Using Dietary Macronutrient Patterns to Predict Sarcopenic Obesity in Older Adults: A Representative Korean Nationwide Population-Based Study

Older adults with sarcopenic obesity (SO) are at increased risk of adverse health outcomes. It has not been identified which pattern of macronutrient intake is appropriate in relation to SO. We aimed to compare the patterns of macronutrient intake for predicting SO in older adults. Data from a total of 3828 older adults who participated in the 2008–2011 Korea National Health and Nutrition Examination Survey were analyzed. The one-day 24 h dietary recall method was used to assess macronutrient intake. SO was defined by a combination of body mass index (BMI) ≥ 25 kg/m2 and BMI adjusted-appendicular skeletal muscle mass <0.789 for men and <0.512 for women. Weighted logistic regression analysis revealed the odds ratio (95% confidence interval) for SO of total calorie intake per 100 increments and carbohydrate (CHO) intake (g/kg/day) per 1 increment to be 0.95 (0.91–0.99) and 0.83 (0.74–0.94), respectively, after adjusting for confounding variables in women. The predictive power for SO of CHO intake (g/kg/day) was higher compared with the other patterns of macronutrient intake both in men and women. In conclusion, total calorie intake and CHO intake (g/kg/day) are inversely related to SO in women. CHO intake (g/kg/day) could be the best index for determining SO.

A systematic review of enteral feeding by nasogastric tube in young people with eating disorders

Background Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. This systematic review sets out to describe current practice of NG in young people with eating disorders. Methods A systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000 to 2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results Twenty-nine studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of refeeding regimes depending on country, settings, and the reason for initiation; 2) standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake alone is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) where NG is routinely implemented to increase total calorie intake, length of stay in hospital may be reduced; however where NG is implemented in correlation to severity of symptoms, it may be increased; 7) both medical and psychiatric wards most commonly report using NG in addition to oral intake. Conclusions NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. There are currently no direct comparisons between continuous, nocturnal or bolus regimes, which may be used to direct future treatment for YP with ED.

Analysis of the Interaction between Polygenic Risk Score and Calorie Intake in Obesity in the Korean Population

<b><i>Introduction:</i></b> Obesity results from an imbalance in the intake and expenditure of calories that leads to lifestyle-related diseases. Although genome-wide association studies (GWAS) have revealed many obesity-related genetic factors, the interactions of these factors and calorie intake remain unknown. This study aimed to investigate interactions between calorie intake and the polygenic risk score (PRS) of BMI. <b><i>Methods:</i></b> Three cohorts, i.e., from the Korea Association REsource (KARE; <i>n</i> = 8,736), CArdioVAscular Disease Association Study (CAVAS; <i>n</i> = 9,334), and Health EXAminee (HEXA; <i>n</i> = 28,445), were used for this study. BMI-related genetic loci were selected from previous GWAS. Two scores, PRS, and association (a)PRS, were used; the former was determined from 193 single-nucleotide polymorphisms (SNPs) from 5 GWAS datasets, and the latter from 62 SNPs (potentially associated) from 3 Korean cohorts (meta-analysis, <i>p</i> &#x3c; 0.01). <b><i>Results:</i></b> PRS and aPRS were significantly associated with BMI in all 3 cohorts but did not exhibit a significant interaction with total calorie intake. Similar results were obtained for obesity. PRS and aPRS were significantly associated with obesity but did not show a significant interaction with total calorie intake. We further analyzed the interaction with protein, fat, and carbohydrate intake. The results were similar to those for total calorie intake, with PRS and aPRS found to not be associated with the interaction of any of the 3 nutrition components for either BMI or obesity. <b><i>Discussion:</i></b> The interaction of BMI PRS with calorie intake was investigated in 3 independent Korean cohorts (total <i>n</i> = 35,094) and no interactions were found between PRS and calorie intake for obesity.

An Immune-modulating Diet Maintains Food Intake during Cancer Chemotherapy

An immune-modulating diet (IMD), an enteral diet enriched with immunonutrition and whey-hydrolyzed peptides, has been shown to bring an improvement of prognosis by suppressing inflammation after surgery or under stress. In this study, we have experimentally and clinically examined the effect of the IMD in cancer chemotherapy. In experiments using colorectal cancer cell-transplanted mice, the mice fed with the IMD in combination with anti-cancer agent showed significantly to maintain their body weight excluding tumor, and to reduce plasma interleukin-6 (IL-6) levels compared with the control group. Furthermore, normal mice fed with the IMD elevated the level of plasma ghrelin, in particular acyl ghrelin. An clinical trial for a patient with malignant lymphoma revealed that the acyl/desacyl ghrelin ratio and total calorie intake was increased when the patient was supplemented with the IMD in conjunction with chemotherapy. These results suggested that the supplementation of the IMD during cancer chemotherapy might enable to maintain the food intake of the patients through elevating their acyl ghrelin levels

Time trend (2008-2016) of food consumption based on the degree of food processing in United Kingdom

Background Ultra-processed foods have been rapidly displacing traditional dietary patterns based on unprocessed and minimally processed foods. We assessed the time trend of food consumption based on the degree and purpose of food processing in United Kingdom from 2008 to 2016. Methods Cross-sectional data from the National Diet and Nutrition Survey were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. Linear regression models were used to estimate linear trend of food consumption across years, adjusted for sex, social class occupation, age and region. Results From the 2008 to 2016, the dietary contribution of processed culinary ingredients increased from 4.1% to 4.8% (p for trend&lt;0.001), while the contribution of processed foods decreased from 9.5% to 8.4% (p for trend=0.001), respectively. The contribution of unprocessed or minimally processed foods (from 30.4% in 2008 to 30.2% in 2016; p for trend=0.462) and ultra-processed foods (from 56.0% to 56.6%, respectively; p for trend=0.194) across survey years has not appreciably changed. Regarding the subgroups, butter and plain oil (Processed culinary ingredients) increased over time, while beer, food preserved and bread (processed food) decreased. Among ultra-processed foods, pre-prepared meals, biscuits and industrial desserts increased, while reconstituted meat and margarine decreased. Among unprocessed or minimally processed foods, poultry, cereals, eggs and legumes increased, while roots, red meat and fresh fruit juice decreased. Conclusions We observed substantial changes in the consumption of processed food and processed culinary ingredients over time. The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Despite this, substantial changes in some subgroups including ultra-processed, were observed for the four NOVA groups. Funding CAPES and FAPESP 2016/14302-7. Key messages The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Actions to mitigate high consumption ultra-processed foods are necessary given that these foods have been strongly associated with obesity and diet-related chronic diseases.

Nutritional Intervention May Improve Body Mass Index of Malnourished Hospitalized Psychiatric Patients – A Preliminary Observation

Malnutrition is an important issue in hospitalized patients. Poor nutrition may lead to increased risk of morbidity and death, impaired mental and physical conditions, apathy, depression, self-neglect, increased risk of medical complications, increased risk of pressure ulcers, reduced immune response, delayed wound healing, longer hospital stays, and reduced quality of life. However, few studies have investigated malnutrition in psychiatric patients. Psychiatric patients are known to have an increased risk of malnutrition, but psychiatric hospitals rarely conduct physical examinations and nutritional assessments. In this preliminary study, patients from a psychiatric ward of the Taipei Tzu Chi Hospital were chosen using the Malnutrition Universal Screening Tool. We used the before-and-after analysis to test the effect of a nutrition intervention on the selected parameters. We found that patients who had an impaired nutritional status showed significant increases in body weight (mean: 43.6 ± 7.5 vs. 46.5 ± 8.2 kg; P < 0.001), BMI (mean: 16.8 ± 2.0 vs. 17.9 ± 2.1 kg/m2; P < 0.001), and total calorie intake (mean: 1128 ± 230 vs. 1378 ± 320 Kcal; P < 0.001). Nutritional intervention significantly improved body weight, BMI, and total calorie intake. Nutritional intervention may help prevent malnutrition and improve the management of psychiatric patients.

Relations between socio-economic factors and nutritional diet in Vietnam from 2004 to 2014: New insights using compositional data analysis

This paper contributes to the analysis of the impact of socioeconomic factors, like food expenditure level and urbanization, on diet patterns in Vietnam, from 2004 to 2014. Contrary to the existing literature, we focus on the diet balance in terms of macronutrients consumption (protein, fat and carbohydrate) and we take into account the fact that the volumes of macronutrients are not independent. In other words, we are interested in the shares of each macronutrient in the total calorie intake. We use compositional data analysis (CODA), adapted to deal with the relative information contained in shares, to describe the evolution of diet patterns over time, and to model the impact of household characteristics on the macronutrient shares vector. We compute food expenditure elasticities of macronutrient shares, and we compare them to classical elasticities for macronutrient volumes and total calorie intake. The compositional model highlights the important role of many factors in the determination of diet choices and we will focus mainly on the role of food expenditure. Our results are consistent with the rest of the literature, but they have the advantage to highlight the substitution effects between macronutrients in the context of nutrition transition.

“Calories in, calories out” and macronutrient intake: the hope, hype, and science of calories

One of the central tenets in obesity prevention and management is caloric restriction. This perspective presents salient features of how calories and energy balance matter, also called the “calories in, calories out” paradigm. Determinants of energy balance and relationships to dietary macronutrient content are reviewed. The rationale and features of the carbohydrate-insulin hypothesis postulate that carbohydrate restriction confers a metabolic advantage. According to this model, a large amount of fat intake is enabled without weight gain. Evidence concerning this possibility is detailed. The relationship and application of the laws of thermodynamics are then clarified with current primary research. Strong data indicate that energy balance is not materially changed during isocaloric substitution of dietary fats for carbohydrates. Results from a number of sources refute both the theory and effectiveness of the carbohydrate-insulin hypothesis. Instead, risk for obesity is primarily determined by total calorie intake.

Az energiamentes édesítőszerek hatása az egyes anyagcsere-paraméterekre

Nonnutritive sweeteners can be found in many other foods apart from soft drinks. Producers of foodstuffs often use a combination of several sweeteners or sweetener and sugar mixes in a single product mainly to achieve a sweeter taste with a lower calorie count. According to the 2012 Scientific Statement of the American Heart and Diabetes Association, reduction of sugar intake plays an important role in establishing an optimal diet and the maintenance of an appropriate body weight. Controlled intervention studies show that during use of calorie-free sweeteners body weight did not change, moreover, in some cases weight even fell. This was also demonstrated in a recently published summary study of randomized controlled studies, according to which calorie-free sweeteners contributed to both loss and maintenance of body weight. According to the summary of the American Dietetic Association, the use of calorie-free sweeteners does not influence the glycemic response and does not increase postprandial blood glucose levels in diabetics. The results thus far, then, show that the use of nonnutritive sweeteners can reduce the consumption of carbohydrates, by which total calorie intake can also be lowered. Their use can promote weight loss and maintenance as well as can help to improve the values of other metabolic parameters (eg. blood sugar, triglycerides). In addition to this, it is important to note that these benefits will not fully materialize if consumption of nonnutritive sweeteners is accompanied by an increase in compensatory caloric intake. Orv. Hetil., 2016, 157(Suppl. 1), 8–13.

Abstract 11809: Sodium Intake is Correlated to Total Calorie Intake and Potassium

Background: Selecting lower-sodium diets are not successful to reduce sodium intake in general population. If systemic approach is considered lowering sodium intake because of the culinary tendencies, we need to aware of the quantitative relationship between nutrients and sodium in daily usual food of the general population. Hypothesis: We assessed the hypotheses that are the positive correlation between total calorie intake, potassium and sodium intake; the cutoff values for sodium recommendation (≤2300 mg per day). Method: We studied 55,544 individuals who completed health examination and nutrition survey in 168,157 randomly selected participants that could represent the country from the 1998-2013 Korea National Health and Nutrition Examination Survey (KNHANES). The nutrition survey was 24 hours recall method to estimate the amount of standardized Korean food. We analyzed the quantitative relationship, and estimated the cutoff value of the total calories and potassium at the recommendation of the sodium intake. Result: The mean values were total calorie 1922±834 Kcal, sodium 4904±3218 mg, potassium 2935±1563 mg, protein 70±41 g (15% in total calorie), fat 37±31 (18%), and carbohydrate 312±123 (67%) in mean value. The standardized coefficients were potassium 0.309, protein 0.226, fat 0.070, carbohydrate 0.097 in model 1 (R2=0.402); total calorie 0.271 and potassium 0.368 in model 2 (R2=0.384) with cardiovascular risk factors in multiple linear regression analysis (table). The optical cutoff value of the total calorie for sodium 2300mg is 1520 Kcal (74% sensitivity, 74% specificity, 93% positive predictive value, 38% negative predictive value, area under the curve: 0.826, 95% CI: 0.82 to 0.83 ; p < 0.001) and the potassium is 1956 mg (82% sensitivity, 69% specificity, 92% PPV, 44% NPV, AUC: 0.825, 95% CI: 0.82 to 0.83 ; p <0.001). Conclusion: In conclusion, the cutoff values for the sodium 2300 mg are the total calorie 1520 Kcal and potassium 1956 mg.