NUTRITIONAL APPROACHES TOWARDS PREVENTION AND TREATMENT OF DCLD

Decompensated chronic liver disease (DCLD) is also known as decompensating cirrhosis. Cirrhosis is a chronic liver disease that is commonly resulting of hepatitis or alcohol use disorder. It is the severe scarring of liver seen at the terminal stages of chronic liver disease. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. In this study we detailed a patient having decompensated chronic liver disease and observed all require parameter in dietary management. The patient undertook a dietary counselling for 16 days and dietary modification was done according to the patient condition. The HB level was 9.1g/dl, so beetroot juice in the mid-morning and soybean and 2 egg whites were suggested to increase the protein level. Later it was seen that Hb level was increased to 9.9g/dl and protein level was increased to 6g/dl. Also, the potassium level was below normal, so coconut water suggested. what to avoid and what to include and a sample menu and a diet chat was given to the patient at the time of discharge. Malnutrition is a potentially reversible condition that, when identified and treated appropriately, can lead to improvement of the outcomes of patients with DCLD.

Randomised Clinical Trial: Effect of Adding Branched Chain Amino Acids to Exercise and Standard-of-care on Muscle Mass in Cirrhotic Patients With Sarcopenia

BackgroundsThe role of branched chain amino acids (BCAA) in improving muscle mass in cirrhosis is presently debatable. AimsTo evaluate the role of BCAA in improving the muscle mass in a double-blind randomized placebo-controlled trial in patients with cirrhosis having sarcopenia.Methods Consecutive patients with cirrhosis with Child Pugh score<10 and sarcopenia were randomized to receive either 12g/day of BCAA orally or a placebo(1:1) for 6 months in addition to a home-based exercise program(30 minutes/day), dietary counselling and standard medical therapy. Sarcopenia was defined according to gender-specific axial skeletal muscle index(SMI) cut-offs. The primary end point was change in muscle mass based on CT scan(SMI) after 6 months of supplementation.ResultsSixty patients (mean age 41.6±9.9 years; males(66.6%) of predominantly viral(40%) and alcohol-related(31.7%) cirrhosis were randomized. Baseline clinical and demographic characters were similar except MELD score (10.2 ± 2.8 vs. 12.2 ± 3.5, p=0.02) and calorie intake (1838.1kcal ± 631.5 vs. 2217.5kcal ± 707.3, p=0.03), both being higher in the placebo arm. After adjusting for both baseline confounders, baseline SMI and protein intake, the change in SMI at 6 months was similar in both groups [mean adjusted difference(MAD) +0.84, CI -2.9; +1.2, p=0.42] by intention-to-treat analysis. The secondary outcomes including change in hand grip strength(p=0.65), 6-meter gait speed(p=0.20), 6-minute walk distance(p=0.39) were similar in both arms. Four patients had minor adverse events in each arm.ConclusionAddition of BCAA to exercise, dietary counselling and standard medical therapy did not improve muscle mass in patients with cirrhosis having sarcopenia. (CTRI/2019/05/019269).

Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial

Background In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. Methods We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. Results Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. Conclusions Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. Trial registration Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): −0.24 mmol/L, 95% confidence intervals (CIs): −0.40 to −0.09), TC (WMD: −0.31 mmol/L, 95% CIs: −0.49 to −0.13), LDL (WMD: −0.39 mmol/L, 95% CIs: −0.61 to −0.16) and FBS (WMD: −0.69 mmol/L, 95% CIs: −0.99 to −0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Feasibility and Preliminary Efficacy of the Lifestyle, Exercise and Diet (LEAD) Study: A Cluster Randomized Controlled Trial of a Combined Exercise and Diet Intervention in Older Adults with Vascular Risk Factors and Early Dementia Risk

Background: Healthy diet and exercise are associated with reduced risk of dementia in older adults. Evidence for the impact of clinical trials on brain health is less consistent, especially with dietary interventions which often rely on varying intervention approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counselling approach among older adults with vascular risk factors (VRFs) and early dementia risk. Methods: Participants with VRF’s and SCD or early MCI were cluster randomized into the intervention (exercise + Baycrest Brain-healthy Eating Approach (EX+DIET)) or control group (exercise + brain health education (EX+ED)). Both groups participated in 1-hour of supervised exercise per week and were prescribed additional exercise at home. EX+DIET involved 1-hour per week of group-based dietary counselling comprising didactic education focused on brain healthy eating recommendations, goal setting and strategy training. Whereas, EX+ED involved 1-hour per week of group-based brain health education. The primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included fitness, diet, cognition, and blood biomarkers. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. Results: Of 190 older adults contacted, 14 (7%) were eligible and randomized, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and diet/education sessions on average. All 6-month follow-up assessments pre-COVID-19 were completed but disruptions to testing during the pandemic resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the intervention. Mean improvements in peak oxygen consumption were observed in both EX+DIET (d = .98) and EX+ED (d =1.15) groups. Substantial improvements in diet and HbA1c were observed in the EX+DIET group compared to EX+ED (d = 1.75 and 1.07, respectively). Conclusions: High adherence and retention rates were observed among LEAD participants and preliminary findings illustrate improvements in cardiorespiratory fitness and diet quality. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. Trial Registration: ClinicalTrials.gov identifier: NCT03056508

Wolfberry Consumption with a Healthy Dietary Pattern Lowers Oxidative Stress and Improves Carotenoids Status in Middle-Aged and Older Adults: A Randomized Controlled Trial

Objectives The incorporation of zeaxanthin rich wolfberry (Lycium barbarum) into a healthy dietary pattern may augment its antioxidant effects although evidence evaluating whole fruits is lacking. The objectives of this study are to (1) investigate the impact of dietary counselling, either with or without whole dried wolfberry on oxidative stress status in middle-aged and older Singaporean adults and (2) delineate underlying mechanisms by examining associations with the corresponding changes in carotenoids status. Methods In this 16-week, parallel design randomized controlled trial, 40 subjects (29 F, 11 M; aged 50 to 64 y) received dietary counselling to follow a healthy dietary pattern. Compared to the control group (CG, n = 18), the wolfberry group (WG, n = 22) additionally cooked and consumed 15 g/d whole dried wolfberry with their main meals. Biomarkers of oxidative stress (plasma malondialdehyde (MDA) by thiobarbituric acid reactive substance assay and 8-isoprostanes by ELISA) were measured at baseline and week 16. Plasma and dietary carotenoids analyzed by HPLC and 3-day food records respectively were measured at baseline, week 8 and week 16 while skin carotenoids status (SCS) by resonance Raman spectroscopy was assayed every 4 weeks. Results Plasma 8-isoprostanes showed a time effect (P &lt; 0.05), attributed to the marked decline in the WG only (WG: −19.0 ± 43.6 ng/L; CG: −7.7 ± 38.7 ng/L, mean ± SD) though no effect was observed for MDA. A significant interaction effect (P &lt; 0.001), driven by higher plasma zeaxanthin (WG: +0.08 ± 0.13 nmol/L; CG: −0.03 ± 0.05 nmol/L) and SCS (WG: +4242 ± 4938 a.u.; CG: +1713 ± 5921 a.u.) was observed in the WG with a marked increase evident from week 8 onwards although concentrations of the other plasma carotenoids were maintained. Moreover, the change value for plasma zeaxanthin in the WG was inversely associated with the corresponding changes in plasma 8-isoprostanes (−0.21 (−0.43, 0.00) ng/µmol, regression coefficient (95% CI); P = 0.05). This same association was absent in the CG. Conclusions Consuming wolfberry with a healthy dietary pattern attenuates oxidative stress in middle-aged and older adults and this may be attributed to the rich zeaxanthin content in wolfberry. Funding Sources National University of Singapore Ministry of Education, Singapore Agency for Science, Technology and Research.

Impact of Dietary Counselling on Cardiometabolic Health Outcomes and Dietary Quality in Singapore Older Adults: A Randomized Controlled Trial

Objectives Dietary counselling is an effective nutritional strategy for improving dietary quality and cardiometabolic health, but these beneficial effects have not been well studied in older adults, especially in Asia. Therefore, this study aimed to assess the impact of dietary counselling on cardiometabolic health outcomes and dietary quality in older Singaporean adults. Methods This was a 12-week, parallel design, randomized controlled trial. Twenty-six women aged above 60 y were randomized where the intervention group received dietary counselling (n = 14) and the control group did not receive dietary counselling (n = 12). Anthropometric measurement, blood pressure, fasting lipid-lipoprotein, glucose and insulin levels were examined at baseline and week 12. The interactive dietary counselling sessions were conducted by a qualified nutritionist every week and each session took 60 minutes. The counselling topics included healthy eating pattern, proper food proportioning, food label reading and several age-related diseases. All participants completed a 3-day food record and the dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). All results were reported as least square means ± SD. Results A significant decrease in serum low density lipoprotein cholesterol level was detected in the intervention group (3.3 mmol/L ± 1.0 to 3.1 mmol/L ± 0.8, P &lt; 0.05) whereas the control group unchanged (3.8 mmol/L ± 0.6 to 3.7 mmol/L ± 0.7). Moreover, although there was an increase in waist circumference in the control group (76 cm ± 7 to 80 cm ± 6, P &lt; 0.05), no change was observed in the intervention group (76 cm ± 7 to 77 cm ± 9). Other anthropometric and cardiometabolic measurements were not changed after intervention. Both groups showed an increase in dietary quality based on the AHEI-2010 score after intervention however change was only significant in the intervention group (44.0 ± 9.1 to 48.9 ± 8.7, P &lt; 0.05). l group, but a significant time effect was observed (P = 0.009). Conclusions The provision of dietary counselling confers the benefits in the cardiometabolic health outcomes and these benefits may be explained by the improvement in dietary quality in Singaporean older adults. Funding Sources National University of Singapore (NUS), NUS-Mind Science Centre.