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Portion controlled ready-to-eat meal replacement is associated with short term weight loss: a randomised controlled trial

Background and Objectives: Strategies to prevent and treat overweight/obesity are urgently needed. This study assessed the effect of a short-term intake of ready-to-eat cereal on body weight and waist circumference of overweight/ obese individuals in comparison to a control group. Methods and Study Design: A randomized, controlled 2-arm trial was carried out on 101 overweight/obese (Body Mass Index - 29.2±2.4 kg/m^2) females aged 18 to 44 years, at St. John's Medical College Hospital. The intervention group received a low fat, ready to eat cereal, replacing two meals/day for two weeks. The control group was provided with standard dietary guidelines for weight loss and energy requirements for both groups were calculated similarly. Anthropometric, dietary, appetite and health status assessments were carried out at baseline and at the end of two weeks. Results: At the end of two weeks, the mean reductions in body weight and waist circumference were significantly greater in the intervention group, -0.53 kg; 95% CI (-0.86 to -0.19) for body weight and -1.39 cm; 95% CI (-1.78, -0.99) for waist circumference. The intervention group had a significantly higher increase in dietary intakes of certain vitamins, fiber and sugar, and significantly higher reductions in total and polyunsaturated fats and sodium intakes, as compared to the control group (p≤0.05). No significant differences were observed between the groups, in change of appetite, health and perception scales. Conclusions: Portion controlled, ready to eat cereal could be effective for short-term weight loss, with some improvements in the nutrient intake profile. However, studies of longer duration are needed.

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Compressed food with added functional oligopeptides improves performance during military endurance training

Background and Objectives: Oligosaccharide or oligopeptide supplementation may have a significant impact on endurance performance. This study evaluated the effects of adding maltooligosaccharides (MO) or soy oligopeptides (SO) to compressed food (CF) on the physical response of soldiers to daily military training. Methods and Study Design: Twelve soldiers were randomized to four diet groups: regular meals, CF, CFMO, and CFSO (crossover design). They participated in exercise tests including 90 minutes running at 55-65% VO_2max and exhaustive running. Heart rates, rating of perceived exertion (RPE), and blood and urine samples were collected during exercise and recovery. Results: The recovery heart rates were significantly lower with the CFMO diet compared with the other diets. Compared with all other diets, blood glucose levels were higher, post-exercise blood lactate levels were lower, and lactate clearance during recovery was higher with the CFMO diet, followed by the CFSO diet. Post-exercise levels of erythrocytes and hematocrit were significantly higher with the CFSO diet. Post-exercise urine specific gravity was lower with the CFMO diet and urine pH was decreased with the CFSO diet. Blood urea nitrogen (BUN) and uric acid (UA) were significantly higher with the CFSO diet than with the other diets. There was no significant difference in skeletal and cardiac muscle injury indices and RPE among diets. Conclusions: CFMO led to better heart rate recovery, improved and maintained blood glucose and increased removal of blood lactate. CFSO accelerated removal of blood lactate during recovery, maintained oxygen supply, and increased fluid retention.

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High prevalence of vitamin B-12 insufficiency in patients with Crohn's disease

Background and Objectives: In Crohn's disease (CD), belonging to inflammatory bowel disease, the small intestine is involved in most cases. Most frequently affected is the distal ileum, where vitamin B-12 is specifically absorbed. Therefore, malabsorption of vitamin B-12 is quite likely to occur in patients with CD. In this study, we have studied the vitamin B-12 status in CD patients. Methods and Study Design: Forty eight patients with CD were evaluated for their food intake, and circulating concentrations of vitamin B-12, folic acid, and homocysteine (Hcy) as a sensitive marker for the insufficiency of these vitamins and a risk factor of atherosclerosis. Results: Plasma Hcy concentration was significantly correlated with serum vitamin B-12 concentration alone, and 60.4 % of the subjects had hyperhomocysteinemia. Receiver Operating Characteristics (ROC) analysis showed that serum concentration of vitamin B-12, but not folic acid, predicted hyperhomocysteinemia. Their intake of vitamin B-12 was much higher than the Japanese RDA, but not correlated with blood concentrations of vitamin B-12 or Hcy, probably due to malabsorption. Conclusions: Vitamin B-12 insufficiency and hyperhomocysteinemia were highly prevalent in CD patients. Recently, the significance of extra-intestinal complications of CD has been increasingly recognized, and our finding is likely to be of clinical importance.

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Association between complement component C3 and body composition: a possible obesity inflammatory biomarker for insulin resistance

Background and Objectives: The C3 complement component (C3) is increasingly recognized as a cardiometabolic risk factor. We aimed to examine the role of C3 in insulin resistance (IR) and its association with adiposity. Methods and Study Design: Sixty-seven obese (18-35 years) participants were matched with normal weight participants from the University of Jordan. BMI, waist-hip ratio (WHpR), and waist-height ratio (WHtR) were calculated. Body percent fat mass (%FM) was determined using the bioelectrical impedance analysis. C3, insulin, and glucose serum concentrations were measured. IR was assessed by the homeostasis model assessment of IR (HOMA-IR). Results: Serum concentrations of C3 and IR were significantly higher in the obese group than that in the normal body weight, regardless of gender (women: 1.2±0.08 and men: 1.2±0.08 vs women: 0.88±0.07 and men: 0.94±0.05, p＜0.01; women: 3.6±0.34 and men: 3.9±0.43 vs women: 1.7±0.12 and men: 2.0±0.24, respectively; p＜0.001). After adjustment for the potential confounders, BMI, waist circumference, WHtR and %FM were correlated positively with C3 (r=0.44; 0.42; 0.47; 0.43, respectively; p＜0.001), and with IR (r=0.67; 0.61; 0.59; 0.59, respectively; p＜0.001). C3 was correlated with IR (r=0.35, p＜0.001). In linear regression analysis, C3 was not associated with IR independent of BMI (p＞0.05). Conclusions: C3 may be a marker of chronic inflammatory process independently underlying IR obese individuals regardless of gender, which may have a role in the progression of IR during obesity.

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Reconfirmation of improved tolerance to a new amino acid-based formula by infants with cow's milk protein allergy

Background and Objectives: Reasons for intolerance to commercial amino acid-based formulas (cAAF) in infants diagnosed with cow's milk protein allergy (CMA) remain unknown. We assume that minute amounts of proteins, presenting in the glucose polymers derived from corn starch (cGPs), can elicit the intolerance to the cAAFs observed in some infants with CMA. By replacing cGPs with glucose polymers derived from rice starch (rGPs), a new amino acid-based (nAAF) formula has been shown to be better tolerated than an existing cAAF. This study was carried out to corroborate the superiority of nAAF over a different commercially available cAAF. Methods and Study Design: Infants with CMA aged less than 4 months underwent a double-blind, placebo-controlled food challenge. They consumed each of the 2 test formulas for 14 days before switching to the other one. Following the 28-day challenge period, infants consumed the tolerated formula for 4 weeks as an at-home open challenge. Results: Out of 36 infants who completed the study, 18 were intolerant to the cAAF, seven of whom (38.8%) were also intolerant to the nAAF. Eleven of the 18 infants who were intolerant to the cAAF tolerated the nAAF (p＜0.01). Conclusions: This study reconfirms that substitution of rGPS for cGPs in the amino acid- based formula improves tolerance of young infants with CMA.

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Dietary intake of heme iron and body iron status are associated with the risk of gestational diabetes mellitus: a systematic review and meta-analysis

Background and Objectives: Some potential role of iron overload in the development of diabetes mellitus have been suggested. Our study aimed to systematically assess the association between the risk of gestational diabetes mellitus (GDM) and iron intakes/body iron status. Methods and Study Design: PubMed and Web of Science were searched for relevant articles. Relative risks (RR) of GDM in relation to dietary iron intakes and body iron stores were pooled with the random-effects model. Weighted mean differences of iron blood markers between GDM and non-GDM individuals were also analyzed. Results: Twenty-five studies were included in the qualitative analysis, and 23 studies with 29,378 participants and 3,034 GDM patients were included in the quantitative analysis. Dietary intake of heme iron was significantly associated with GDM risk (RR=1.65, 95% CI: 1.28 to 2.12), and the pooled RR for each 1mg/day increment of heme iron intake was 1.38 (95% CI: 1.19 to 1.61). No association between GDM and the intakes of nonheme iron, total iron, or supplemental iron was detected. Body iron stores, as represented by serum ferritin level, were correlated with GDM risk (RR=1.64, 95% CI: 1.27 to 2.11). Moreover, the concentrations of both serum ferritin and serum iron were increased in GDM patients, compared with non-GDM individuals. Conclusions: Increased dietary intake of heme iron and body iron status are positively associated with the risk of GDM development in pregnant women. Future studies are warranted to better understand the role of iron in GDM development.

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Screening for nutritional risk in hospitalized children with liver disease

Background and Objectives: Malnutrition is a major contributor to morbidity and mortality from pediatric liver disease. We investigated the prevalence of both malnutrition and high nutritional risk in hospitalized children with liver disease as well as the rate of in-hospital nutritional support. Methods and Study Design: A total of 2,874 hospitalized children and adolescents with liver disease aged 1 to 17 years (inclusive) were enrolled. Malnutrition was screened by anthropometric measures (height-for-age, weight-for-height, weight-for-age, and BMI-for- age z-scores). The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) was used to evaluate nutritional risk status. Nutrition markers in blood, rate of nutritional support, length of hospital stay, and hospital fees were compared among nutritional risk groups. Results: The overall prevalence of malnutrition was 38.6%. About 20.0% of children had high nutritional risk, and prevalence of malnutrition was markedly greater in the high nutritional risk group compared with the moderate risk group (67.9% vs 31.3%). Serum albumin and prealbumin differed significantly between high and moderate risk groups (p＜0.001). Only 8.9% of children with high nutritional risk and 3.5% with moderate nutritional risk received nutrition support during hospitalization. Children with high nutritional risk had longer hospital stays and greater hospital costs (p＜0.001). Conclusions: The prevalence of malnutrition is high in children with liver disease. High nutritional risk is also prevalent at admission. Albumin and prealbumin are sensitive markers for distinguishing nutritional risk groups. High nutritional risk prolongs length of stay and increases hospital costs. The nutritional support rate is still low and requires standardization.

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Qualitative study of eating habits in Bruneian primary school children

Background and Objectives: Childhood obesity is a serious public health issue globally and poor eating habits are an important contributing factor. This study aimed to explore the perceptions, practices and attitudes towards healthy eating in Bruneian primary school children. Methods and Study Design: A qualitative study was conducted among 40 subjects involving 18 children (aged 9-10 years old), 12 parents and 10 teachers, who were recruited from two primary schools using convenience sampling. Five focus group discussion sessions were conducted, and recorded discussions were translated. The transcripts were entered into NVivo10 and thematic analysis was conducted. Results: All participants had differing perceptions of the term 'healthy eating'. Children reported 'healthy eating' by identifying foods or food groups they perceived as healthy and unhealthy. Only a few mentioned fruits and vegetables as essential to a healthy diet. Parents mainly perceived 'healthy eating' as consuming 'any quality food' that contains 'vitamins and minerals'. Teachers described a healthy diet as including balanced and varied dietary practices, having breakfast and eating regularly at the right, set times. They also associated eating healthily with traditional, home-grown and home-cooked food. All participants had positive attitudes towards healthy eating, however most children demonstrated unhealthy eating habits and frequently consumed unhealthy foods. Conclusions: The Bruneian primary school children reported favourable knowledge despite having poor healthy eating habits. The factors influencing participants eating behavior included food preferences, familial factors (parental style and parenting knowledge), food accessibility and availability, time constraints, as well as convenience. These factors hindered them from adopting healthy eating practices.

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Screening for inadequate dietary vitamin B-12 intake in South Asian women using a nutrient-specific, semi-quantitative food frequency questionnaire

Background and Objectives: A high prevalence of vitamin B-12 (B-12) deficiency among young women of South Asian origin predisposes to significant health risks for these women and their future offspring. Vegetarian or low-meat based dietary practices contribute to B-12 deficiency. This study validated a nutrient-specific, semi-quantitative food frequency questionnaire (B12FFQ), developed to estimate dietary B-12 intake in South Asian women. Methods and Study Design: The B12FFQ was developed, then tested in 60 apparently healthy South Asian women aged 18-50 years, living in Auckland, New Zealand. Participants recalled the frequency and quantity of vitamin B-12-containing foods consumed in the preceding three months. Pearson's correlations measured the associations between dietary B-12 intake and B-12 biomarkers (serum B-12 and holotranscobalamin [holoTC]). Likelihood of B12 insufficiency was calculated for vegetarian and non-vegetarian dietary practices. Results: The B12FFQ was a valid measure of dietary B-12 intake - supported by moderate positive associations with serum B-12 (r=0.50, p＜0.001, 95% CI [0.28, 0.67]) and holoTC (r=0.55, p＜0.001, 95% CI [0.34, 0.71]). A dietary B-12 intake of less than 2.4 μg/day increased the likelihood of serum B-12 (X^2 (1)=11.79, p=0.001) or holoTC (X^2 (1)=6.33, p=0.012) insufficiency. A dietary B-12 intake of less than the recommended dietary allowance (2.4 μg/day), occurred in 61% (n=20/33) of participants with vegetarian and 22% (n=6/27) with non-vegetarian dietary practices. Conclusions: The B12FFQ provides a valid estimate of dietary B-12 intake. This easily administered food frequency questionnaire has the potential to identify low dietary B-12 intake as a contributor to B-12 depletion or deficiency.

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Snack and beverage consumption and preferences in a sample of Chinese children - Are they influenced by advertising?

Background and Objectives: The consumption of unhealthy snack and beverages can lead to childhood obesity, which has become a major concern globally. Television food advertisements may influence children's snack and beverages preferences. This article aims to explore children's snack and beverage consumption habits; examine the extent of television advertising for non-core (energy-dense, nutrient poor) snack and beverages; and assess the influence of television advertising on children's snack and beverages preferences in Harbin, China. Methods and Study Design: The study consisted of two components, a recall survey on the snack and beverage consumption and preferences of 9-11 years old school children; and recording snack and beverage advertisements on three popular television channels. Odds Ratio (OR) was used to estimate the likelihood of children selecting particular snack and beverages as their top three choices according to whether their preferences were influenced by television advertisements. Results: The majority of children consumed non-core snacks (100%) and beverages (80%) in the four weeks prior to the survey. Nearly 40% of television food advertisements were for non-core snacks and beverages. Non-core snacks (OR of 1.13) and non-core beverages (OR of 1.23) were more likely chosen as children's top three snack/beverage choices, particularly, ＂puffed food and tubers＂ snack and carbonated beverages (OR of 1.31 and 1.45, respectively). Conclusions: The snack and beverage preferences appeared to be influenced by television advertisements in this sample of Chinese children, highlighting the potential health and nutritional value of policy to reduce advertising of non-core foods in China.