia, the northernmost developing country, to characterize the assay's usefulness and inform the design of epidemiologic studies in similar regions. Methods and Study Design: We collected paired summer and winter serum samples from 120 men and women (aged 20-57 years) in urban and rural Mongolia, analyzed each sample for 25(OH)D concentration using both Immunodiagnostic Systems ELISA and DiaSorin LIAISON 25(OH)D TOTAL, and compared the assays using multiple statistics. LIAISON was itself validated by participation in the DEQAS program. Results: Correlation and agreement between assays were higher in summer (Pearson's correlation=0.60, Spearman's rank correlation=0.67, Lin's concordance correlation=0.56) than winter (rP=0.37, rS=0.43, rC=0.33), although ELISA less accurately assigned subjects to sufficiency categories in summer (percent agreement=44%) than winter (58%), during the latter of which most subjects were deficient ([25(OH)D] categories used: ＞75 nmol/L (optimal), 50-75 nmol/L (adequate), 25-50 nmol/L (inadequate), ＜25 nmol/L (deficient)). Compared with LIAISON, ELISA tended to indicate higher vitamin D status in both seasons (mean paired difference: 7.0 nmol/L (95% CI: 3.5-10.5) in summer, 5.2 nmol/L (95% CI: 2.9-7.5) in winter). Conclusions: ELISA proved useful for measuring and ranking subjects' vitamin D status in Mongolia during summer, but levels were too low in winter to sensitively discriminate between subjects, and ELISA overestimated status in both seasons. These findings have implications for the timing and interpretation, respectively, of vitamin D surveys in highly deficient populations.

• 期刊

Validity of the Malnutrition Universal Screening Tool (MUST) in Australian hospitalized acutely unwell elderly patients

Background and Objectives: This study validated the Malnutrition Universal Screening Tool (MUST) for nutritional screening in acutely unwell elderly patients against a reference assessment tool - Patient-Generated Subjective Global Assessment (PG-SGA). Methods and Study Design: One hundred and thirty two acutely admitted general medical patients contributed data for this study. In addition to performance of MUST and PG-SGA the following nutritional parameters were measured: weight loss ＞5% in previous 3-6 months, handgrip strength, triceps skinfold thickness, Mid-arm circumference, Mid-arm muscle circumference (MAMC). Quality of life (QoL) was determined using the EuroQoL Questionnaire (EQ-5D 5 level). Sensitivity, specificity, predictive values and concordance were calculated to validate MUST against PG-SGA. Results: MUST when compared to PG-SGA gave a sensitivity of 69.7%, specificity of 75.8%, positive predictive value of 75.4%, negative predictive value of 70.1% and kappa statistics showed 72.7% agreement (k=0.49) for detecting malnutrition. The MUST score had significant inverse correlation with body mass index, Triceps skinfold thickness and Mid-arm muscle circumference but not with Handgrip strength. Malnourished patients (PG-SGA class B/C) were found to have a significantly worse QoL. Conclusions: This study demonstrates that MUST can be confidently administered with respect to validity in acutely unwell general medical elderly patients to detect malnutrition. In this study, significant recent weight loss also seems to have validity, almost comparable to MUST, for predicting the risk of malnutrition. Further research is needed to verify this finding, as a single item may be more feasible to complete than an instrument consisting of two or more items.

• 期刊

Simple method to estimate daily sodium intake during measurement of dialysis adequacy in chronic peritoneal dialysis patients

Background and Objectives: Restriction of dietary sodium intake for peritoneal dialysis (PD) patients is recommended, but there is limited information on the measurement and monitoring of sodium intake. We have developed a simple method to estimate daily sodium intake during the measurement of dialysis adequacy in PD patients. Methods and Study Design: A total of 83 PD patients were enrolled in the study. The patients were divided into two groups based on residual renal function (RRF). We measured total sodium removal and estimated daily sodium intake using dietary recall for one day, during the assessment of dialysis adequacy. Results: There were 39 patients in the RRF(-) group and 44 in the RRF(+) group. In both groups, and all patients, there were significant positive correlations between sodium intake and total sodium removal: RRF(-) group, r=0.598; RRF(+) group, r=0.577; total patients, r=0.595. There were linear relationships between dietary sodium intake and total sodium removal in both groups: RRF(-) group, sodium intake (mg/d) = 19.3 × peritoneal sodium removal (mEq/d) + 211; RRF(+) group, sodium intake (mg/d) = 15.4 × total sodium removal (mEq/d) + 609. All PD patients, sodium intake (mg/d) = 15.6 × total sodium removal (mEq/d) + 646. Conclusions: The measurement of total sodium removal during the assessment of dialysis adequacy could be an effective and simple method to estimate dietary sodium intake in PD patients. A dietary intake of 2,000 mg of sodium corresponds to a total sodium removal of approximately 87 mEq/d.

• 期刊

Appropriate nutritional management in patients with impaired mastication and those with mild dysphagia: a multicenter study of the usefulness of novel foods processed and softened by enzymes

Background and Objectives: Our aim was to investigate the safety of iEAT (a food that is softened by heat and enzyme homogeneous permeation) and iEAT-affected nutrition parameters, e.g., nutrition intake (calculated from the consumption rate in patients with impaired mastication and those with mild dysphagia). Methods and Study Design: A multicenter, randomized, cross-over study of iEAT was conducted in 50 patients (mean age 77.0±11.0 years) with dysphagia due to Occasional aspiration (4 points on the Dysphagia Severity Scale [DSS]) or Oral problems (5 points) randomly assigned to the study diet (iEAT) or its opposite (the modified traditional [control] diet) for 1 week and then switched for 1 week to the opposing diet. Intake of energy, protein, lipid, carbohydrate, and sodium were evaluated along with questionnaire-assessed levels of satisfaction. Results: The mean intake was significantly lower for the study diet, whereas the intakes of energy, protein, carbohydrate on day 1, intake of protein on day 7, and body weight on day 7 were significantly higher for the study diet. We found no between-group differences in hematologic and blood biochemistry parameters, no diet-related adverse events, greater satisfaction with the appearance of the study diet (p＜0.001), and comparable levels of satisfaction with ease of eating, ease of swallowing, and taste for both diets. Conclusions: iEAT was provided to patients with mild dysphagia as safely as a blender diet or other diets usually provided at each study site, and can serve as an efficient nutrition source.

• 期刊

Energy intake in the first week in an emergency intensive care unit may not influence clinical outcomes in critically ill, overweight Japanese patients

Background and Objectives: The American Society for Parenteral and Enteral Nutrition recommends hypocaloric feeding for critically ill patients with a BMI of ≥30.0 kg/m^2. However, the cut-off value of obesity in Japan is BMI ＞25.0 kg/m^2, due to the higher prevalence of type 2 diabetes mellitus, and cardiovascular risk factors, even at a lower BMI than in Western populations. Thus, the optimal energy intake for critically ill, overweight Asian patients is unknown. Methods and Study Design: A retrospective chart review was conducted in patients with BMI of ≥25.0 kg/m^2 in an emergency intensive care unit (EICU). Patients were categorized into two groups by average daily energy intake during the first week in the EICU, with Group A at ＜50% of requirement and Group B at ≥50%. Results: A total of 72 patients with a median BMI of 27.5 kg/m^2 were included in the study. No significant differences between the groups were observed for all-cause mortality, ICU-free days, or length of hospital stay. The number of ventilator-free days (VFDs) was significantly higher in Group A than Group B (20.0 [15.5-24.5] vs 17.0 [2.0-21.0] days; p=0.042). On multiple adjusted analysis, however, we found that %energy intake/requirement was not independently associated with VFDs (regression coefficient=0.019; 95% confidence interval, -0.115 -0.076). Conclusions: Energy intake in the first week in the EICU did not influence clinical outcomes in critically ill, overweight Japanese patients. Confirmation of these results in larger, randomized trials is required.

• 期刊

Pharmacoeconomics of parenteral nutrition in surgical and critically ill patients receiving structured triglycerides in China

Background and Objectives: A prior meta-analysis showed favorable metabolic effects of structured triglyceride (STG) lipid emulsions in surgical and critically ill patients compared with mixed medium-chain/long-chain triglycerides (MCT/LCT) emulsions. Limited data on clinical outcomes precluded pharmacoeconomic analysis. We performed an updated meta-analysis and developed a cost model to compare overall costs for STGs vs MCT/LCTs in Chinese hospitals. Methods and Study Design: We searched Medline, Embase, Wanfang Data, the China Hospital Knowledge Database, and Google Scholar for clinical trials comparing STGs to mixed MCT/LCTs in surgical or critically ill adults published between October 10, 2013 and September 19, 2015. Newly identified studies were pooled with the prior studies and an updated meta-analysis was performed. A deterministic simulation model was used to compare the effects of STGs and mixed MCT/LCT's on Chinese hospital costs. Results: The literature search identified six new trials, resulting in a total of 27 studies in the updated meta-analysis. Statistically significant differences favoring STGs were observed for cumulative nitrogen balance, prealbumin and albumin concentrations, plasma triglycerides, and liver enzymes. STGs were also associated with a significant reduction in the length of hospital stay (mean difference, -1.45 days; 95% confidence interval, -2.48 to -0.43; p=0.005) versus mixed MCT/LCTs. Cost analysis demonstrated a net cost benefit of ¥675 compared with mixed MCT/LCTs. Conclusions: STGs are associated with improvements in metabolic function and reduced length of hospitalization in surgical and critically ill patients compared with mixed MCT/LCT emulsions. Cost analysis using data from Chinese hospitals showed a corresponding cost benefit.

• 期刊

Parenteral nutrition combined with enteral feeding improves the outcome of cancer patients

Background and Objectives: This study investigated whether total parenteral nutrition combined with enteral nutrition is associated with improved biochemical and clinical outcomes in cancer patients with gastrointestinal dysfunction. Methods and Study Design: From January to December 2014, the clinical data of 68 patients in a cancer ward were retrospectively collected, and these patients were classified into two groups according to nutrition delivery, through parenteral nutrition, combined with enteral nutrition more (group A) or less (group B) than 250 kcal/day. The following variables were analyzed: the route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, diagnosis at admission, complications of intestinal failure, modified Glasgow Prognostic Score, co-morbidities, duration of total parenteral nutrition support, performance status scale, and plasma nutritional markers. Results: A significant difference was observed between the two groups in functional capacity, including the Karnofsky index, World Health Organization/Eastern Cooperative Oncology Group score, body-weight loss, and serum albumin levels. However, no significant difference was observed in the modified Glasgow Prognostic Score. Conclusions: Cancer patients receiving total parenteral nutrition who were fed enterally more than 250 kcal/d exhibited more favorable clinical outcomes than those who were fed enterally less than 250 kcal/d. Enteral nutrition should be considered for these severely ill patients.

• 期刊

Peanut butter increases the bioavailability and bioconversion of kale β-carotene to vitamin A

Background and Objectives: Kale is a rich source of provitamin A- β-carotene. This study used intrinsically labeled kale [^2H_9] β-carotene to determine the effect of peanut butter on the bioconversion of kale β-carotene to vitamin A in preschool children. Methods and Study Design: Preschool children (n=37; age 12-36 mo) were randomly assigned to 50 g cooked kale (1.5 mg β-carotene content) with either 33 g peanut butter (PBG) or with 16 g lard (LG) and a reference dose of 1 mg [^(13)C_(10)] retinyl acetate capsule. Blood samples were processed to serum and analyzed by Negative Chemical Ionization-Gas Chromatography Mass Spectrometry (NCI-GCMS) for the enrichments of [^2H] retinol from kale [^2H_9] β-carotene and [^(13)C_(10)] retinol from reference dose. Results: The area under curves (AUCs) of molar enrichment at days 1, 2, 3, 6, 15, and 21 after the labeled doses was 56.3±10.5 and 84.8±16.2 (nmole) for [^2H] retinol from LG and PBG kale [^2H_9] β-carotene, respectively. The AUC of [^(13)C_(10)] retinol from reference dose was 432.6±54.9 (LG) and 560.3±156.7 (nmole) (PBG), respectively. The calculated β- carotene conversion factors were 13.4±3.1 and 11.0±3.9 to 1 (p＞0.05) by weight for LG and PBG, respectively. Conclusions: This study showed that peanut butter enhances the vitamin A value of kale.

• 期刊

Energy restriction combined with green coffee bean extract affects serum adipocytokines and the body composition in obese women

Background and Objectives: Obesity has become a public health problem and is a cause of some preventable illnesses. Among several methods for treating obesity, the use of food supplements is highly common. A commonly used food supplement is green coffee bean extract. The objective of this study was to evaluate the efficacy of green coffee bean extract combined with an energy-restricted diet on the body composition and serum adipocytokines in obese women. Methods and Study Design: In this randomised clinical trial, 64 obese women aged 20-45 years were selected and divided into two groups: an intervention group (receiving 400 mg green coffee bean extract for 8 weeks) and control group (receiving placebo). All participants were on an energy-restricted diet. The body composition, leptin, adiponectin, lipid profile, free fatty acids (FFAs), and fasting blood sugar were compared between the two groups. Results: We observed significant reductions in the body weight, body mass and fat mass indices, and waist-to-hip circumference ratio in both groups; however, the decrease was higher in the intervention group. Moreover, serum total cholesterol, low-density lipoprotein, leptin, and plasma free fatty acids significantly decreased in the intervention group (p＜0.05) after adjustment for energy and fibre intake. The serum adiponectin concentration significantly increased in the intervention group (p＜0.05). Conclusions: Green coffee bean extract combined with an energy-restricted diet affects fat accumulation and lipid metabolism and is thus an inexpensive method for weight control in obese people.