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Dietary soybean isoflavones in Alzheimer's disease prevention

Soybean isoflavone (SIF) is a type of polyphenol present extensively in legumes. Because of its unique chemical construction and the physiological activity of the phenolic hydroxyl group, SIF exhibits strong antioxidant activity in antioxidant and nonantioxidant enzyme systems. Genistein is the major isoflavone in soy foods, accounting for more than 50% of the isoflavone content. The health effects of soybean dietary isoflavones on humans have gained increased attention. Recent studies have suggested that SIF may alleviate neurodegenerative diseases such as Alzheimer's disease (AD). Despite the comprehensive research on AD, effective treatments for AD are yet to be established. The early diagnosis and prevention of mild cognitive impairment (MCI) have become crucial for delaying AD development. Several dietary polyphenols have exerted cognitive effects on AD, and the appropriate intake of dietary SIF helps reduce the risk of AD. This study reviews the possible mechanisms of AD pathogenesis and their relationships with SIF intake; the results provide useful insights for AD prevention in the future.

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Nutritional outcomes with radiotherapy for head and neck cancer: a before and after comparison of 'best practice guidelines' implementation

Background and Objectives: Malnutrition is prevalent amongst people with head and neck cancer treated with radiotherapy and can result in reduced tolerance to treatment and increased hospital admissions. Current best-practice guidelines recommend weekly dietetic review during radiotherapy and fortnightly review for six weeks following radiotherapy to minimize weight loss. The primary aim of this study was to compare percent weight loss during radiotherapy before and after the implementation of weekly dietetic review. In the post-guideline implementation group we aimed to investigate factors associated with greater weight loss and describe weight changes 4-8 weeks post radiotherapy. Methods and Study Design: Adults with head and neck cancer who received dietetic input and curative intent radiotherapy were included. Data were collected via retrospective chart audit of records from the Nutrition and Dietetics department. Results: The analysis involved 142 people, 66% (n=94) of whom received dietetic input in the post-guideline implementation period. Mean weight loss was not different between the pre- and post-guideline implementation groups (-5.9±6.34% vs -6.6±5.29%; p=0.477). In the post-guideline implementation group, advanced tumor stage and concurrent chemoradiation were associated with greater percent weight loss (p=0.006 and p＜0.001, respectively). Mean weight loss increased by 1.9±4.96%, 4-8 weeks after radiotherapy (p=0.004). Conclusions: Percent weight loss during radiotherapy was not reduced following the implementation of weekly dietetic review. In the 4-8 weeks following radiotherapy, weight loss increased significantly over that between baseline and end of radiotherapy. Future research should explore and address the reasons why critical weight loss occurs despite improved access to dietetic care.

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Serum vitamin D decreases during chemotherapy: an Australian prospective cohort study

Background and Objectives: Vitamin D plays an important role in bone and muscle function, and cell proliferation. The impact of chemotherapy and associated behavioural changes such as fatigue and sun avoidance on vitamin D (25(OH) D) is unknown. This study aims to evaluate variations in serum vitamin D during chemotherapy and the predictive value of latitude, season and pre-existing vitamin D deficiency. Methods and Study Design: A 12-week prospective cohort study was conducted in chemotherapy-naïve patients in two Australian locations with different sun exposure. Vitamin D deficiency was defined as ≤25 nmol/L and insufficiency 26-50 nmol/L 25(OH) D. Demographics, chemotherapy regimen, nutritional status, sun exposure, geographic location, and season were collected at baseline, 6 and 12 weeks after commencing chemotherapy. Results: Eighty-five patients (μ55.3±13.4 years of age; 49% female) were recruited, 96% Caucasian. Fifty-four patients were treated with curative intent (mostly for breast [n=29] or colorectal [n=12] cancers). At baseline, 10 patients were vitamin D deficient and 33 were insufficient. Mean serum 25(OH) D (nmol/L) was higher at latitude -27.5° (Brisbane) than latitude -34.9° (Adelaide) (μ61.9±22.1 vs μ42.2±19.2, p＜0.001) and varied according to season (spring: μ46.9±20.3, summer: μ50.8±18.2, autumn: μ76.4±25.2, winter: μ36.5±15.7, p＜0.001). Serum 25(OH) D decreased with chemotherapy (baseline: μ49.2±22.3, 6-weeks: μ40.9±19.0, 12-weeks: μ45.9±19.7, p=0.05), with a significant and more rapid decline in winter and autumn (p=0.03). Conclusions: Chemotherapy is associated with a decrease in serum vitamin D, particularly during winter and autumn. Investigations into the underlying mechanism and associated potential outcomes with this decrease requires further investigation.

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Fasting leads to fasting: examining the relationships between perioperative fasting times and fasting for symptoms in patients undergoing elective abdominal surgery

Background and Objectives: A growing body of evidence indicates traditional perioperative care practices of extended fasting and delayed feeding are outdated and detrimental to patient prognosis. This study aimed to explore associations between perioperative fasting, progression to solids and fasting for symptoms; assessing whether excessive pre-operative fasting results in further fasting post-operatively. Methods and Study Design: Two hundred patients who underwent elective surgery from March 2015 to June 2015 in upper gastrointestinal, colorectal and urological departments of a major teaching hospital were included in the study. A retrospective medical record audit was conducted to determine patient demographics, clinical data, perioperative fasting times and diet progression. Results: Preoperative fasting significantly correlated with time taken to progress to solids (rs(198)=0.180, p=0.011), but not with postoperative fasting. Patients who experienced subsequent fasting episodes for symptom management had a significantly longer postoperative fasting time (Med=25.5 hours +/- 19.7) than those who did not (Med=6.2 hours +/- 38.7, p=0.025). Significant differences in fasting times and diet progression were found based on Enhanced Recovery After Surgery (ERAS) status, magnitude of surgery, surgical department, and morning versus afternoon operating lists. Conclusions: Associations between extended perioperative fasting times, diet progression, and fasting for symptoms exist, such that the adverse effects of suboptimal nutritional status on recovery may be traced back to before the patient even arrives for surgery. Challenges of reducing fasting times may be overcome with repeated training of clinicians with best practice guidelines, and improving postoperative adherence to ERAS protocols.

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Safety and benefit of pre-operative oral carbohydrate in infants: a multi-center study in China

Background and Objectives: Pre-operative oral carbohydrate administration (POCA) is an important aspect of enhanced recovery after surgery and has many advantages. The objective of this study was to explore the safety and effect of pre-operative oral carbohydrate administration in infants. Methods and Study Design: This was a prospective, multi-center, randomized study that randomly assigned 1200 infants into four groups. In the control group (group A), the infants were strictly restricted to 6-h preoperative fasting before anesthesia. In the enhanced recovery after surgery (ERAS) groups (groups B, C, and D), the infants were orally administered a 10% carbohydrate solution (10% glucose water; 5, 10, and 15 mL/kg, respectively) 2 h before anesthesia. Blood glucose, gastric residual volumes, crying ratios, and the length of hospital stay were observed. Results: The blood glucose was significantly higher in groups B, C, and D than group A at the time of anesthesia. The gastric residual volume revealed virtually no residue in groups A, B, and C, but 15 infants in group D had a gastric residual volume. The crying ratio was significantly higher in group A. The length of hospital stay was not significantly different between the groups. Conclusions: POCA is well-tolerated in infants at a dose of 10 mL/kg.

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Prevalence of undernutrition in Japanese pediatric patients on admission: Comparison of tertiary, acute-care, and rehabilitation hospitals

Background and Objectives: There exist many studies in Western countries dealing with pediatric nutritional assessment on admission, but those in Asian countries are comparatively limited. This study aimed at clarifying the prevalence of undernutrition in 3 Japanese pediatric hospitals, especially focusing on their different characteristics. Methods and Study Design: Study participants included 313 patients aged 1-17 years admitted to a tertiary hospital (175 patients), an acute-care hospital (99 patients), or a rehabilitation hospital (39 patients). On admission, body height, weight, and serum albumin were measured. BMI was calculated by dividing the weight (kg) by the square of height (m). Patients exhibited undernutrition on account of BMI z-score ＜-2, weight-for-height (W/H) ＜90%, height-for-age (H/A) ＜95%, or albumin ＜3.5 g/dL. Results: The overall prevalence of undernutrition was 53.0%. Among 4 nutritional measures, the prevalence was highest in H/A (33.9%), followed by W/H (26.8%), BMI z-score (17.6%) and albumin (12.8%). A rehabilitation hospital exhibited significantly higher prevalence than that in a tertiary- or acute-care hospital. By the classification of International Statistical Classification of Diseases and Related Health Problems-10, neurological diseases and congenital anomalies showed higher prevalence among the disease categories which had the number of enrolled patients more than twenty. Conclusions: This study indicates that hospital characteristics and inpatient disease categories are important in the admission evaluation of the likelihood of undernutrition. These observations require consideration by hospital physicians in paediatric nutritional diagnosis and management.

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Prevalence and associated risk factors of malnutrition among hospitalized adults in a multisite study in Ho Chi Minh city Viet Nam

Background and Objectives: This study aims to assess the prevalence and associated risk factors of malnutrition in adults in acute care settings. Methods and Study Design: A cross-sectional study among 883 participants from 6 representative general public hospitals was conducted during April and May 2016. Participants were considered malnourished if they were classified using Subjective Global Assessment (SGA) as malnourished (B or C) or with BMI ＜ 18.5kg/m^2. Demographic and socio-economic status characteristics were measured using interviewer- administered questionnaires. Sampling weights for the number of participants in each hospital were calculated to account for the difference in the stratified cluster sampling design. Logistic regression was used to examine the association of malnutrition with potential risk factors. Results: The prevalence of underweight (BMI ＜18.5 kg/m^2) and hospital malnutrition (B/C on SGA or BMI ＜18.5 kg/m^2) in acute care setting was 14.0% and 34.1%. The prevalence was higher in participants over 80 years old (49.7%), attending a Level 1 hospital (37.1%), with an oncology (46.5%) or pulmonary (43.6%) diagnosis. The risk of being malnourished was statistically significantly higher among participants who were living in poverty (OR: 1.6), were living in marginal poverty (OR: 1.3), did not work in the last six months (OR: 1.7), had a length of stay over 10 days (OR: 1.6) and were admitted via emergency (OR: 1.5). Conclusions: Hospital malnutrition is a significant health problem in Ho Chi Minh City. Socio-economic status and pre-admission underweight were significant risk factors besides other clinical risk factors. Improvement of nutrition and dietetics services is crucial to optimize patient outcomes.

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Prognostic nutritional index relevance in chemoradiotherapy for advanced oral cavity, oropharyngeal and hypopharyngeal cancer

Background and Objectives: This study was designed to evaluate the impact of the prognostic nutritional index (PNI) on treatment-related toxicities and tolerance in patients with advanced head and neck cancers who were undergoing concurrent chemoradiotherapy (CCRT). Methods and Study Design: We retrospectively analyzed and compared the clinical characteristic, toxicities and survival of 143 patients with stage III, IVA, and IVB head and neck cancer who were treated with CCRT according to their PNI between 2007 and 2010. Results: Low PNI was correlated with T classification and advanced tumor stage. Patients with low PNI were less likely to tolerate CCRT, required tube feeding support more frequently and had higher percentages of grade 3/4 hematological toxicities, sepsis and toxic death. Conclusions: Pretreatment PNI predicts treatment-tolerance and toxicity in patients with advanced head and neck cancer undergoing CCRT.

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HDL subfraction changes with a low-fat, plant-based Complete Health Improvement Program (CHIP)

Background and Objectives: Low HDL concentrations are considered an important risk factor for cardiovascular disease. Interventions promoting a low-fat, plant-based eating pattern appear to reduce CVD risk while paradoxically also reducing HDL concentrations. Recent studies show HDL to comprise a range of subfractions, but the role these play in ameliorating the risk of CVD is unclear. The purpose of this study was to characterise changes in HDL subfractions in participants where HDL decreased following the CHIP intervention which promotes a low-fat, plant-based diet, with physical activity. Methods and Study Design: Individuals (n=22; mean age=55.4±16.3 years; 45.5% men, 54.5% women) participating in a CHIP intervention were assessed at baseline and 30 days for changes in BMI, blood pressure, lipid profile, (including large-, intermediate- and small-HDL subfractions) and fasting glucose. Results: HDL significantly decreased (10.6%, p＜0.001) together with BMI (2.5%, p=0.028), systolic blood pressure (7.1%, p=-0.005), total cholesterol (9.5%, p=0.002), LDL (11.2%, p=0.007) and fasting glucose (8.2%, p=0.028). Triglycerides (TG) did not significantly change. Physical activity (22.7%, p=0.016) and consumption of whole plant-foods (13.9%, p=0.003) significantly increased, while nonplant (energy and animal) foods decreased (43.1%, p=0.009). Large-, intermediate- and small-HDL decreased (- 10.0%, p=0.003; -8.3%, p=0.013 and 22%, p=0.005, respectively). Conclusions: This paper discusses specific changes in HDL subfractions when overall-HDL decreases as a response to low fat, whole-food, plant-based eating and exercise. Additional research is required to elucidate the reasons through which behavioural therapies remodel the HDL particle and how this impacts the functional properties of HDL and CVD risk.

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Prolonged effectiveness of 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism

Background and Objectives: To investigate the prolonged effects of a 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism. Methods and Study Design: A total of 180 participants were randomly divided into an intervention group (n=94), and a control group (n=86). An exercise-plus- diet intervention was conducted on the intervention group for 12 months. The effects were evaluated by questionnaire, physical examinations, and blood tests at baseline, 3 months, 12 months (the end of intervention), and 24 months (one year after the end of intervention). The control group took only the same examinations as the intervention group. Results: At the end of the 12-month intervention, body weight, waist circumference, fasting glucose, HbA1c, triglycerides, and LDL-cholesterol were improved in the intervention group compared to the control group (all p＜0.05). One year after the end of the intervention, body weight, waist circumference, fasting glucose, triglycerides, and LDL-cholesterol were still decreased in the intervention group compared to the control group (all p＜0.05), especially among non-overweight participants. Among overweight persons, only body weight in the intervention group was lower than the control group. The personal behaviours of physical activity and diet in the intervention group were also improved. Conclusions: The 12-month exercise-plus-diet programs were found to be effective in improving glucose and lipid metabolism, as well as personal behaviour one year after completion of the intervention.