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Self-monitoring networks for personal and societal health: Dietary patterns, activities, blood pressure and Covid-19

The contributors to and consequences of disordered health are increasingly complex with sociodemographic, ecological, economic and food system change. But there are opportunities for any adversity to be mitigated by advances in the understanding of human, especially nutritional, ecobiology and in its more accessible and affordable evaluation and monitoring. Viral pandemics are on the rise with climate change and loss of ecosystems. They threaten human civilisation and planetary habitability. Human security is dependent on sustainable livelihoods of which food and water systems are a vital part. We are socioecological beings and depend for our health on biodiversity and the food diversity that ensures; and on connectedness and communication, made more difficult in pandemics. Rapid and accessible point-of-care (POC) tools are now becoming available to compliment other self-monitoring network approaches, whether checklist or questionnaire, physical, chemical, or biological, for healthcare and nutritional health. They can provide information as several complimentary and interdependent health indices to facilitate personal, group and community action and management plans. This applies to indices of both communicable and non-communicable disease which problems separately and together are compromising health prospects. These indices include ones of physical and mental activities, dietary patterns, metabolites, blood pressure and now the presence and severity of viruses like Covid-19. Of imminent relevance and promise are optically- readable biosensor based strips for nasal, pharyngeal or salivary samples to check viral presence or finger prick blood for immunoglobulins and interleukins. These should allow less socially prohibitive measures to curb viral transmission and promote personal and societal wellbeing.

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Implications of protein malnutrition and inflammatory disorders in the pathophysiology of Alzheimer's disease

Lean body mass (LBM) agglomerates the bulk of nitrogen (N)-containing molecules following well-identified age and sex evolutionary patterns best appraised in clinical practice using the serial measurement of plasma transthyretin (TTR). Methionine (Met), the sole essential amino acid bearing a sulfur (S) atom, presides at the initiation of protein synthesis while maintaining stable body tissue S:N molar ratios of approximately 1:14.5. In protein- depleted states, N- and Met-deficiencies operate as limiting factors for LBM protein synthesis and accretion, causing growth retardation and subnormal TTR plasma values. In inflammatory disorders, LBM is subjected to cytokine-induced tissue breakdown reflecting the S:N ratio found in healthy tissues whereas the liver secretion of TTR declines in proportion. Both malnutrition and inflammation are characterized by stepwise LBM downsizing and reduced bioavailability of Met body stores setting in motion molecular mechanisms safeguarding Met homeostasis at the expense of augmented homocysteine (Hcy) values in biological fluids. Divergent TTR and Hcy alterations indicate that rising Hcy values measured in plasma and cerebrospinal fluid should be regarded as the dark side of efficient compensatory processes. As a result, the neuroprotective activities normally exerted by TTR are weakened, whereas the oxidative burden generated by supranormal Hcy concentrations are strengthened. The combination of protein malnutrition and inflammatory disorders of any cause maximizes the risk of incurable neurodegenerative effects.

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Improved nutritional support with immune-modulating formula in patients with head and neck and esophageal cancer undergoing radiochemotherapy: A retrospective clinical study

Background and Objectives: Malnutrition is frequent in patients with head and neck (HN) and esophageal cancer, aggravated by radiochemotherapy (RCT), and increases morbidity and mortality and treatment toxicity. Recent studies suggest that the immune, nutritional, or inflammatory status can be modulated by the use of pharmaconutrients in RCT-treated patients. In this study, the effect of immunonutrition, including arginine, ω-3 fatty acid, and nucleotide enriched diet, on nutritional status in patients with HN or esophageal cancer undergoing RCT was investigated. Methods and Study Design: A retrospective review of 88 patients undergoing RCT was conducted. Either an immune-modulating enteral nutrition (IEN) (Impact formula) or a standard enteral nutrition (SEN) (isonitrogenous and isoenergetic formula) was administered. Anthropometric parameters, nutritional risk index (NRI), serum albumin, and functional capacity were recorded at the beginning and end of the RCT. Results: Approximately 45% of patients were moderate to severely malnourished (NRI ＜97.5) at the beginning of the RCT in the SEN (n=19) and IEN (n=21) groups alike. Significant improvement was observed in the NRI of malnourished patients of the IEN group (97.3±11.9 vs 98.0±12.0, p=0.021). Additionally, a significant difference in the body weight (BW) between the two groups was observed, and BW increased (65.4±14.8 kg vs 66.3±14.3 kg, p=0.03) in the IEM group but decreased (62.3±12.3 kg vs 61.7±12.0 kg, p=0.023) in the SEM group. Conclusions: Pharmaconutrient- enriched IEN had a more potent effect than SEN in preventing deterioration of nutritional status during RCT.

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Does early postoperative enteral ecoimmunonutrition enhance intestinal function in gastric cancer?

Background and Objectives: We assessed the effect of enteral ecoimmunonutrition (enteral nutrition involving probiotics and immune nutrients) on gastric cancer in the postoperative period. Methods and Study Design: In total, 60 patients with gastric cancer were randomized into an enteral ecoimmunonutrition group or an enteral nutrition group. Information on postoperative complications; hospitalization length; time to first bowel movement and first flatus; and differences between preoperative and postoperative nutritional status, inflammatory reactions, and immune function was collected. Results: No significant between-group differences in nutritional status and complications were observed. C-reactive protein concentrations were lower in the enteral ecoimmunonutrition group than in the enteral nutrition group on postoperative day 7 (p＜0.001) and CD4^+ concentrations were significantly higher (p=0.01). The enteral ecoimmunonutrition group had a significantly shorter time to first flatus than the enteral nutrition group (p=0.03). Conclusions: Early postoperative enteral ecoimmunonutrition significantly improved immune function, reduced inflammatory responses, and promoted intestinal function recovery in patients with gastric cancer undergoing gastrectomy.

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Association of ABC (HbA1c, blood pressure and LDL-cholesterol) goal achievement with visit-to-visit ABC variability and postprandial dysmetabolism in type 2 diabetic patients

Background and Objectives: Although roles of ABC (HbA1c, blood pressure [BP] and LDL-cholesterol) goal attainment on CVD risk outcomes have been well established, it is less studied whether ABC goal attainment associates with ABC variability, non-traditional risk factors. Methods and Study Design: : Intrapersonal mean levels and standard deviation (SD) of HbA1c, BP and LDL-cholesterol, fasting and post-breakfast plasma glucose (PG) and serum triglyceride (TG) during 12 months were calculated in 168 type 2 diabetes patients (aged 62.3 years, 53.6% men). Associations of ABC goal attainment with non-traditional glycemic, BP and lipid risk factors were analyzed. Results: Among 168 patients, 92 (54.8%), 91 (54.2%) and 111 (66.1%) patients achieved HbA1C, BP and cholesterol goal, respectively, and 47 (28.0 %), 45 (26.8 %), 63 (37.5 %) and 13 (7.7 %) achieved triplegoal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC goals was associated with stepwise decreases in mean levels and SD of fasting and post-breakfast PG, and HbA1c. It was also associated with stepwise decreases in mean levels and SD of fasting and post-breakfast TG, and LDL-cholesterol. Further, achieving more ABC goals was associated with stepwise decreases in brachial pulse pressure and mean levels and SD of systolic BP. Conclusions: ABC goal achievement was associated with a broad range of non-traditional glycemic, BP and lipid risk factors in type 2 diabetic patients. Reaching more ABC treatment targets may be important for reductions in long-term ABC variability and postprandial dysmetabolism.

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Impact of a low-carbohydrate and high-fiber diet on nonalcoholic fatty liver disease

Background and Objectives: To study the effects of a low-carbohydrate and high-fiber diet and education on patients with nonalcoholic fatty liver disease. Methods and Study Design: We randomly divided 44 patients with nonalcoholic fatty liver disease into two groups: low-carbohydrate and high-fiber diet and education (intervention group), and education alone (control group). Liver and kidney function, fasting plasma glucose, insulin resistance index, body composition, and controlled attenuation parameter were detected before and after the intervention. Results: After 2 months, the body fat, body weight, abdominal circumference, and visceral fat area, fasting plasma glucose, insulin resistance index, and levels of serum alanine aminotransferase, aspartate transaminase, uric acid, and insulin of the intervention group were significantly lower than before (p＜0.05). In the female intervention group, the insulin resistance index and levels of serum alanine aminotransferase, uric acid, triglyceride, fasting plasma glucose, and C-peptide were lower and the level of serum high-density lipoprotein cholesterol was higher than in the female control group (p＜0.05). In the male intervention group, the levels of serum alanine aminotransferase, triglyceride, and fasting plasma glucose were lower and the level of serum high-density lipoprotein cholesterol was higher compared with the male control group (p＜0.05). Conclusions: A low-carbohydrate and high-fiber diet and education can effectively reduce the body weight and body fat of patients with nonalcoholic fatty liver disease and improve metabolic indicators such as liver enzymes, blood glucose, blood lipid, and uric acid. Our female patients showed significantly better improvement in the indicators than our male patients.

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Tomato juice preload has a significant impact on postprandial glucose concentration in healthy women: A randomized cross-over trial

Background and Objectives: Our aim was to evaluate the effect of consuming tomato juice before carbohydrate on postprandial glucose concentrations in healthy women. Methods and Study Design: In this randomized controlled cross-over study, 25 healthy women (age 21.6±3.8 years, HbA1c 5.3±0.2 %, mean±SD) consumed either 200 g of tomato juice, tomato, or water (control) at 30 min before consuming 200 g of boiled white rice at 9:00 and consumed identical lunch at 13:00 for 3 days. The blood glucose concentrations were measured by self-monitoring blood glucose at 0, 30, 45, 60, 90, 150, and 210 min pre- and post-breakfast, and at 0, 30, 60, 120, 150, and 180 min pre- and post-lunch. The concentration of postprandial glucose, incremental glucose peak (IGP), and incremental area under the curve for glucose after the test meals were compared among 3 days. Results: Incremental blood glucose concentrations at 60 min (2.32±0.16 vs 2.97±0.19 mmol/L, p＜0.05, mean±SEM), 90 min (2.36±0.23 vs 3.23±0.24 mmol/L, p＜0.01), and IGP (2.77±0.19 vs 3.68±0.22 mmol/L, p＜0.001) in consuming tomato juice 30 min before carbohydrate were all significantly lower than those of water, while IGP of consuming tomato was tended to be lower than that of water (2.82±0.19 mmolL, p=0.023). No significant difference was observed in glycaemic parameters after consuming lunch among 3 days. Conclusions: Consuming tomato juice half hour before carbohydrate ameliorates the postprandial blood glucose concentrations, although total amounts of energy and carbohydrate of tomato juice are higher than those of water.

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The effects of eel biscuits on nutritional intake of hospitalized children

Background and Objectives: Support from fortified food during hospitalization is an important factor to increase nutritional intakes of patients to meet nutritional needs and nutritional status. The objective of the study was to analyze the effects of eel biscuits on the nutritional intake of sick children. Methods and Study Design: The study had an experimental post-test design, and included 40 hospitalized children at Dr. Hasan Sadikin Hospital, Bandung, who were selected by consecutive sampling. The inclusion criteria were children aged from 1 to 18 years old who received standard hospital food. The exclusion criteria were patients with fish allergies and those undergoing special diet therapy. The intervention was conducted for 5 days, in which the intervention group was given eel biscuits while the control group was given standard hospital snacks. The food intake was assessed using the food record and 24-hour recall methods. Unpaired t-test and Mann-Whitney test were used in data analysis. Results: There was an increase in nutritional intake from snacks in the intervention group, namely energy (p＜0.001), protein (p＜0.001), fat (p＜0.001), carbohydrate (p=0.005), zinc (p=0.012), and vitamin A (p=0.046) intake. There was also a positive impact on the main meal intake, especially in protein (p=0.037), fat (p=0.032), and zinc (p=0.037) intake. Conclusions: Consumption of eel biscuits to hospitalized children could increase their nutrient intake. Eel biscuits could be given as a snack to fulfill the nutritional requirements for sick children.

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Beneficial effects of konjac powder on lipid profile in schizophrenia with dyslipidemia: A randomized controlled trial

Background and Objectives: Konjac powder has the effect of improving blood lipids in the general population, but there is no research on schizophrenic patients who are susceptible to dyslipidemia. The aim of our study is to evaluate the effects of konjac powder on blood lipid, glucose levels, body weight, and blood pressure in schizophrenia inpatients with dyslipidemia. Methods and Study Design: After a two-week adaptation period, 76 people with schizophrenia were enrolled in a 30-day double-blind randomized controlled trial. The subjects in the experimental group were given a beverage containing konjac powder 30 minutes before each meal, whereas those in the control group were given a beverage containing resistant maltodextrin. Results: The lipid profile, plasma glucose, blood pressure, and body weight were measured at baseline and at the end of 30-day treatment. Fifty-nine subjects completed the study. There was a substantial decrease in total serum cholesterol in the experimental group, but an increase in the control group. Likewise, apolipoprotein B decreased in the experimental group but increased in the control group. Conclusions: We concluded that a diet supplemented with konjac powder may prevent the deterioration of dyslipidemia in people with schizophrenia, demonstrating its potential value in the treatment of metabolic disorders in schizophrenia as a new therapeutic method.

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Dietary patterns and anemia morphology in young men and women in Shandong province, China

Background and Objectives: The association between diet and macrocytic and hypochromic anemia in young Chinese men and women remains unclear. The present study aimed to investigate the relationship between dietary pattern and macrocytic and hypochromic microcytic anemia in young Chinese men and women. Methods and Study Design: Some 4,840 first-year students (2,385 men and 2,455 women) were recruited for this study from Qingdao University, China. Biochemical and hematological parameters, and food frequency questionnaires were obtained from the subjects. Based on dietary intake, participants were divided into three dietary patterns: seafood dietary pattern (SDP), vegan dietary pattern (VDP) and omnivorous dietary pattern (ODP). The risks for macrocytic and microcytic hypochromic anemia in three dietary patterns were assessed. Results: Macrocytic and hypochromic anemia were less common in participants who adhered to the omnivorous dietary pattern than to the vegan or seafood dietary patterns (p＜0.05). Adhering to an omnivorous dietary pattern was negatively associated with macrocytic anemia in men [odds ratio (95% CI): 0.74 (0.62, 0.89), p＜0.001] and microcytic, hypochromic anemia in both genders [men: odds ratio (95% CI): 0.64 (0.45, 0.92), p=0.01; women: odds ratio (95% CI): 0.71 (0.51, 0.99), p=0.04]. Conclusions: Adhering to an omnivorous dietary pattern was associated with less common macrocytic anemia in young men and microcytic, hypochromic anemia. Dietary diversity is important in preventing macrocytic anemia in men and also microcytic, hypochromic anemia in young men and women. Excessive alcohol intake is the most plausible explanation for macrocytosis in the young men.