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Addressing nutritional requirements of ageing consumers in Asia-recommendations from an expert workshop

The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to support the older persons, most of these efforts targeted the general population rather than the older persons population segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different countries, initiatives, and programs to further evaluate the available data to underpin future research.

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Bioavailability and incorporation of nonheme iron from a representative Chinese diet in young urban Chinese women

Background and Objectives: This study assessed the bioavailability and biological incorporation of nonheme iron from staple food diets in healthy young urban Chinese women and determined the relevant effects of typical regional patterns of staple foods in South and North China. Methods and Study Design: Twenty-two young urban Chinese women aged 20-23 years were enrolled and randomly allocated to two groups, with rice (rice group) and steamed buns (steamed buns group) as the staple food, respectively. Each participant received three meals daily containing approximately 3.25 mg of stable ^(57)FeSO_4 for 2 consecutive days, along with daily intravenous injection of approximately 2.0 mg of ^(58)FeSO_4. Nonheme iron absorption and infused iron incorporation rates were assayed. Results: In all participants, the rice group, and the buns group, nonheme iron intake was 7.2±1.6, 5.9±0.6, and 8.4±1.2 mg, respectively; mean ^(57)FeSO_4 absorption rate was 22.2%±9.6%, 22.2%±10.6%, and 22.2%±8.9%, respectively; and the mean infused ^(58)FeSO_4 incorporation rate was 91.6%±8.2%, 93%±7.3%, and 90%±9.1%, respectively. No substantial differences existed in the nonheme iron intakes and the ^(57)FeSO_4 absorption and ^(58)FeSO_4 incorporation rates between the rice and buns groups (all p＞0.05). Conclusions: The bioavailability and incorporation rates of nonheme iron from representative comprehensive Chinese diets in healthy young urban Chinese women were evaluated. Our results can facilitate the establishment of dietary reference intake for iron in Chinese women.

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Pretreatment nutritional risk as a prognostic factor in head and neck cancer patients receiving radiotherapy or chemoradiotherapy

Background and Objectives: Head and neck cancer patients often experience nutritional deterioration, which decreases their treatment tolerance and is associated with poor outcomes. We analyzed nutritional status in head and neck cancer patients before and during treatment, and its impact on clinical outcomes. Methods and Study Design: Between January 2009 and April 2012, 336 head and neck cancer patients receiving radiotherapy or chemoradiotherapy were prospectively entered into the study. The Nutritional Risk Screening 2002 (NRS 2002) assessment was used to evaluate their nutritional status. Results: A total of 227 patients with nasopharyngeal carcinoma and 109 patients with head and neck cancers were analyzed. The proportion of patients receiving radiotherapy or chemoradiotherapy at nutritional risk was 61.3%, with 11.9% at risk before treatment and 49.4% developing risk during treatment. In multivariate analysis, nutritional risk before treatment was associated with T stage for the two groups. Risk was significantly higher in patients receiving concurrent chemoradiotherapy during treatment for nasopharygeal carcinoma patients. The prognosis of pretreatment nutritional risk patients was worse than those becoming at risk during treatment and those without nutritional risk (3-year overall survival 62.9% vs 81.7% vs 80.6%, p=0.026; 3-year disease-free survival 64.8% vs 84.5% vs 84.4%, p=0.019). Conclusions: The incidence of nutritional risk is high in head and neck cancer patients receiving radiotherapy or chemoradiotherapy, especially during treatment. Pretreatment nutritional risk evaluated using the NRS 2002 can predict patient prognosis.

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The impact of daily use of an enteral feeding checklist on clinical outcomes in shock patients: a retrospective cohort study

Background and Objectives: The optimal delivery of enteral nutrition in shock patients has an important prognostic clinical value; thus, checklists for standardizing enteral nutrition should be developed. This study examined whether the use of an enteral feeding checklist can improve enteral nutrition in shock patients. Methods and Study Design: A retrospective cohort study was conducted. A multidisciplinary working group developed an enteral feeding checklist. Information on patients' demographics, checklist items, and clinical outcomes was collected. Results: In total, 148 patients were included. The checklist was used for 35 patients but not for the remaining 113 patients. Patients in the checklist group received enteral nutrition earlier (2.6 vs 4.6 days, p=0.017) and had a lower mechanical ventilation rate (62.9% vs 85.0%, p=0.004). The checklist group had shorter intensive care unit stay (mean 17.3 vs 25.7 days, p=0.043). No significant differences were observed in 28- and 90- day mortality, mechanical ventilation duration, and intolerance to enteral nutrition. Conclusions: The use of an enteral feeding checklist in shock patients was associated with earlier enteral nutrition delivery and decreased intensive care unit stay.

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Barriers to enteral feeding of critically ill adults in Korea

Background and Objectives: Evaluating barriers to provision of enteral nutrition in intensive care units and planning an appropriate intervention can improve nutritional nursing practice in these units. This study aimed to develop a Korean version of the Barriers to Enterally Feeding Critically Ill Patients Questionnaire (BEFIP-K) and to explore the barriers to enteral feeding of critically ill patients in Korea. Methods and Study Design: The 24- item BEFIP-K was developed according to the process laid down by the World Health Organization. Its psychometric properties were assessed, including acceptability; validity, which included content validity and construct validity; and reliability, which consisted of internal consistency and item-total correlation, using data from 207 critical care nurses in four tertiary hospitals in South Korea. Results: The calculated content validity indices for each item were from 0.88 to 1.00. As for the exploratory factor analysis, 24 items were loaded on five domains, accounting for 56.9% of the total variance. The Cronbach's alpha coefficient of the total scale was 0.913 and the coefficients for item-total correlation analyses ranged from 0.469 to 0.694. The total BEFIP-K score was 32.1, with a range from 18.5 to 45.4. Conclusions: The findings support that the BEFIP-K is a feasible, valid instrument for assessing barriers to provision of enteral nutrition.

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Nutrition support for critically ill patients in China: role of the pharmacist

Background and Objectives: The participation of a nutrition support pharmacist (NSP) in a multidisciplinary team (MDT) for patients receiving nutrition support therapy (NST) may lead to more favourable outcomes and fewer complications and adverse events. However, few studies have demonstrated the role of NSPs in MDTs in China. To investigate pharmacy interventions and physician acceptance of these interventions for patients receiving NST in an intensive care unit (ICU). Methods and Study Design: A prospective study over a 12-month period was conducted in an ICU at an academic hospital in China. Interventions were documented and divided into the following categories: indication of NST, parenteral nutrition (PN) prescription and delivery, enteral nutrition (EN) route and formulation, fluids and electrolytes, laboratory test monitoring, nutritional supplements, and other medication-related problems. Data regarding the intervention categories, timing, acceptance rates, and methods of communication to discuss pharmacy interventions were collected. Results: In total, 247 interventions for 120 patients were identified. The overall acceptance rate of interventions was 85.0% (210/247), and more than half of the interventions (143, 57.9%) were performed during daily follow-up. The most common intervention categories were PN prescription and delivery (81/247, 32.8%), EN route and formula (33/247, 13.4%), indication of NST (33/247, 13.4%), and nutritional supplements (30/247, 12.1%). The most accepted intervention category was PN prescription and delivery (79/81, 97.5%), and the most common method of communication was oral communication during MDT rounds (201/247, 81.4%). Conclusions: This study demonstrated the unique perspectives offered and importance of having pharmacists as members of MDTs.

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Impact of nutritional status on length of stay and hospital costs among patients admitted to a tertiary care hospital in Thailand

Background and Objectives: Malnutrition has high prevalence among hospitalized patients but goes unrecognized in many patients. Early detection of malnutrition using an effective screening tool is required. This study aimed to examine the effects of nutritional status determined by the Nutrition Alert Form (NAF) and its individual sections on length of stay (LOS) and hospital costs in hospitalized patients, to investigate their associated factors, and to determine hospital malnutrition prevalence. Methods and Study Design: This retrospective cohort study enrolled 2,906 hospitalized patients aged ≥15 years in Ramathibodi Hospital between January and September 2016. At admission, nutritional status was screened using NAF. Nutrition status was defined as: NAF-A (normal/mild malnutrition; scores of 0-5), NAF-B (moderate malnutrition; 6-10), and NAF-C (severe malnutrition; ≥11). Information regarding LOS and hospital costs during patients' hospitalization was also collected. Results: The prevalence of malnutrition was 15.3%. After adjusting for age, sex and primary diagnosis, we found significantly longer LOS and higher hospital costs among those with NAF-B and NAF-C, in comparison with patients having NAF-A. The highest increase in LOS was in male patients aged ≥60 years with NAF-C. The highest increase in LOS and hospital costs was associated with higher scores for functional capacity. Conclusions: Higher levels of malnutrition screened using the NAF were significantly associated with longer LOS and higher hospital costs. Older adult patients had the highest risk of being malnourished and developing negative consequences. A prospective study of nutritional support by a nutrition care team is underway.

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Oat porridge consumption alleviates markers of inflammation and oxidative stress in hypercholesterolemic adults

Background and Objectives: Oats contain antioxidant phytochemicals that may help reduce inflammation as well as oxidative stress. In this study we aimed to investigate the effect of oat porridge consumption on inflammatory marker levels and oxidative stress in Thai adults with high blood lipid levels. Methods and Study Design: A randomized crossover study was conducted. Hypercholesterolemic adults were randomly assigned to a 4-week daily consumption of oat or rice porridge. After 4 weeks, they were switched to alternate intervention arms for 4 weeks. At baseline, before and after each intervention period, inflammatory markers including hsCRP, IL-6, IL-8, TNF-α, and MCP-1 and antioxidant status markers including ORAC, FRAP, and MDA of all subjects were measured. Results: Compared to baseline, levels of hsCRP, IL-6, IL-8, and TNF-α were significantly decreased after oat porridge consumption (mean change: -0.6±0.9 mg/L, -26.9±27.6 pg/mL, -56.3±27.6 pg/mL, and - 9.7±11.6 pg/mL, p＜0.05 for all, respectively). In addition, consumption of oat porridge also increased antioxidant capacity; ORAC and FRAP levels (mean change: 2.7±1.0 μmol of Trolox/L and 2.4±0.8 μmol of Fe^(2+)/L, p＜0.001, respectively). However, MCP-1 and MDA levels were not affected. Consumption of rice porridge did not lead to significant changes in these measures. Conclusions: Daily consumption of 70 grams oat porridge containing 3 grams β-glucan for 4 weeks may help reduce markers of inflammation and oxidation in hypercholesterolemic adults. Therefore, oat may be an appropriate dietary recommendation for individuals with hypercholesterolemia.

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Consumption of black food decreases the risk of abdominal obesity in Korean women

Background and Objectives: The association between black-colored foods (black foods) such as black beans, known for their high antioxidant capacity, and the prevention of metabolic diseases has been explored, but not in a large population. Therefore, this study examined relationships between the consumption of black foods and metabolic syndrome in Korean adults. Methods and Study Design: Data from 9,499 40-65-year old subjects (3,675 men and 5,824 women) from the 2010-2015 Korea National Health and Nutrition Examination Survey were used in the analysis. Black food consumption was estimated using 24-h dietary recall data, and analyses were performed according to black food consumer and non-consumer groups. Results: The average total consumption of black foods was higher in women than men. The total black food consumer group in women had a 24% reduced risk of abdominal obesity than the non-consumer group (p=0.007). Furthermore, waist circumference decreased significantly with an increase in total black food consumption in women. High consumption of total black foods and black beans reduced the risk of abdominal obesity by 26% (p for trend=0.012) and 29% (p for trend=0.003) compared with no consumption. No risk factors for metabolic syndrome were associated with black food consumption in men. Conclusions: In conclusion, black foods, including black beans, may have beneficial effects on metabolic syndrome components, especially abdominal obesity.

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Fish and meat intakes and prevalence of anemia among the Japanese elderly

Background and Objectives: Information about an association between animal food intakes and risk of anemia is still limited. This study aimed to investigate the association between fish and meat intake and anemia risk in the Japanese elderly. Methods and Study Design: A nationally representative sample of 6,469 aged 65 years and over was obtained from pooled data of annual National Health and Nutritional Survey in Japan during 2002-2011. Anemia was defined as hemoglobin concentrations ＜13.0 g/dL in males and ＜12.0 g/dL in females. Logistic regression analysis, with the lowest intake tertile as the reference, was applied to estimate anemia risk for each nutrient and food group. Results: After adjustment for putative confounding factors, males in the highest tertile of animal protein intake had significantly lower risk of anemia than those in the lowest tertile (odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63, 0.95; p for trend=0.017). These associations were not seen in females (OR: 0.72, 95% CI: 0.49, 1.06; p for trend=0.100). Multivariate analyses revealed that anemia risk (OR: 0.80; 95% CI: 0.65, 0.97; p for trend =0.002) was lower for males in the highest tertile of fish intake than in the lowest tertile; this effect was also observed for females (OR: 0.64; 95% CI: 0.45, 0.92; p for trend =0.014). In both sexes, the highest tertile of meat intake was not associated with lower anemia risk in the multivariate-adjusted models. Conclusions: The current cross-sectional study in Japanese elderly males suggests that higher animal protein, specifically the high protein content of fish may be associated with a lower prevalence of anemia.