Decreasing Energy and Nutrient Intake During Hospitalization In Muhammadiyah Lamongan Hospital

Inpatient Malnutrition rates are quite high and distributed in almost all hospitals for all types of diseases and socio-economic sufferers. This study aims to examine the nutritional status, total patient intake, and factors that influence the total intake of newly hospitalized patients at Muhammadiyah Lamongan Hospital. The study was conducted from November to December 2019 in the internal, surgical, and Obgyn departments of the Muhammadiyah Lamongan Hospital. A total of 80 patients were selected as samples using the accidental sampling technique. The results showed that 87.5% of patients were hospitalized due to non-communicable diseases such as diabetes mellitus, acute and chronic kidney failure, cirrhosis, acute myocardial infark, and others. Only 12.5% ​​are treated for infectious diseases such as tuberculosis, meningitis, diarrhea, and others. Calculation of BMI in patients shows that 10% of patients are obese, 30% are overweight, 50% are normal and 10% are malnourished. 24-hour recall results showed that 100% of patients could not meet energy and nutrient requirements (<80% of energy and nutrient demand figures). The average patient is only able to meet 24% of energy, 17% protein, 24% carbohydrates, and 18% fat. As many as 35% of patients complained of nausea and 22.5% of them were accompanied by vomiting. The number of patients said that decreased appetite because abdominal pain (35%), 25% patients experienced shortness of breath. Many patients complained that their bodies were weak / without strength (95%). Appetite also decreased due to difficulty chewing (17.5%) and difficulty swallowing (22.5%). Physical conditions like weakness accompanied by other eating disorders can be the cause of the patient's decreased food intake. This has led to a decrease in nutritional status in patients due to inadequate energy and nutrient need (especially those who have to go through a long period of hospitalization).

Assessment of Nutritional Status of Chronic Renal Failure Patients on Hemodialysis in Damanhour National Medical Institute in El-Beheira Governorate, Egypt

Background: Nutritional problems are of the most important risk factors of increasing mortality rates in chronic renal failure patients on hemodialysis and morbidity occurring from malnutrition significantly severely affects their quality of life. Aim: To assess the nutritional status of chronic renal failure patients on hemodialysis (HD) attending HD unit in Damanhur National Medical Institute. Methods: A cross-sectional study was carried out in the hemodialysis unit on 174 patients. Data collection was done via a specially designed questionnaire containing; socio-demographic and clinical data, anthropometric measurements, biochemical measurements, 24-hour recall list and questions for assessment of nutritional knowledge. Malnutrition inflammation score (MIS) was used for assessment of the nutritional status. Results: 65.5% of the patients were mildly malnourished, 24.7% were moderately malnourished and only 9.8% were normal and the level of malnutrition was significantly affected by duration of renal disease and hemodialysis duration. 44.3 % of patients had poor nutritional knowledge level, and only 4% had good nutritional knowledge and the nutritional knowledge level had a significant association with level of malnutrition. 96% did not attend any nutritional health education sessions, but they were willing to attend these sessions. Conclusions: Malnutrition was highly prevalent among the studied patients. There was a statistically significant relationship between levels of malnutrition (MN) and the level of nutritional knowledge of hemodialysis patients.

Frailty and Macronutrients Intake Among Older Brazilian Adults

The adequate nutrition has an important role in the prevent and treatment of frailty, however, there are only few studies showing the relationship between macronutrients intake and this geriatric syndrome, especially in Latin countries. The aim of this study was to analyze the association between macronutrients intake and frailty among older adults in Brazil. This study included 521 community-dwelling individuals aged 60 years old or older. Frailty was assessed using a self-reported instrument and individuals were categorized in two groups: frail and non-frail (robust + pre frail). Food consumption was evaluated using the 24-hour recall and the software NDSR®. Differences between groups was assessed using the Mann Whitney test. The prevalence of frailty was 42.0%. Older adults considered frails presented lower intake of calories (1510.9 kcal vs 1639.3 kcal; p = 0.016), carbohydrates (196.8 g vs 213.3 g; p = 0.011), proteins (60.7 g vs 68.5 g; p = 0.016) and fiber (15.1 g vs 17.5 g; p= 0.002). They also had lower intake of protein per kilograms of weight (0.88 g/kg vs 0.99 g/kg; p= 0.010). The findings demonstrate high prevalence of frail in our sample, and that intake of most macronutrients was significantly lower among older adults with frail, indicating the importance of the screening of frail as well the evaluation of macronutrients intake among community-based older adults, to prevent malnutrition, sarcopenia and frailty in this population.

Evaluating Smartphone App Based Dietary Tracking in a Military Population: Validation Study (Preprint)

BACKGROUND Collecting dietary intake data is a key component for a majority of nutritional epidemiology studies. Smartphone technology advancements allow researchers to use health and nutrition apps as alternatives to currently available tools (food frequency questionnaires, 24-hour recalls, and food diaries). Service Members (SM) can greatly benefit from the always-available information and easily accessible nature of smartphones to track their intake. Clinicians working with military units can help provide these SM with the skills to evaluate their intake for performance benefits. Understanding the accuracy of these apps is important to determine their effectiveness for use in clinical and research settings. OBJECTIVE This study evaluated the relative validity of self-reported intake with the HealthWatch 360 (HW 360) app compared to the Automated Self-Administered 24-hour Dietary Assessment (ASA24). METHODS Recruitment targeted Army and Air Force SM from Joint Base Lewis-McChord, WA and Joint Base San Antonio-Lackland, TX who currently or previously failed to meet body composition standards. Participants (n=53) completed a demographic questionnaire, baseline anthropometric measurements, and recorded daily intake on the HW 360 app. They returned approximately two weeks later to complete a 24-hour recall using the ASA24. Agreement and relative validity were evaluated using Bland-Altman plots and two one-sided tests at a ± 10% equivalency range of ASA24 mean nutrient intake values between HW 360 and ASA24 data. Multilinear regressions analyzed relationships between participant demographics and relative validity. RESULTS HW 360 was not significantly equivalent to the ASA24. Large levels of underreporting were found in total energy (Mean Difference (Mdiff) = -503.3 kcal, 90% CI: -649.8 to -356.7 kcal), carbohydrates (Mdiff = -52.2 g, 90% CI: -70.4 to -34.1 g), protein (Mdiff = -20.4 g, 90% CI: -29.4 to -11.3 g), and fat (Mdiff = -24.6 g, 90% CI: -32.5 to -16.7 g). Bland-Altman plots failed to illustrate agreement. No significant correlations existed for demographic variables and relative validity. CONCLUSIONS Differences between all variables tested were above clinically significant values and limit the usage of this application in research and clinical settings. Further research is needed to determine the potential causes of underreporting and evaluate methods to minimize this effect. Understanding these effects allows the implementation of a tailored app for use with SM. It has the potential to be an invaluable asset for this population due the unpredictable nature of deployments and training exercises. CLINICALTRIAL ClinicalTrials.gov NCT04959318; https://clinicaltrials.gov/ct2/show/NCT04959318

Interaction effects of socioeconomic position in the association between eating location and diet quality in Portuguese children and adolescents: results from the National Food, Nutrition and Physical activity survey 2015-2016

This study aims to evaluate the interaction effect of socioeconomic environment (SEE) in the relationship between the eating location (EL) and diet quality, in children and adolescents. Data included children and adolescents (3-17y) from a National Dietary Survey Sample (IAN-AF 2015/2016, n=987). Dietary intake was obtained by 2-day food diaries (children) or 2-24-hour-recall (adolescents). Participants were classified into four groups of EL: “Home”, “Other homes”, “School” and “Restaurants”. Diet quality was measured as a higher adherence to a healthy eating pattern. A previous developed socioeconomic classification was used, and participants were grouped as belonging to a low socioeconomic environment (LSE) or middle-high socioeconomic environment (MHSE). Linear regression models were used to evaluate the association between EL and diet quality, stratified by the SEE. One-quarter of participants was classified in the “Home” group, 14% in “Other homes”, 17% in “Restaurants” and 45% in “School”. A statistically significant interaction effect was found (p<0.01) for the SEE in the association between eating location and diet quality. After adjustment for potential confounders, in LSE, children and adolescents belonging to “Other homes” (β̂=−2.07; 95%CI:−3.70;−0.44) and “Restaurants” (β̂=−3.31; 95%CI:−5.08;−1.54) had lower scores in the diet quality score, comparing to “Home”. In MHSE, comparing to “Home”, “Restaurants” showed lower diet quality (β̂=−1.56; 95%CI:−2.65;−0.48), while the “School” had better diet quality (β̂=0.90; 95%CI:0.16;1.64). The SEE influences the association between EL and diet quality and, belonging to more disadvantaged SEE, might represent a higher risk of unhealthy eating habits when eating out-of-home compared to when eating at home.

Ultra-processed food consumption, socio-demographics, and diet quality in Australian adults

Objective: To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPFs) in a cross-sectional nationally representative survey of Australian adults. Design: Using a 24-hour recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI – 2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPFs. Setting: Australian Health Survey 2011-13 Participants: Australian Adults aged ≥ 19 years (n=8,209) Results: Consumption of UPFs was higher among younger adults (19-30 years), adults born in Australia, those experiencing greatest area level disadvantage, lower levels of education, and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPFs was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar. Conclusions: This research adds to the evidence on dietary inequalities across Australia and how UPFs are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.

194Nonlinear isocaloric substitution analysis in nutritional epidemiology: An example using the UK Biobank data

Background Intake of macronutrients and its components are associated with mortality and morbidity. Isocaloric substitution analysis is a tool to examine how changing the source of energy intake (e.g. from saturated to monounsaturated fat) is associated with health. However, conventional methods assume linearity, which may be untrue in many cases. This paper presents a nonlinear alternative, using UK Biobank data as an example data set. Methods Nonlinear isocaloric substitution analysis was conducted using penalised cubic splines in Cox proportional hazard models. In the UK Biobank, 195,658 participants completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using the Oxford WebQ, a web-based 24-hour recall questionnaire. Prospective all-cause mortality was derived from on linked death records. Results More than half of the associations between macronutrient intake and all-cause mortality were nonlinear. Nonlinear isocaloric substitution analysis provides effect sizes conditional on the current intake, while conventional analysis provides an average over the whole range of intake. For example, conventional isocaloric substitution estimated no effect of replacing sugar with starch. However, the nonlinear method revealed that replacing sugar with starch was associated with a higher risk when the current starch intake was greater than 30% of total energy, and with a lower risk when current intake was less than 25%. Conclusions Nonlinear isocaloric substitution provides an alternative to conventional isocaloric substitution analysis when the underlying association is nonlinear. Key messages Nonlinear associations are common in nutritional epidemiology. In such cases, nonlinear isocaloric substitution analyses should be used.

Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study (Preprint)

BACKGROUND The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. OBJECTIVE The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. METHODS Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. RESULTS Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. CONCLUSIONS This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s INTERNATIONAL REGISTERED REPORT DERR1-10.2196/32891