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Intraindividual double burden of malnutrition: The contribution of the infant gut microbiome

The prevalence of the double burden of malnutrition in society is well known with the coexistence of undernutrition with an increase in overweight/obesity; this has been increasing globally with nutritional imbalances and infectious diseases being the major etiological factors. However, there is also the coexistence of inappropriate adiposity or metabolic dysfunction in an individual who appears currently undernourished by anthropometric standards (stunted or underweight); this is the intraindividual double burden of malnutrition. It could also occur in temporal sequence, as anthropometric overweight in an individual who has previously endured childhood undernutrition. IIDBM has increased the risk for diet-related non-communicable diseases over the past few decades, as it tracks into adulthood, warranting an urgent need for intervention and prevention. While gut dysbiosis has been associated with various forms of malnutrition, the early life gut microbiome composition and its related metabolites and regulatory factors, are possibly linked to the development of inflammatory and metabolic conditions in IIDBM. The possible underlying physiological mechanisms are reviewed here, working through host dietary influences, gut microbial metabolites, host inflammation and metabolic dysregulation. When validated experimentally and tested through appropriately designed randomised, controlled trials, these mechanistic insights will likely lead to development of preventive strategies.

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Vitamin D deficiency in Bangladesh: A review of prevalence, causes and recommendations for mitigation

Vitamin D is essential for the maintenance of calcium homeostasis and bone mineralization. Overt deficiency of vitamin D causes rickets in children and osteomalacia in adults. Vitamin D deficiency is an important public health problem worldwide. This review examines the available published data from all peer-reviewed original research articles of community and hospital-based research carried out on vitamin D status in different population groups in Bangladesh. Baseline data of intervention trials are also included. The available selected articles were in English and retrieved from 2002 to January 2022. The paper concentrates on underlying factors for increased prevalence of vitamin D deficiency in Bangladesh. Studies uniformly report very high prevalences of hypovitaminosis D among different population groups. Age and sex-specific comparisons indicate that prevalence is higher for the elderly and women. Hypovitaminosis D ranged from 21 to 75 % for infants, children, and adolescents, 38 to 100 percent for premenopausal women, 66 to 94.2 % for pregnant women, 6 to 91.3 % for adult men and 82 to 95.8 % for postmenopausal women. Important underlying factors related to this silent epidemic include dark skin colour, homebound and sedentariness, insufficient sunlight exposure, atmospheric pollution, clothing style, obesity, use of sunscreen and no supplementation. A comprehensive strategy to alleviate and control the health consequences of vitamin D deficiency is needed. This would include the creation of public awareness, refrain in sunscreen usage, exposure to sunlight, regular exercise, food fortification, and supplementation with vitamin D (bearing in mind potential differences between them and food-based sources).

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Comparative analysis of malnutrition diagnosis methods in lung cancer patients using a Bayesian latent class model

Background and Objectives: There are no consensus criteria for malnutrition diagnosis in clinical settings, the Global Leadership Initiative on Malnutrition (GLIM) criteria were developed to facilitate global comparisons of malnutrition prevalence, interventions and outcomes. Validation to assess usefulness in clinical practice is essential, however, the imperfect nature of reference standards used in concurrent validation may result in biased estimates of diagnostic accuracy. The Bayesian latent class model (BLCM) can assess the diagnostic performance when a ＂gold standard＂ is absent. This study's objective was to assess the diagnostic performance of the GLIM criteria in comparison with the Nutritional Risk Screening 2002 (NRS-2002) and the Patient Generated Subjective Global Assessment (PG-SGA) in lung cancer patients using a BLCM. We hypothesized that the GLIM criteria are more sensitive and specific for malnutrition diagnosis in lung cancer patients. Methods and Study Design: 1,384 patient records retrospectively obtained from the ＂Investigation on Nutrition Status and its clinical outcome of common Cancers＂ (INSCOC) study were used to determine the prevalence of malnutrition, sensitivity (Se) and specificity (Sp) by applying a BLCM. Results: The prevalence of malnutrition was 0.56. The sensitivity and specificity of the GLIM criteria were Se: 0.85 and Sp: 0.88; Se: 0.74 and Sp: 0.85 for NRS-2002 and Se: 0.96 and Sp: 0.89 for PG-SGA. Conclusions: Although the GLIM criteria were acceptable for malnutrition diagnosis, PG-SGA is superior for determining cancer-associated malnutrition. Because of its fair sensitivity, NRS-2002 was best equipped to screen out patients not at nutritional risk.

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Protein food avoidance behaviour among cancer patients - perspectives of nutrient intake and diet quality

Background and Objectives: Previous study reported that high proportion of Chinese cancer patients practise food avoidance behaviour for fear of cancer recurrence. The present study aims at documenting the degree of food avoidance behaviours and its association with nutrient intake and diet quality among Chinese cancer patients. Methods and Study Design: Cross-sectional face-to-face interviews were conducted with 245 patients suffering from nasopharyngeal and colorectal cancer to investigate their food avoidance behaviour. Participant's nutrient intake was assessed by 3-day diet record. Diet quality was measured by Diet Quality Index - International (DQII). Results: As many as 86% cancer participants reported practicing food avoidance behaviours. The nutrients to which less than half of the participants met its daily requirement include vitamin D (0%), vitamin E (0.4%), calcium (7.8%), zinc (26.1%) and vitamin B1 (32.2%). Among all participants, only 47.8% met their daily energy requirement. Those reported having high degree of food avoidance behaviours are more likely to have low intake of protein, zinc and iron. However, there was no association between FAB and overall diet quality although the Variety subscale of DQI-I showed that food avoidance behaviours negatively link to participant's dietary sources of protein. Conclusions: Degree of practicing food avoidance behaviour is negatively associated with nutrients of animal origin, in particular protein. However, the overall diet quality was not affected by such. The study results provided important information to frontline clinical workers who are dealing with cancer patients practising nonmainstream diet.

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Metabolic dysfunction associated fatty liver disease (MAFLD) and serum vitamin D concentration in South Korea

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) has recently been renamed as metabolic dysfunction-associated fatty liver disease (MAFLD) by the Asian Pacific Association for the Study of the Liver (APASL) to reflect metabolic dysfunction. Vitamin D regulates free fatty acid flux from the periphery to the liver. The association MAFLD and vitamin D has been controversial. We investigated the association of MAFLD, nutrient intake, and vitamin D status in South Korean adults. Methods and Study Design: We analyzed patient responses from the Korea National Health and Nutrition Examination survey (KNHANES) 2010-2011. The disease group was selected as per the latest guidelines. Steatosis was evaluated by the fatty liver index (FLI). Frequency analysis was performed on general characteristics. We compared differences in nutritional status using complex sample adjusted chi-square tests and generalized linear models. After adjusting for age, complex sample logistic regression analysis was used to examine the relationship between MAFLD and vitamin D. Results: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), LDL, triglyceride, creatinine, glucose, nutrient intake, and serum 25(OH)D concentrations were significantly elevated while HDL was reduced in the disease group than in the control group. The OR for 25(OH)D was 1.015 (95% CI: 1.004-1.026, p＜0.0001). However, MAFLD presented no significant association with vitamin D concentration (OR 1.010, 95% CI: 0.985-1.037, p=0.431) after adjusting for age. Conclusions: We found no significant relationship between MAFLD and serum vitamin D concentration in South Korean adults.

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Intensivists' cognizance of nutrition management and its determinants in ICUs in Guizhou province, China

Background and Objectives: To investigate the Intensivists' cognizance of nutritional management and its determinants, and to provide evidence for standardizing nutritional therapy with protocols. Methods and Study Design: From April to July 2021, a multi-stage sampling method was used to investigate the nutritional cognizance of critical care physicians in secondary and tertiary hospitals in Guizhou Province, China; Questionnaires and scales were used as survey tools. The questionnaires sought general information about the respondents and documented their nutrition cognizance and practice. Five scalar dimensions explored nutritional management, with answers scored for 1-5 points, 3 points being the pass score. Results: 322 respondents from 147 hospitals were surveyed. The average score was passable, but not good at 3.37±0.71 (p＜0.01 with 3.0 as reference). Among the five dimensions, evaluation and monitoring of nutritional status had the highest score (3.79±0.67, p＜0.01), the understanding of nutritional preparations had the lowest (3.09±0.86, p＞0.05), and the scores of other dimensions ranged from 3.21 to 3.49. Almost 70% of intensivists said that they would give priority to other than nutritional therapeutic measures in actual clinical practice. But 96% thought it necessary to strengthen and emphasise nutritional management. Conclusions: Critical care physicians' knowledge and understanding of nutritional therapy are limited, especially in the use of supportive preparations; Recourse to protocols and standardized nutritional management of assistance may depend on training, assigned role, peer expectations and health system policy, each of which has the potential for advancement in the interest of better nutritional care in provincial Guizhou.

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Effects of an individualized nutritional intervention on the prognosis of patients with liver failure

Background and Objectives: Patients with liver failure often have energy metabolism disorders and malnutrition, which lead to poor prognosis, rendering nutritional interventions essential. Methods and Study Design: Individualized nutritional interventions were offered according to the resting energy expenditure (REE) of patients with liver failure, and the patients were followed up for 180 days. Results: Sixty patients with liver failure were enrolled and grouped by their prognosis and energy intake. Model for end-stage liver disease (MELD) score and body fat mass of the nonsurvival group were significantly higher than those of the survival group (p＜0.05), whereas the mean energy intake/REE (MEI/REE) and mean respiratory quotient (RQ) of the nonsurvival group were significantly lower than those of the survival group (p＜0.01). Prediction REE (PredREE) was calculated using the Harris–Benedict formula. Most patients in the nonsurvival and survival groups had hypometabolic (REE/PredREE ＜0.9) and normal metabolic status (0.9＜REE/PredREE＜1.1; p=0.014), respectively. MEI/REE, MELD score, and REE/PredREE were independent predictors of survival in patients with liver failure. The optimal threshold for MEI/REE was 1.15 for predicting favorable prognosis, and the sensitivity and specificity of the threshold were 61.1% and 85.0%, respectively. The survival rates of patients in the ＜1.2-REE group and ≥1.2-REE group were 45.2% and 88.0%, respectively (p=0.001). Conclusions: Hypometabolism state and insufficient energy intake predict poor prognosis in patients with liver failure. Individualized nutritional interventions with energy intake ≥1.2 REE may improve the RQ and prognosis of such patients.

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Efficacy and safety of parenteral nutrition with iron sucrose for anemia prevention in preterm infants: A randomized, double-blind controlled study

Background and Objectives: Our objective is to study the efficacy and safety of parenteral nutrition (PN) with iron sucrose to prevent anemia in preterm infants. Methods and Study Design: We performed a randomized, double-blind controlled trial in which preterm infants were divided into five groups randomly: a control group (PN without iron sucrose, namely group Iron-0), and intervention groups (PN with iron sucrose 100 μg/kg/d, 200 μg/kg/d, 300 μg/kg/d and 400 μg/kg/d, namely group Iron-1, 2, 3, and 4, respectively). The indicators were red blood cell (RBC) parameters, iron storage and oxidant stress. Results: One hundred infants completed this study. Excepting the RBC count in Iron-2, the value of erythrocyte parameters in intervention groups decreased less than that in the control group. And the decrease of RBC count in Iron-1 (-0.6×10^(12)/L vs -0.9×10^(12)/L, p=0.033), hemoglobin in Iron-4 (-26.0 g/L vs -41.0 g/L, p=0.03) and hematocrit in Iron-1(-9.5% vs -14.0%, p=0.014) was significantly less than in the control group. The change of ferritin in Iron-4 was significantly higher than in the control group (280 ng/ml vs 118 ng/ml, p=0.04). There was no difference in serum iron in intervention groups when compared to the control group (p＞0.05). Except for the change of malondialdehyde (MDA) in Iron-1, the increase in other intervention groups was higher than in the control group (p＞0.05). Conclusions: PN with iron sucrose for prevention of anemia in preterm infants is safe and efficacious to some extent.

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Medium-chain triglycerides reduce diarrhea with improved immune status and gut microbiomics in tunnel workers in China

Background and Objectives: Adverse environmental factors in tunnels increase the occurrence of respiratory and intestinal inflammatory disease, which is seriously harmful to worker health. It is reported that medium-chain triglycerides (MCT) can improve immune status and alter the gut microflora. This study investigates MCT effects on immune status and gut microbiota among tunnel workers. Methods and Study Design: Forty-five workers were randomly divided into an MCT group (n=30) and control group (n=15), where they ingested MCT-milk or a placebo milk for 12 weeks, respectively. The primary outcome measure was the incidence of respiratory infection and diarrhea. Secondary outcomes were changes in serum immune-related markers and changes in gut microbiota. Results: The incidence of diarrhea in MCT group was significantly decreased after 4 weeks (p＜0.01), with no significant differences in the control group. MCT reduced the level of pro-inflammatory cytokines (TNF-α, CRP, and IL-6) and enhanced the anti-inflammatory cytokines (IL-10, C3, C4, IgA, IgG, and IgM), respectively (p＜0.01). The Chao index was reduced (p＜0.01) and microbiota composition changed significantly after 12 weeks of MCT intervention. MCT reduced the abundance of Bacteroides, Roseburia, Ruminococcus_1, Lachnospira and increased that of Blautia and Fusicatenibacter at the genus level (p＜0.01). Conclusions: The consumption of MCT reduces diarrhea occurrence and improves serum immune profiles together with gut microbiomics in tunnel workers.

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Relationship between iron metabolism and gestational diabetes mellitus: A systemic review and meta analysis

Background and Objectives: To investigate the relationship between serum iron metabolism indexes and gestational diabetes mellitus (GDM) using a meta-analysis. Methods and Study Design: Databases including Pub-Med, Web of Science, Embase, and Cochrane Library were searched. Prospective cohort or case-control studies evaluating the relationships between serum iron metabolism indexes and GDM were retrieved from these databases. The outcome indicators, such as mean ± standard deviation, relative risk (RR), or odds ratio (OR) were extracted. The RR or OR, standard mean difference (SMD), and 95% confidence interval (CI) were used to calculate the combined effect sizes. Results: A total of 32 studies on the relationships between serum iron metabolic indexes and GDM were included. The serum iron [SMD=0.40 mg/dL, 95% CI (0.16, 0.64), p=0.001], ferritin [SMD=0.58 ng/mL, 95% CI (0.35, 0.81), p＜0.001], hemoglobin [SMD=0.48 g/dL, 95% CI (0.28, 0.67), p＜0.001], transferrin saturation [SMD=0.83%, 95% CI (0.15, 1.52), p=0.000], and hepcidin [SMD=0.63 ng/mL, 95% CI (0.09, 1.18), p=0.023] levels were higher in the GDM group than in the non-GDM group, whereas total iron binding ability [SMD = -0.53μg/dL, 95% CI (-1.05, -0.02), p=0.001] was lower in the GDM group than in the non-GDM group. High serum ferritin [OR=1.92, 95% CI (1.59, 2.32), p＜0.001] and hemoglobin levels [OR=1.30, 95% CI (1.04,1.63), p=0.023] were associated with GDM risk. Conclusions: Serum iron, ferritin, transferrin saturation, hepcidin, and hemoglobin levels were higher and total iron binding ability was lower in GDM patients than in those without GDM. High serum ferritin and hemoglobin levels were associated with GDM risk.