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Advances and gaps in recommendations for adequate water intake in China

Water is essential for life survival and development. It plays a pivotal role in metabolic function, modulates normal osmotic pressure, maintains the electrolyte balance, and regulates body temperature. Adequate water intake is necessary for optimal hydration-both excessive and insufficient water consumption can have adverse effects on health. Water requirements among people vary based on various factors such as gender, age, physical activity, dietary factors, ambient temperature, and renal concentrating capacity. In recent years, water intake guidelines have been developed in some countries and by some organisations. Even in China, it is important to develop such guidelines considering specific dietary habits, height of people, and environmental factors. In 2013, guidelines for adequate water intake were developed in China, but the scope was somewhat limited; there are still specific challenges in formulating such recommendations. Future water-related studies should focus on surveying water intake among infants and toddlers, older adults, and pregnant and lactating women. Moreover, additional studies should be conducted to elucidate water intake among adults and adolescents in different regions and seasons, and the association between water intake and related diseases should also be investigated. It is imperative to transform the results of scientific research into action plans for water-related health education so as to inform and evaluate pertinent public health programmes.

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Docosahexaenoic acid and the brain- what is its role?

Docosahexaenoic acid (DHA) is a 22-carbon omega 3 PUFA highly enriched in the neuronal cell membranes and rod outer segment membranes. When DHA is depleted from these cell membranes it is replaced nearly quantitatively by a 22-carbon omega 6 PUFA, docosapentaenoic acid, which has similar, but less potent, biophysical and physiological properties to DHA. It is speculated that omega 6-docosapentaenoic acid is a buffer to prevent the possible catastrophic effects of DHA depletion on brain and visual function. The primary insult from the loss of DHA from cell membrane glycerophospholipids, and replacement by omega 6-docosapentaenoic acid, is on the flexibility/compression of the membrane lipids which affects the optimal function of integral membrane proteins (receptors, voltage-gated ion channels and enzymes). This leads to effects on second messenger systems, and subsequently affects neurotransmitter concentrations due to 'weakened' signals from the initiating receptors. Remembering there are more than 80 billion neurones and many times more synaptic connections between neurons, a very small loss of ＂efficiency＂ in signal due to altered properties of membrane proteins would likely result in meaningful changes in brain and visual function. Additionally, impairment of neurotransmission could be due, in part, to sub-optimal brain energy metabolism (glucose entry into the brain), which is significantly reduced in omega 3 deficiency. Many studies report that dietary omega 3 deficiency results in changes in learning, coping with stress, behavioural changes, and responses in visual function. It is thus concluded that DHA is an essential fatty acid for optimal neuronal function.

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Vitamin D and depression: mechanisms, determination and application

Depression is the most common debilitating psychiatric disease, the pathological mechanisms of which are associated with multiple aspects of neural function. While recent evidence has consistently suggested that a suboptimal vitamin D status is frequently observed in patients with depression, the results concerning whether vitamin D insufficiency is a causal factor of depression or is secondary to depressive behavior are conflicting; additionally, the lack of consistency of the method of vitamin D determination between labs has further worsened this confusion. Herein, we reviewed the neuroactivities of vitamin D that may be associated with depression and the current studies and clinical investigations to provide a full overview on the use of vitamin D in the treatment and prevention of depression.

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Percutaneous endoscopic gastrostomy feeding is beneficial in patients with advanced dementia

Background and Objectives: We aimed to show the long-term results of patients who received percutaneous endoscopic gastrostomy (PEG) tubes and to evaluate the usefulness of this method in advanced dementia patients, which is considered to be of controversial benefit in the literature. Therefore, we compared three groups of patients: advanced dementia patients fed via PEG, stroke patients fed via PEG and advanced dementia patients not fed via PEG. Methods and Study Design: In total, 305 files of patients who underwent PEG implantation were screened retrospectively, and 283 were analyzed. A total of 93 advanced dementia patients who were not fed via PEG were included as the control group, and the PEG-fed group was compared in terms of mortality and CRP levels with the advanced dementia control group not fed via PEG. Results: The median length of PEG stay was 9 months. In total, 49 (17.5%) patients developed complications. Mortality (p=0.0002) and CRP levels (p=0.01) were statistically significant in the advanced dementia group not fed via PEG. The group with stroke and the dementia patients were analyzed regarding length of PEG stay, complications and mortality. The length of PEG stay, rate of complications and mortality in the stroke group were not found to be statistically significant in comparison to the dementia group. Conclusions: Mortality and CRP levels were statistically significantly higher in the advanced dementia group not fed via PEG. The mortality and rate of complications in the dementia group were similar to those in the stroke group. Feeding with PEG-tubes is a proper and preferable method for advanced dementia patients.

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Probiotics in preventing and treating chemotherapy-induced diarrhea: a meta-analysis

Background and Objectives: To systematically assess the safety and effectiveness of probiotics in preventing and treating chemotherapy-induced diarrhea (CID), so as to provide the evidence-based evidence for clinical practice. Methods and Study Design: Electronic databases, including EMbase, Cochrane Library, pubMed, CNKI, VIP, CBM, and Wanfang databases, were retrieved to search for the randomized controlled trials (RCTs) of CIDs among patients with malignant tumors treated with probiotics as of March 2019. Later, the Rev Man 5.3 statistical software was employed to extract data and assess the quality of the identified literature for meta-analysis. Results: Finally, 13 RCTs involving a total of 1024 patients were included into the current meta-analysis. Results of this meta-analysis showed that the addition of probiotics to conventional symptomatic treatment could evidently reduce the total diarrhea rate in patients with cancer [RR=0.47, 95% CI (0.35, 0.63), p＜0.00001] and grade III-IV diarrhea [RR=0.16, 95% CI (0.05, 0.42), p=0.0008], increase the total effective rate [OR=4.26, 95% CI (2.55, 7.12), p＜0.00001], and shorten the duration of diarrhea [MD=-1.92, 95% CI (-1.96, -1.88), p＜0.00001]; meanwhile, the difference was statistically significant. But in patients with grade I-II diarrhea [RR=0.81, 95% CI (0.53, 1.24), p=0.34], the difference was not statistically significant. Besides, none of the enrolled study had reported adverse reactions. Conclusions: The application of probiotics before or during chemotherapy can effectively prevent the occurrence of CID among cancer patients. Moreover, the combination of probiotics in treating CID can also improve the therapeutic effect on CID, with less adverse events.

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Early intervention with supplemental parenteral nutrition reduces the incidence of granulocytopenia-related infections in patients with lung cancer: a retrospective cohort study

Background and Objectives: The optimal timing for initiating supplemental parenteral nutrition in chemotherapy-induced severe granulocytopenia in patients with lung cancer remains uncertain. Methods and Study Design: A retrospective study was conducted among patients with lung cancer from February 2016 to June 2018. In total, 182 eligible patients were included and divided into 2 groups according to the time of supplemental parenteral nutrition intervention: early initiation (within 72 hours of development of granulocytopenia) and late initiation (over 72 hours). The primary outcomes of the study were bacterial infection and fungal infection, and the secondary outcomes were duration of absolute neutrophil count less than 1.0×10^9 cells/L, length of hospital stay, mortality rate, and rate of chemotherapy (4 cycles) completion. Results: The incidence rates of bacterial infection and fungal infection were significantly lower among patients who received supplemental parenteral nutrition early than among patients who received it late. No significant difference in mortality was observed between the groups. In addition, compared with late supplemental parenteral nutrition, early supplemental parenteral nutrition was associated with a higher rate of completion of 4 chemotherapy cycles and shorter hospital stays and leukocyte recovery periods in our cohort. Univariate and multivariate logistic regression analyses revealed that the subgroup of patients with an NRS-2002 score of 2 benefited from early supplemental parenteral nutrition. Conclusions: Early supplemental parenteral nutrition after chemotherapy-induced severe granulocytopenia could reduce the risk of infection, improve the likelihood of chemotherapy completion, and shorten hospital stays and leukocyte recovery times.

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Effect of exercise therapy combined with branched-chain amino acid supplementation on muscle strength in elderly women after total hip arthroplasty: a randomized controlled trial

Background and Objectives: Many patients develop a prolonged decrease of muscle strength after total hip arthroplasty (THA) despite their reconstructed hip joint. Physical exercise combined with branched-chain amino acid (BCAA) supplementation has been reported to improve muscle strength in elderly persons with sarcopenia. However, the effect of BCAA supplementation in patients after THA is unknown. This study examined the effects of BCAA supplementation combined with exercise therapy on the improvement of physical function in elderly patients after THA. Methods and Study Design: The subjects were 31 elderly women who underwent THA. The participants were randomly assigned to two groups: BCAA (n=18) and control (n=13). The combined therapy was carried out for one month after THA. For the exercise intervention, a 3-set physical exercise program was conducted. For the nutritional intervention, the participants consumed 3.4 g of BCAA supplement or 1.2 g of starch immediately after the exercise intervention. Results: BCAA supplementation combined with muscle strengthening exercises had a significant effect on knee extension strength of the contralateral side and on upper arm cross-sectional area. The improvement ratio of knee extension strength before and after intervention on the operated side was also significantly higher in the BCAA group. Conclusions: BCAA supplementation is effective for patients to improve the strength of some muscles when combined with physical exercises, but hip abductor muscle strength of the operated leg did not improve. A future study is needed to determine the efficacy of this combined therapy for hip abductor muscle strength.

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A randomized controlled trial of preoperative carbohydrate drinks on postoperative walking capacity in elective colorectal surgery

Background and Objectives: Routine overnight fasting may increase the risk of postoperative complications and delay postoperative recovery. Oral carbohydrate drinks have been shown to reduce glucose utilization and postoperative negative nitrogen balance while preserving muscle mass and strength. This randomized controlled trial aimed to examine whether preoperative oral carbohydrate drinks can enhance postoperative physical recovery in patients undergoing major colorectal surgery. Methods and Study Design: Seventy patients were randomly assigned to receive either a 12.5% oral carbohydrate drink or pure water. Patients in both groups received 800-mL of one of the drinks on the evening before surgery, and another 400-mL drink on the morning of the operative day. The primary outcomes were the distances covered in 2-minute-walk tests at 24, 48 and 72-hours and 6-minute walk tests at 7-10 days postoperatively. The secondary outcomes were the postoperative serum insulin and glucose concentrations, nitrogen balance, duration of hospital stay, and the patient satisfaction scores. Results: There were no significant differences in the characteristics of the two patients-groups. The postoperative 2-minute and 6-minute walk test distances, serum insulin and glucose concentrations of both groups were not statistically different. Patients receiving carbohydrate drink had more positive nitrogen balance than the control group. The duration of hospital stay and patient satisfaction scores were similar for both-groups. Conclusions: There were no statistically significant differences in the postoperative walking capacities of patients receiving a carbohydrate drink or pure water; only the nitrogen balance on postoperative day 3 was higher for patients receiving the carbohydrate drink.

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Recovery of Lactobacillus casei strain Shirota (LcS) from faeces with 14 days of fermented milk supplementation in healthy Australian adults

Background and Objectives: A key measure for classifying bacteria as a probiotic is the ability to survive gastric transport and be recoverable in faeces. The aim of this study was to determine whether Lactobacillus casei strain Shirota (LcS) could be recovered in the faeces of healthy young Australian adults following ingestion of a fermented milk drink. Methods and Study Design: A cohort of 25 healthy individuals (male/female: 14/11; age: 29.3±6.6 years; BMI: 25.3±2.7 kg/m^2, mean±SD) ingested one 65 ml bottle of fermented milk containing 6.5×10^9 LcS live cells daily for 14 days. Participants provided a faecal sample at day 0, day 7 (mid-supplementation), day 14 (end of supplementation) and 14 days after cessation of the supplement (day 28) for assessment of the number of viable LcS via microbial culture on selective media with confirmation using a colony-direct polymerase chain reaction and species-specific primers. Results: The supplement was well tolerated by participants. No LcS colonies were recovered from participants prior to ingestion of the fermented milk drink. All participants had recoverable LcS colonies at day 7 and day 14, with a mean recovery of 6.5±1.1 and 6.4±1.1 log_(10) CFU/g of faeces (mean±SD) at each time point respectively. LcS was detectable in only one sample at 14 days following the cessation of supplementation. Conclusions: Live LcS is recoverable in faeces from healthy Australian adults following daily ingestion of a fermented milk drink.

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Effect of green tea consumption on human brain function in resting-state functional MRI

Background and Objectives: Green tea is reported to have wide benefits on psychological states and cognitive functions. Studies that focus on the underlying neural mechanisms of green tea are limited to its single composition while people usually benefit from green tea water that contains various composition. In this study, we examined the human brain activity changes after drinking natural green tea by using regional homogeneity and functional connectivity based on the resting-state functional MRI technique. Methods and Study Design: Fifteen healthy volunteers participated in two imaging sessions: a control (water) session and a green tea session, each session comprised a predrinking, drinking, and postdrinking section, during the drinking section, the subject consumed 200 mL of green tea infusion or water in 3 to 5 minutes. Then the post-tea and post-water imaging data were selected for regional homogeneity and functional connectivity analysis. Results: Our results revealed that, compared with the control group, the green tea group exhibited an increased regional homogeneity in the frontal, parietal, and occipital areas of the brain, decreased regional homogeneity values in the left cuneus and left lingual gyrus, mainly a decreased functional connectivity in the default mode network, somatosensory, visual cortex, and parieto-frontal areas and enhanced functional connectivity in brain regions associated with memory. Conclusions: This result indicates that green tea consumption impacts the brain activity during resting state.