Taiwan Society of Colon and Rectum Surgeons (TSCRS) Consensus for Anti-Inflammatory Nutritional Intervention in Colorectal Cancer

Malnutrition and systemic inflammatory response (SIR) frequently occur in patients with colorectal cancer (CRC) and are associated with poor prognosis. Anti-inflammatory nutritional intervention is not only a way to restore the malnourished status but also modulate SIR. Nine experts, including colorectal surgeons, physicians and dieticians from 5 hospitals geographically distributed in Taiwan, attended the consensus meeting in Taiwan Society of Colon and Rectum Surgeons for a 3-round discussion and achieved the consensus based on a systematic literature review of clinical studies and published guidelines. The consensus recommends that assessment of nutritional risk and SIR should be performed before and after CRC treatment and appropriate nutritional and/or anti-inflammatory intervention should be adapted and provided accordingly.

A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

The Impact of High Carbohydrate Intake on Physical Frailty in Older Korean Adults: a Cohort-based Cross-sectional Study

Background: The relationship between macronutrients and frailty is unclear. Previous studies have confirmed the relationships between energy and protein intake and physical frailty, while few studies have examined the role of carbohydrate or fat intake in the prevalence of frailty. The aim of this study is to investigate the relationship of energy and macronutrients with physical frailty in the Korean elderly population who had a high proportion of energy intake from carbohydrates.Methods: This study included 954 adults aged 70 to 84 years who have completed the assessment of frailty and 24-h recall upon enrolment in the Korean Frailty and Aging Cohort Study and have no extreme intake under 400 kcal (n = 2). The relationship between energy or macronutrients and frailty was evaluated using multivariate logistic regression models and multivariate nutrient density models.Results: In the subjects with low energy intake (odds ratio [OR] = 2.94, 95% confidence interval [CI] = 1.34–6.45) and total subjects (OR = 2.01, 95% CI = 1.03–3.93), consuming carbohydrates above the acceptable macronutrient distribution range (65% of energy) was related to a higher risk of frailty. Substituting the energy from fat with carbohydrates was related to a higher risk of frailty (1%, OR = 1.05, 95% CI = 1.00–1.09; 5%, OR = 1.26, 95% CI = 1.02–1.56; 10%, OR = 1.59, 95% CI = 1.03–2.43).Conclusions: This study showed that the proportion of energy intake from carbohydrates and fats may be an important nutritional intervention factor for reducing the risk of frailty.

Study on the Effects of Individualized Nutritional Intervention on Pregnancy Outcome and Neonatal Immune Function in Patients with Gestational Diabetes Mellitus

Objective. To study the effects of individualized nutritional intervention on pregnancy outcome and neonatal immune function in patients with gestational diabetes mellitus (GDM). Methods. A retrospective analysis was conducted on 100 GDM patients from the obstetrics and gynecology department of our institute between February 2019 and February 2020. The patients were allocated into the control group given regular intervention and the experimental group given individualized nutritional intervention according to different intervention measures, with 50 cases in each group. The comparison was carried out for patients in the two groups with regard to their modality of delivery, neonatal health, their plasma glucose in fasting state, 2 h after eating, and before bedtime; glycohemoglobin at 8 months of pregnancy, at 9 months of pregnancy, during labor, and 1 month after delivery; their complications; and neonatal CD3+, CD4+, and CD8+ levels. Results. The experimental group outperformed the control group in terms of the spontaneous delivery rate, the number of healthy neonates, and neonatal CD3+, CD4+, and CD8+ levels ( P < 0.05 ). The plasma glucose in fasting state, 2 h after eating, and before bedtime; the glycohemoglobin at 8 months of pregnancy, at 9 months of pregnancy, during labor, and 1 month after delivery; and the incidence of complications of the experimental group were significantly lower than those of the control group ( P < 0.05 ). Conclusion. Individualized nutritional intervention increases the rate of spontaneous delivery in GDM patients, enhances neonatal immune function, stabilizes plasma glucose, and reduces complications.

Effect of Matrix Rhythm Therapy Along With Conventional Physiotherapy Management in Quadriplegic Patient: A Case Study

A 26-year old Yemeni girl with a gunshot injury with cervical spine fracture at C6-C7 Level injury in June 2018 with complete loss of sensation in all the limbs, motor loss below C3 level with loss of saddle sensation and anal tone. The patient sustained spinal cord injury at C6-7 levels and edema extending upto C3 level, resulting in quadriplesgia.She was airlifted in medevac from yemen to Sultan Qaboos Hospital Salalah Oman in 28th June 2018.The patient underwent extensive Neuro surgical procedures for cervical fracture and spinal decompression.Additionally, the patient received education and counseling, nursing and nutritional intervention, and comprehensive physical therapy treatment including Matrix Rhythm therapy and other conventional Physiotherapy management.We conclude that Physiotherapy management with other medical disciplines are crucial in recovary of the patient and to improve quality of life.

Effects of Nutritional Interventions on Accuracy and Reaction Time with Relevance to Mental Fatigue in Sporting, Military, and Aerospace Populations: A Systematic Review and Meta-Analysis

Background: Research in sport, military, and aerospace populations has shown that mental fatigue may impair cognitive performance. The effect of nutritional interventions that may mitigate such negative effects has been investigated. This systematic review and meta-analysis aimed to quantify the effects of nutritional interventions on cognitive domains often measured in mental fatigue research. Methods: A systematic search for articles was conducted using key terms relevant to mental fatigue in sport, military, and aerospace populations. Two reviewers screened 11,495 abstracts and 125 full texts. A meta-analysis was conducted whereby effect sizes were calculated using subgroups for nutritional intervention and cognitive domains. Results: Fourteen studies were included in the meta-analysis. The consumption of energy drinks was found to have a small positive effect on reaction time, whilst the use of beta-alanine, carbohydrate, and caffeine had no effect. Carbohydrate and caffeine use had no effect on accuracy. Conclusions: The results of this meta-analysis suggest that consuming energy drinks may improve reaction time. The lack of effect observed for other nutritional interventions is likely due to differences in the type, timing, dosage, and form of administration. More rigorous randomized controlled trials related to the effect of nutrition interventions before, during, and after induced mental fatigue are required.

Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy

Aim. To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. Methods. We retrospectively analyzed data from 586 women referring to our unit (2015–2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). Results. 43.2% of women came from HMPC; they were younger p < 0.0001 and required insulin treatment more frequently than Caucasian women born in Italy (χ2 = 17.8, p = 0.007 ). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016–1.060, p = 0.005 ; OGTT T120: OR = 1.01, CI 95% 1.002–1.020, p = 0.02 ; BMI: OR = 1.089, CI 95% 1.051–1.129, p < 0.0001 ). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145–3.612, p = 0.016 ). We did not find any association between ethnicities and neonatal/maternal complications. Conclusions. In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.

Pre-Digested Protein Enteral Nutritional Supplementation Enhances Recovery of CD4+ T Cells and Repair of Intestinal Barrier in HIV-Infected Immunological Non-Responders

AIDS patients with immune non-response are prone to malnutrition, intestinal barrier damage, thus aggravating chronic immune activation and inflammation. However, nutritional interventions targeting malnutrition may be beneficial to restore immune function, improve clinical outcomes, and reduce mortality remains largely unclear. This work aimed to evaluate the efficacy of a nutritional supplement in HIV-infected immune non-responders (INRs). The subjects received oral supplementation of a pre-digested protein nutrition formula for three months. We show that the CD4+ T and CD8+ T cell counts were significantly increased after supplementation of the pre-digested enteral nutritional supplement. Among all pro-inflammatory cytokines in the serum, only IL-1β level was significantly decreased, while TNF-β was significantly increased (P &lt; 0.05). The levels of intestinal mucosal damage markers, diamine oxidase (DAO), D-lactic acid (D-lactate), and lipopolysaccharide (LPS), decreased significantly (P &lt; 0.05) after the nutritional intervention. Moreover, at month 3 after the intervention, the body weight, body mass index, albumin, and hemoglobin of all subjects were significantly increased (P &lt; 0.05). The correlation analysis demonstrated a significantly negative correlation of CD4+ T cell count with levels of DAO (r = -0.343, P = 0.004), D-lactate (r = -0.250, P = 0.037), respectively, and a significantly positive correlation of IL-1β level with levels of DAO (r = 0.445, P &lt; 0.001), D-lactate (r = 0.523, P &lt; 0.001), and LPS (r = 0.622, P &lt; 0.001). We conclude that the pre-digested enteral nutrition supplement is effective for HIV-infected INRs.

Association between oral nutritional supplementation and clinical and nutritional outcomes in the management of hospital malnutrition

Objective: To evaluate the association between oral nutritional supplementation and clinical and nutritional outcomes in the management of hospital malnutrition. Methods: This is a longitudinal observational study conducted by collecting electronic medical records of patients admitted to a university hospital between 2019 and 2020. Malnourished adult and elderly patients, who have been eating exclusively orally and using a nutritional supplement, were included.Sociodemographic, clinical, biochemical, nutritional risk, nutritional assessment, acceptance of nutritional prescription and characteristics of the nutritional supplement used were analyzed. An α = 5% was considered. Results: Forty patients were evaluated, most of them elderly and male. Among the oral nutritional supplements, the high-calorie and high-protein types were more prevalent, with an offer twice a day, average use of 39 days, and total acceptance of the nutritional prescription by only 30% of the patients. This nutritional intervention resulted in a slight improvement in anthropometric data, with no significant difference. Conclusion: Using the oral nutritional supplement for a longer period and better adherence would possibly present greater nutritional benefits to patients.

Acceptability of home fortification with multiple micro-nutrients among Sri Lankan children

Micronutrient deficiencies are mostly hidden; clinically less visible compared to macronutrient deficiencies. Food fortification with multiple micronutrients (MMN) is provided for children between 6–23 months, daily for two months at three-time points. We assessed the acceptance and adherence of this nutritional intervention in an urban community setting in Sri Lanka. This cross-sectional study enrolled caregivers of children aged 7 to 23 months with a cluster sampling method. Caregivers ’ acceptance of taste and smell, health gains, ease of use, and need perception (Cronbach’s reliability: 0.801) were assessed. Also, anemia knowledge (Cronbach’s reliability: 0.642), MMN knowledge, and reported adherence (number of sachets consumed per month) were evaluated through a self-administered questionnaire. Adequate adherence was defined as the use of ≥80% sachets. The univariate and multivariate statistical analysis examined the association of acceptability, adherence, and anemia knowledge with independent variables (socio-demographic, household characteristics, and knowledge). The survey included 153 respondents. The Median (range) age of children was 12 months (7–23). The mean (SD) acceptability score was 66.82% (9.78%). Acceptance of sensory qualities (smell/taste) had a lower score than perceived health benefit. Most consumed MMN adequately (72.5%). The mean (SD) anemia knowledge score was 62.20% (25.79%). In multivariate analysis, child’s age (OR: -0.360, 95% CI:-0.510,-0.211) and father’s education (OR: 2.148, 95% CI: 0.439, 3.857) were independently associated with acceptability. Child’s age (OR: -0.108, 95% CI:0.818, 0.985), anemia knowledge (OR:0.016, 95% CI: 1.003, 1.031) and acceptability (OR:0.236, 95% CI:1.140, 1.406) were significant determinants of adherence. Anemia knowledge was significantly associated with the mother’s education and household income when adjusted. In conclusion, unpleasant smell/taste and daily schedule were reported as barriers to MMN use. Yet, perception and trust regarding health benefits were encouraging. Reported adherence was somewhat high. Improving acceptability and anemia knowledge could enhance adherence further in this population.