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Nutritional composition of breast milk in Chinese women: a systematic review

Background and Objectives: As breast milk is considered nature’s best food for infant growth and development, understanding its nutritional composition is crucial for optimising the components of infant formula milk. In this study, we aimed to summarise the available evidence on the nutritional composition of breast milk from Chinese women, in particular, the macronutrients, fatty acids and minerals. Methods and Study Design: We searched PubMed, Embase, and Chinese databases for articles about human breast milk from Chinese women published in English or Chinese between 1999 and 2015. We classified the data in 35 articles from the literature search into three lactation stages: colostral, transitional and mature milk. Results: The content of each component varied greatly during the three lactation stages. Protein content decreased from colostral milk to mature milk (mean±SD, 1.64±0.32 g/dL vs 1.22±0.12 g/dL). In contrast, lipid content increased from colostral milk (2.36±1.17 g/dL) to mature milk (3.39±1.24 g/dL). Colostrum contained more linoleic acid (LA) than transitional and mature milk, while colostrum contained less α-linolenic acid (ALA) than transitional and mature milk. As lactation progressed, the ratios of docosahexaenoic acid (DHA) and arachidonic acid (AA) to total fatty acids decreased while the potassium (K), zinc (Zn), and copper (Cu) concentrations decreased significantly, but their standard deviations were large. Magnesium (Mg) and manganese (Mn) concentrations showed significant differences across the three lactation stages. Conclusions: The stage of lactation was an important factor affecting the nutritional composition of breast milk from Chinese women.

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The anti-wasting effects of L-carnitine supplementation on cancer: experimental data and clinical studies

Background and Objectives: Cachexia is a paraneoplastic syndrome that affects the large majority of patients with end-stage cancer. No known therapy exists to effectively overcome the severe symptoms of cachexia, which include anorexia, weight loss and fatigue. This study considered the results of both experimental and clinical studies to evaluate the suitability of L-carnitine and its derivatives as potential therapies for cachexia in patients with cancer. Methods and Study Design: All available English-language papers on the use of L-carnitine in patients with cachexia related to cancer, including reviews, case reports, case series, and clinical trials, were obtained by searching multiple databases, including all Elsevier publications, Web of Knowledge, PubMed, Scopus, clinical trials, and the Cochrane database of systematic reviews. Results: The protective effects of L-carnitine were extracted from the literature review based on critical mechanisms involved in skeletal muscle loss, including increased proteolysis, impaired protein synthesis, myonuclear apoptosis, oxidative stress, and mitochondrial dysfunction. The results of this process favored L-carnitine supplementation in patients with cancer-related cachexia. Nitrogen balance was improved either through the increase of protein synthesis or by reduction in proteolysis, inhibiting apoptosis or reversing inflammatory processes. Conclusions: Although clinical studies are inconclusive, studies in animal models support L-carnitine administration to prevent oxidative stress and ameliorate mitochondrial function. L-carnitine supplementation leads to beneficial effects on several critical mechanisms involved in pathologic skeletal muscle loss and improved fatigue-related parameters in patients with cancer. However, more well-designed, double-blinded, randomized clinical trials are necessary to establish L-carnitine supplementation as a therapeutic strategy for cachexia.

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Pancreatic enzyme replacement therapy (PERT) in children with persistent diarrhea: avoidance of elemental diet need, accessibility and costs

Background and Objectives: Persistent diarrhea has been proven to cause pancreatic exocrine insufficiency, due to decreased stimulation to the pancreas caused by prolonged mucosal injury. Pancreatic enzyme replacement therapy (PERT) given in conjunction to regular treatment is thought to be beneficial in replacing this pancreatic enzyme deficiency, avoiding the need of elemental diet. This study aims to evaluate the benefit of PERT in children with persistent diarrhea. Methods and Study Design: This is a randomized, two double-blind parallel group, placebo-controlled clinical trial to evaluate the effects of pancreatic enzyme supplementation in persistent diarrhea. Children age 6-60 months were recruited from pediatric inpatient and outpatient units of five hospitals in Jakarta. Subjects was randomly assigned to either pancreatic enzyme 8371 USP unit of lipase or placebo, 3 times daily for 1 month, as an adjunctive therapy to standard treatment. Subjects were then reevaluated at 2 weeks and 4 weeks interval after administration of enzyme or placebo. Variables observed were length of diarrhea after the start of intervention, change in serum prealbumin, and change in FE-1 between week 0 and week 4. Results: Pancreatic enzyme supplementation shortens the length of diarrhea by 7 days in the intervention group compared to placebo (p=0.019). Serum prealbumin and FE-1 shows trend that favors the intervention group, although not statistically significant (p＞0.05). Conclusion: PERT is clinically effective in reducing the length of diarrhea, thus minimizing the need, accessibility and costs of an elemental diet.

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Thalassemia and other hemoglobinopathies among anemic individuals in Metro Manila, Philippines and their intake of iron supplements

Background and Objectives: Iron deficiency is the most common cause of anemia worldwide. In Southeast Asia, studies showed that genetic hemoglobin disorders also contribute significantly to the burden of anemia. The study aimed to estimate the proportion of thalassemia and other hemoglobinopathies versus iron deficiency and other causes in a sample of anemic individuals; describe the characteristics of thalassemic subjects in terms of severity of anemia, adequacy of iron stores, and hematological profile; examine the intake of iron supplements among individuals with varying causes of anemia. Methods and Study Design: A random sample of 101 anemic individuals living in Metro Manila was examined. Hemoglobinopathy was determined using capillary electrophoresis. Iron deficiency was determined using immunoradiometric assay for serum ferritin. A questionnaire was used to obtain information on the use of iron supplements. Results: The most frequent underlying cause of anemia was iron deficiency (37.6%), followed by anemia due to other causes (34.7%), and hemoglobinopathy (27.8%). The most prevalent form of hemoglobinopathy was alpha-thalassemia trait (20.8%), followed by betathalassemia trait (5%), iron deficiency anemia with concomitant HbE (1%), and beta-thalassemia HbE interacting (1%). Thalassemic subjects exhibited mild anemia, had either normal or excessive iron stores, and did not ingest iron supplements. Conclusion: The majority of anemia (62.5%) in this sample was due to other causes and hemoglobinopathy, rather than iron deficiency. Genetic hemoglobin disorders appear to be common among anemic individuals. Population screening is needed to determine the real prevalence of the disease. Further investigation is needed to identify other causes of anemia among Filipinos.

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Malnutrition and chronic inflammation as risk factors for sarcopenia in elderly patients with hip fracture

Background and Objectives: To evaluate malnutrition and chronic inflammation as risk factors for sarcopenia in elderly patients with hip fractures, as defined by the criteria of the Asian Working Group on Sarcopenia (AWGS). Methods and Study Design: A total of 327 elderly patients with hip fractures were enrolled in this retrospective observational study. The main outcome measure was the nutritional status and nutritional risk factors for sarcopenia in elderly patients. Diagnosis of sarcopenia was made according to the guidelines of the AWGS. Whole body densitometry analysis was used to measure skeletal muscle mass, and muscle strength was evaluated by handgrip testing. Multivariable regression analysis was utilized to analyze the nutritional risk factors for sarcopenia in patients with hip fractures. Results: Of 327 patients with hip fractures (78 men and 249 women), the prevalence of sarcopenia was 60.3% and 30.1% in men and women, respectively. The rates of three indicators of malnutrition in men and women (low BMI, hypoalbuminemia, and hypoproteinemia) in sarcopenia patients with hip fractures were 23.4%, 31.9%, and 53.2% and 21.3%, 21.3%, and 37.3%, respectively. The prevalence of markers of chronic inflammation (increased CRP and ESR) in men and women with sarcopenia and hip fractures were 74.9% and 52.2%, and 49.3% and 85.1%, respectively. After adjusting for covariates, low BMI and hypoproteinemia in women were associated with a 2.9- and 2.1-fold greater risk of sarcopenia than non-sarcopenia, respectively. Conclusions: The present study revealed a strong relationship between sarcopenia and malnutrition and chronic inflammatory factors in elderly patients with hip fractures.

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Identifying errors in meals provided to and sourced by patients on therapeutic diets in hospital

Background and Objectives: Patients requiring therapeutic diets in hospital are at risk of exposer to dietary errors that may pose an acute threat to their safety. This study aimed to determine the prevalence of meal-related errors among hospitalised patients prescribed therapeutic diets, following the implementation of an electronic foodservice system (EFS). Methods and Study Design: This observational study involved six wards in a tertiary metropolitan hospital that used an EFS for meal ordering and plating. Participants were adult medical inpatients receiving a therapeutic diet for medical or nutritional reasons. Meal accuracy was assessed for up to 48-hours per patient by comparing the dietary items placed on patients’ meal trays or personal meals consumed by patients to their therapeutic diet prescription. Inaccuracies were categorised as critical or non-critical errors and were identified as having occurred at one of four steps in the EFS: menu planning (main-meals), meal assembly (main-meals), meal delivery (mid- and main-meals) and meal consumption (personal-meals). Results: A total of 167 inpatients were included in the study. Of the 906 meals assessed, 69 errors (8%) were observed; with 97% classified as critical. Error rates differed according to the foodservice system step assessed: 17% for menu planning, ＜1% for meal assembly, 53% for meal delivery: main-meals, 9% for meal delivery: mid-meals and 33% meal consumption. Conclusion: An EFS almost completely eliminated errors associated with meal assembly. However, when foodservice staff and patients selected dietary items at ward level (without a guiding system) a substantial number of potentially critical errors occurred.

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Prognostic value of preoperative prognostic nutritional index in stage III gastric cancer after curative resection: a retrospective cohort study

Background and Objectives: Nutrition and inflammation play a crucial role in the development of cancer. The prognostic value of the prognostic nutritional index (PNI) has been confirmed in some types of human cancers. This study analyzed the prognostic significance of the preoperative PNI in patients with stage III gastric cancer after curative surgery. Methods and Study Design: In this retrospective study, we enrolled 274 patients who underwent curative operation for stage III gastric cancer. The correlation between the preoperative PNI and overall survival (OS) was analyzed using Kaplan–Meier curves and multivariate Cox regression analyses. Results: The patients with a high PNI had a significantly higher median OS than did those with a low PNI (46.8 months vs 24.1 months, p=0.01). In the subgroup analysis, the survival benefit of the PNI was limited to the patients with poorly differentiated gastric cancer (high PNI, 46.8 months; low PNI, 21.8 months, p=0.004) and was not observed in those with well and moderately differentiated cancer (high PNI, 30.3 months; low PNI, 26.7 months, p=0.30). In the multivariate analysis, the PNI was an independent prognostic factor for OS. Conclusions: The PNI can be used as an independent prognostic biomarker for operable advanced gastric cancer.

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The impact of self-efficacy education based on the health belief model in Iranian patients with type 2 diabetes: a randomised controlled intervention study

Background and Objectives: Type 2 diabetes is a chronic illness which can be managed by patients' commitment to self-care and self-efficacy behaviors. Methods and Study Design: A randomized controlled intervention study was carried out to determine the impact of self-efficacy education based on the Health Belief Model (HBM) in 240 patients with type 2 diabetes at the Golestan Hospital, Ahvaz, Iran between October 2014 and August 2015. The education duration was three months followed by a 24-week follow-up visit to determine the progress of the subjects. In this study, reliable and validated diabetes educational booklet and questionnaires based on knowledge, health beliefs and quality of life were used. The participants were randomly allocated to either the intervention group (n=120) or to the conventional dietary counseling group as controls (n=120), and assessed at the baseline, week 12 and week 36. The study was divided into primary outcome measurements consisting of glycated hemoglobin A1c (HbA1c), fasting blood glucose, lipid profile, and anthropometric levels. Secondary outcome measures were related to nutrition knowledge, health beliefs and quality of life. Results: The results showed that subjects in the intervention group had significantly better metabolic and glycemic profiles compared with those in the control group. It also showed that knowledge, health belief and quality of life significantly increased in the intervention group. Conclusions: Findings indicate that through tailored self-efficacy education, the quality of life and metabolic profile of diabetes patients can be improved.

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Cinnamon improves metabolic factors without detectable effects on adiponectin in women with polycystic ovary syndrome

Background and Objectives: The objectives of this study were to investigate the effects of cinnamon supplementation on glycemic indices, serum lipids and adiponectin in patients with polycystic ovary syndrome (PCOS). Methods and Study Design: This double-blind randomized controlled clinical trial was conducted on 84 overweight or obese PCOS patients. Subjects in cinnamon (n=42) and placebo (n=42) groups were given 3 cinnamon capsules (each one contained 500 mg cinnamon) or placebo daily for 8 weeks. Fasting blood samples, anthropometric measurements and dietary intake data were collected at the baseline and at the end of the trial. Data were analyzed by independent t test, paired t test and analysis of covariance. Results: Cinnamon significantly decreased serum fasting blood glucose, insulin, homeostatic model assessment for insulin resistance, total cholesterol and low-density lipoprotein cholesterol and weight and increased high-density lipoprotein cholesterol compared with placebo (all p＜0.05). Serum triglyceride and body mass index significantly decreased in the cinnamon group, in comparison with baseline values (p=0.001 and p=0.002, respectively). No significant changes were seen in serum adiponectin in either group. Conclusions: Short term supplementation of cinnamon had some favourable effects on metabolic risk factors of women with PCOS and may be useful in management of PCOS complications.

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Efficacy of actinidin-containing kiwifruit extract Zyactinase on constipation: a randomised double-blinded placebo-controlled clinical trial

Background and Objectives: Zyactinase® is an extract of green kiwifruit, formulated into the consumer healthcare products marketed as Phloe® and Kivia, used to assist in the relief of the symptoms associated with a range of digestive system dysfunction, including constipation and Irritable Bowel Syndrome (IBS). Methods and Study Design: A randomised, double-blind, placebo-controlled clinical trial was undertaken to determine the effects of the kiwifruit extract on bowel movement, stool formation and IBS associated symptoms amongst a subject group of generally healthy individuals experiencing a period of moderate constipation. Fifty-eight participants were randomized to the kiwifruit extract (28) or placebo (30). Selection criterion was decreased number of bowel movements (＜3/week), with increased faecal hardness and IBS associated symptoms. The study ran for three weeks, with participants first undergoing a seven-day wash out period, followed by a seven-day dosing period, and then a seven-day follow up period. Results: There was a significant increase in the defecation frequency (p＜0.001), with a significant improvement in faecal score (p＜0.01). There was a significant difference in painful defecation and abdominal pain between the two groups (p＜0.01). No side effects, including diarrhoea, urgency or abdominal pain, were observed during the trial. Conclusions: The green kiwifruit extract significantly induced normal bowel movements with no adverse effects. The kiwifruit extract relieved constipation and the symptoms of IBS such as bloating, flatulence and abdominal pain.