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Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure.
Zhou, C, Wang, S, Sun, X, Han, Y, Zhang, L, Liu, M
BMC cardiovascular disorders. 2023;23(1):80
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Chronic heart failure (CHF) is the terminal stage of heart disease and in recent years, the prevalence of CHF has been increasing among the elderly. Studies have demonstrated that the incidence rate of malnutrition among elderly patients with stable CHF is relatively high. Thus, how to help elderly CHF patients based at home to effectively carry out nutritional self-management and prevent the occurrence of malnutrition, has become a major focus of medical research. The aim of this study was to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF. This study is a randomised controlled trial that enrolled a total of 90 elderly patients with stable CHF. The patients were randomly divided into the experimental group and the control group. Results show that home-based food exchange nutritional interventions can effectively improve the malnutrition status as well as the cardiopulmonary function and exercise tolerance of elderly patients with CHF. Furthermore, after two months of intervention, the protein content and skeletal muscle mass were significantly higher in the experimental group than in the control group, while the reduction in body fat and body fat rate was also significantly higher in the former than in the latter. Authors conclude that the food exchange method is easy to grasp, operate and master, and is highly suitable for home-based elderly CHF patients.
Abstract
BACKGROUND The home treatment of elderly patients with chronic heart failure (CHF) is often accompanied by malnutrition, which increases the risk of re-hospitalisation and affects the prognosis. Therefore, how to effectively improve the nutritional self-management of patients is a current focus of medical research. This study aims to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF. METHODS A total of 90 hospitalised elderly patients with CHF were randomly divided into the experimental group (n = 45) and the control group (n = 45). The patients in both groups were given standardised drug therapy and their nutritional status was evaluated using a body composition analyser prior to discharge (protein, body fat percentage, visceral fat area, skeletal muscle, upper arm muscle circumference, left lower limb and right lower limb muscle mass), with the cardiopulmonary function evaluated using a six-minute walk test and the metabolic equivalents method. The control group was given general nutrition education and routine dietary guidance from cardiac rehabilitation nurses, while the experimental group was given an individualised nutrition prescription by dietitians based on the evaluation results, according to which one-to-one food exchange dietary intervention training was given until the patients mastered the process. RESULTS The nutritional indexes at the end of the study were significantly higher in the experimental group than in the control group and were higher than those before the intervention (P < 0.05). The muscle circumference of the upper arm, the muscle mass of the left lower limb and the right lower limb had no statistical significance following the intervention compared to the control group and before the intervention (P > 0.05). The cardiopulmonary function indexes were significantly better in the experimental group at the end of the study than before the intervention and were better than those in the control group, with statistically significant differences (P < 0.05), while no significant changes were observed in the control group before and after the intervention (P > 0.05). CONCLUSION The home-based nutritional intervention method of food exchange portions can effectively improve the nutritional status of elderly patients with CHF, with the distribution of visceral fat more reasonable and the cardiopulmonary function and exercise endurance improved.
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Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota.
Suta, S, Surawit, A, Mongkolsucharitkul, P, Pinsawas, B, Manosan, T, Ophakas, S, Pongkunakorn, T, Pumeiam, S, Sranacharoenpong, K, Sutheeworapong, S, et al
Nutrients. 2023;15(5)
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Inadequate protein intake results in reduced growth and an immune system that is susceptible to disease and infection in early life. It has also been shown to affect school performance and intelligence status. Recent research shows that malnutrition has been associated with intestinal dysbiosis by altering the healthy and pathogenic microbiota that efficiently processes foods or produces vitamins. The aim of this study was to investigate the effects of prolonged egg supplementation on growth, blood biochemical indices, and gut microbiome in school-aged Thai children. This study was a cluster randomised controlled trial with parallel design. The study enrolled students from six rural primary schools and were randomly assigned to three groups: (1) whole egg - consumed 10 additional whole chicken eggs/week, (2) protein substitute - consumed a yolk-free egg substitute equivalent to 10 eggs/week, and (3) control group. Results showed that long-term whole egg supplementation significantly increased growth and improved important biomarkers in young school-age children without adverse effects on blood cholesterol levels. Furthermore, it also promoted intestinal microbial diversity by maintaining an intestinal microbiota composition that benefits health. Authors conclude that long-term whole egg supplementation is a feasible, low-cost, and effective intervention. However, further research is needed on the mechanistic effects of egg consumption on gut microbiota and growth.
Abstract
Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.
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Personalized Dietary Advice to Increase Protein Intake in Older Adults Does Not Affect the Gut Microbiota, Appetite or Central Processing of Food Stimuli in Community-Dwelling Older Adults: A Six-Month Randomized Controlled Trial.
Fluitman, KS, Wijdeveld, M, Davids, M, van Ruiten, CC, Reinders, I, Wijnhoven, HAH, Keijser, BJF, Visser, M, Nieuwdorp, M, IJzerman, RG
Nutrients. 2023;15(2)
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Undernutrition in older adults is a problem and the recommendation of increased protein intake may prevent this. However, dietary protein can increase feelings of being full and subsequently reduce the amount of food eaten, which is counterproductive. It is thought that it does this through modulation of the gut microbiota and appetite regulation in the brain. This subgroup analysis of a randomised control trial of 90 older adults with protein intake of <1.0g/kg of adjusted body weight/day aimed to determine if protein intakes of 1.2g/kg of adjusted body weight/day affect gut microbiota composition and appetite. The results showed that gut microbiota composition, brain activity in response to food, and appetite were unaffected by increased protein intake for 6 months. It was concluded that increased protein intake in older adults has no negative effects on gut microbiota or appetite. This study could be used by healthcare professionals to recommend a higher protein diet to older adults with decreased muscle mass or who are undernourished without concerns that it will decrease dietary intake of other nutrients.
Abstract
Expert groups argue to raise the recommended daily allowance for protein in older adults from 0.8 to 1.2 g/kg/day to prevent undernutrition. However, protein is thought to increase satiety, possibly through effects on gut microbiota and central appetite regulation. If true, raising daily protein intake may work counterproductively. In a randomized controlled trial, we evaluated the effects of dietary advice aimed at increasing protein intake to 1.2 g/kg adjusted body weight/day (g/kg aBW/day) on appetite and gut microbiota in 90 community-dwelling older adults with habitual protein intake <1.0 g/kg aBW/day (Nintervention = 47, Ncontrol = 43). Food intake was determined by 24-h dietary recalls and gut microbiota by 16S rRNA sequencing. Functional magnetic resonance imaging (fMRI) scans were performed in a subgroup of 48 participants to evaluate central nervous system responses to food-related stimuli. Both groups had mean baseline protein intake of 0.8 ± 0.2 g/kg aBW/day. At 6 months’ follow-up this increased to 1.2 ± 0.2 g/kg aBW/day for the intervention group and 0.9 ± 0.2 g/kg aBW/day for the control group. Microbiota composition was not affected, nor were appetite or brain activity in response to food-related stimuli. Increasing protein intake in older adults to 1.2 g/kg aBW/day does not negatively impact the gut microbiota or suppress appetite.
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HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge.
Blondal, BS, Geirsdottir, OG, Beck, AM, Halldorsson, TI, Jonsson, PV, Sveinsdottir, K, Ramel, A
European journal of clinical nutrition. 2023;77(1):45-54
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Malnutrition, which is commonly observed among older adults, is strongly associated with altered body composition, diminished physical and mental function as well as other adverse clinical outcomes. The aim of this study was to investigate the effects of intense nutritional therapy, including free access to energy- and protein-dense foods delivered to subjects recently discharged from hospital. This study is a 6-month, randomised controlled, assessor blinded intervention trial conducted in older adults. The participants (n=106) were randomly allocated to either the intervention or the control group. Results show that the nutrition intervention: - had strong beneficial effects on body weight (moderate weight gain in the intervention group compared to weight loss in the control group) and other anthropometric measures; - had favourable effects on physical function (however, there were no changes in muscular strength), and - led to improved nutritional status after being discharged from hospital (whereas the dietary intake decreased dramatically in the control group despite being informed at discharge of the importance of nutrition). Authors conclude that a 6-month nutrition therapy provided by a clinical nutritionist, following the principles of Nutrition Care Process in combination with freely delivered supplemental energy- and protein-dense foods, has beneficial effects on body weight, physical function, dietary intake, and nutritional status.
Abstract
BACKGROUND/OBJECTIVES Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION This study was registered at ClinicalTrials.gov ( NCT03995303 ).
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Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial.
Baggs, GE, Middleton, C, Nelson, JL, Pereira, SL, Hegazi, RM, Matarese, L, Matheson, E, Ziegler, TR, Tappenden, KA, Deutz, N
Clinical nutrition (Edinburgh, Scotland). 2023;42(11):2116-2123
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Malnutrition in hospitalised adults is recognized as a challenging health concern that is associated with many adverse outcomes. Malnutrition screening and assessment are essential for all patients admitted to the hospital and are particularly important for adults who are vulnerable. The aim of this study was to determine whether specialised oral-nutritional supplements (S-ONS) benefits were further associated with measurable improvements in quality of life (QoL) domains during the post-hospitalisation period. This study was a post-hoc analysis of NOURISH trial data. The NOURISH trial was a multicentre, prospective, randomised, double-blind, placebo-controlled, parallel-group study. Six-hundred and twenty-two patients were included in the intent-to-treat analysis. Results showed that malnourished, older patients who received daily interventions with S-ONS (during hospital stay and for 90-day post-discharge) had significantly better QoL domain scores compared to those who received only placebo intervention. Specifically, there were significant differences in the QoL domains of mental health/ cognition, vitality, social functioning, and general health. Further, there were significant QoL differences for physical component, physical functioning, bodily pain, and emotional role. Authors concluded that among malnourished, hospitalised patients (aged 65 years and over), supplementation with S-ONS during the hospitalisation and 90-days post discharge resulted in improvements in QoL.
Abstract
BACKGROUND & AIMS Both during and after hospitalization, nutritional care with daily intake of oral nutritional supplements (ONS) improves health outcomes and decreases risk of mortality in malnourished older adults. In a post-hoc analysis of data from hospitalized older adults with malnutrition risk, we sought to determine whether consuming a specialized ONS (S-ONS) containing high protein and beta-hydroxy-beta-methylbutyrate (HMB) can also improve Quality of Life (QoL). METHODS We analyzed data from the NOURISH trial-a randomized, placebo-controlled, multi-center, double-blind study conducted in patients with congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Patients received standard care + S-ONS or placebo beverage (target 2 servings/day) during hospitalization and for 90 days post-discharge. SF-36 and EQ-5D QoL outcomes were assessed at 0-, 30-, 60-, and 90-days post-discharge. To account for the missing QoL observations (27.7%) due to patient dropout, we used multiple imputation. Data represent differences between least squares mean (LSM) values with 95% Confidence Intervals for groups receiving S-ONS or placebo treatments. RESULTS The study population consisted of 622 patients of mean age ±standard deviation: 77.9 ± 8.4 years and of whom 52.1% were females. Patients consuming placebo had lower (worse) QoL domain scores than did those consuming S-ONS. Specifically for the SF-36 health domain scores, group differences (placebo vs S-ONS) in LSM were significant for the mental component summary at day 90 (-4.23 [-7.75, -0.71]; p = 0.019), the domains of mental health at days 60 (-3.76 [-7.40, -0.12]; p = 0.043) and 90 (-4.88 [-8.41, -1.34]; p = 0.007), vitality at day 90 (-3.33 [-6.65, -0.01]; p = 0.049) and social functioning at day 90 (-4.02 [-7.48,-0.55]; p = 0.023). Compared to placebo, differences in LSM values for the SF-36 general health domain were significant with improvement in the S-ONS group at hospital discharge and beyond: day 0 (-2.72 [-5.33, -0.11]; p = 0.041), day 30 (-3.08 [-6.09, -0.08]; p = 0.044), day 60 (-3.95 [-7.13, -0.76]; p = 0.015), and day 90 (-4.56 [-7.74, -1.38]; p = 0.005). CONCLUSIONS In hospitalized older adults with cardiopulmonary diseases and evidence of poor nutritional status, daily intake of S-ONS compared to placebo improved post-discharge QoL scores for mental health/cognition, vitality, social functioning, and general health. These QoL benefits complement survival benefits found in the original NOURISH trial analysis. CLINICAL TRIAL REGISTRATION NCT01626742.
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Frailty-Preventing Effect of an Intervention Program Using a Novel Complete Nutritional "COMB-FP Meal": A Pilot Randomized Control Trial.
Nakazeko, T, Shobako, N, Shioya, N, Iwama, Y, Hirano, Y, Fujii, S, Nakamura, F, Honda, K
Nutrients. 2023;15(20)
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Frailty is a complex and diverse combination of diseases, including physical dysfunctions and psycho-social problems. The aim of this study was to compare a 12-week programme with an exclusive dietary intervention in determining the impact of meals related to frailty. This study was a 12-week, open-label, randomised controlled trial. A total of 288 participants were recruited: 110 participants were enrolled and randomly assigned to the test (exercise and test food) or control (only exercise) group. Results showed that the 12-week intervention improved multiple outcomes related to frailty. There were significant improvements in both functional ability and cognitive function. Authors concluded that their findings indicate the important role of nutritional intervention in preventing frailty.
Abstract
Frailty is a huge concern for the aging population, and dietary nutrition is considered a key factor in the prevention of aging. To solve the problem of frailty in the aging population, we developed a novel dietary intervention program using a novel COMpletely Balanced for Frailty Prevention (COMB-FP) meal, based on the Dietary Reference Intake for Japanese; in addition, we conducted a pilot randomized control trial comparing an exercise program only (control group) with exercise plus the COMB-FP meal program (test group). We included 110 male and female healthy volunteers with pre-frailty or frailty; the trial lasted for 12 weeks. Two daily meals were replaced with the COMB-FP meals during the trial in the test group. Walking speed and cognitive function were significantly improved in the test group compared with the control group. We observed a similar pattern in other frailty-related outcomes, such as occupancy of the microbiome, World Health Organization well-being index (WHO-5), and oxidative stress. Our study might indicate the importance of a well-balanced intake of nutrients for frailty prevention.
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The Effect of Omega-3 Enriched Oral Nutrition Supplement on Nutritional Indices and Quality of Life in Gastrointestinal Cancer Patients: A Randomized Clinical Trial.
Sim, E, Kim, JM, Lee, SM, Chung, MJ, Song, SY, Kim, ES, Chun, HJ, Sung, MK
Asian Pacific journal of cancer prevention : APJCP. 2022;23(2):485-494
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Cancer cachexia is a multifactorial condition that reveals impairments in energy and protein balance leading to weight loss through the loss of skeletal muscle and body fat. Nutritional status of cancer patients affects therapeutic efficacy, and the disease survival is influenced by the degree of anorexia. The aim of this study was to evaluate the efficacy of omega-3 fatty acids fortified nutrition supplement intervention on nutritional status, quality of life (QOL) and pro-inflammatory cytokine concentrations of cancer patients. This study was a randomised controlled study. Participants (n = 58) included in the study were patients who were in stages between II to IV receiving one or more cancer therapies without taking any nutritional supplements. Both control and experimental groups received regular nutrition counselling and education, while only the experimental group was asked to take oral nutrition supplements (ONS) twice a day (400 ml, 400 kcal). Results show that ONS intervention: - alleviated symptoms of gastrointestinal symptoms including nausea, vomiting and constipation; - exerted improvements in many of QOL indices; and - did not improve (statistically significant) biochemical markers of nutritional status and concentration level of pro-inflammatory cytokines. Authors conclude that nutritional supplements can improve some of the QOL components which need evidence-based explanation in mechanistic aspects.
Abstract
OBJECTIVE Gastrointestinal (GI) cancer patients often experience severe malnutrition during cancer therapies due to gastrointestinal dysfunctions including poor digestion and absorption as well as tumor-associated anorexia. In this study, we performed a randomized clinical trial to determine the efficacy of oral nutrition supplement (ONS) enriched with omega-3 fatty acids on nutritional status, quality of life (QOL), and pro-inflammatory indices. METHODS Patients diagnosed with GI cancers were recruited and screened for eligibility. A total of 58 patients were randomly allocated to either the control group (n=27) or the experimental group (n=31). The intervention group received 200 ml ONS twice a day while the control group received routine care. Anthropometrics, Patient-Generated Subjective Global Assessment (PG-SGA) score, QOL score and nutrient intake data were collected at baseline, week 4 and week 8. Blood was drawn for biochemical assessments. Nine patients from each group dropped out of the study Forty patients (18 control patients and 22 intervention patients) completed the study. RESULTS This study showed that ONS intervention improved PG-SGA scores in the intervention group (p<0.01). Scores of physical functioning score and role functioning were declined only in the control group and the difference between week 8 and baseline for role functioning was significant (p<0.001). Fatigue score was steadily decreased in the experiment group, and the differences between week 8 and baseline was significant between two groups (p<0.02). However, no statistically significant improvement in biochemical markers of nutritional status and pro-inflammatory cytokine concentrations were found. These results suggests that ONS intervention for 8 weeks improves PG-SGA scores and QOL scores in patients undergoing cancer therapy.
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Effect of Lactobacillus casei on lipid metabolism and intestinal microflora in patients with alcoholic liver injury.
Li, X, Liu, Y, Guo, X, Ma, Y, Zhang, H, Liang, H
European journal of clinical nutrition. 2021;75(8):1227-1236
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Alcoholic liver disease (ALD) is a series of liver diseases caused by long-term heavy drinking. Lipid metabolism disorder often occurs in people with alcoholic liver injury. Treatment is mainly a combination of alcohol abstinence, improving nutrition, treating the liver injury, and preventing or reversing the progress of liver fibrosis or promoting liver regeneration. The aim of this study was to investigate the effect of Lactobacillus casei on lipid metabolism and intestinal microflora in patients with alcoholic liver injury. This study was a randomised, double-blind, placebo-controlled trial. A total of 181 ALD patients were recruited and randomly assigned to one of the three groups; low-dose group, high-dose group and positive control group (+ there was another group of 20 healthy people which served as normal control group). Results showed disorder of lipid metabolism, intestinal flora imbalance and inflammation in patients with alcoholic liver injury. Furthermore, after supplementation of Lactobacillus casei, there was a significant increase in the amount of Lactobacillus and Bifidobacterium. Authors conclude that Lactobacillus casei supplementation can improve lipid metabolism and regulate intestinal flora disorders in patients with alcoholic liver injury.
Abstract
BACKGROUND The present study aims to investigate the effect of Lactobacillus casei on lipid metabolism and intestinal microflora in patients with alcoholic liver injury. METHODS In a double-blind randomized controlled trial, 158 recruited alcoholic liver injury patients were randomized to three treatments for 60 days: low-dose group (LP, n = 58, 100 ml of Lactobacillus casei strain Shirota (LcS)), high-dose group (HP, n = 54, 200 ml of LcS), and positive control group (PC, n = 46, 100 ml of special drinks without active Lactobacillus casei). Another group of 20 healthy people was served as normal control group (NC). RESULTS The serum levels of TG and LDLC in the HP group were significantly decreased by 26.56% and 23.83%, respectively than those in the PC group (P < 0.05). After supplementation of Lactobacillus casei, there was a significant increase in the amount of Lactobacillus and Bifidobacterium when compared with the PC group (P < 0.05). CONCLUSIONS Supplementation of Lactobacillus casei can improve lipid metabolism and regulate intestinal flora disorders in patients with alcoholic liver injury.
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Efficacy of probiotics on digestive disorders and acute respiratory infections: a controlled clinical trial in young Vietnamese children.
Mai, TT, Thi Thu, P, Thi Hang, H, Trang, TTT, Yui, S, Shigehisa, A, Tien, VT, Dung, TV, Nga, PB, Hung, NT, et al
European journal of clinical nutrition. 2021;75(3):513-520
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The World Health Organization (WHO) reported that acute respiratory infection (ARI) is the leading cause of death in children followed by diarrhoea and constipation. In Vietnam, despite many achievements in malnutrition prevention, the rate of malnutrition is elevated. Malnutrition results in ARI, diarrhoea, and physical and mental retardation in children The aim of this study was to investigate the effects of a probiotic fermented milk product containing Lactobacillus casei strain Shirota (LcS) on gastrointestinal symptoms, respiratory infections, and the nutrition status of children from Vietnam. This study was a community based, controlled open trial and it was conducted over a period of 18 weeks consisting of 2-week screening/pre-observational period; 12-week intervention period; and 4-week postintervention period. A total of 1036 children (518 children in the Control group and 518 children in the Probiotic group) were enrolled in this study. Results showed a significant reduction in the incidence of constipation and beneficial effects to prevent infectious diseases in Vietnamese children. Furthermore, while LcS did not affect the duration of diarrhoea, the incidence of diarrhoea tended to be improved after 12 weeks of intervention. Authors conclude that habitual consumption of fermented milk containing LcS prevented constipation and ARI in Vietnamese children, and it may be useful for treating diarrhoea and improving nutritional status, thus conferring remarkable health benefits to children in Vietnam.
Abstract
OBJECTIVES To evaluate the efficacy of fermented milk containing Lactobacillus casei strain Shirota (LcS) on the incidence of constipation, diarrhea, acute respiratory infections (ARI), and nutritional status of young Vietnamese children. METHODS A controlled field trial was conducted with 1003 children (3-5 years old) in Thanh Hoa province in Vietnam. The probiotic group (n = 510) consumed fermented milk 65 mL/day containing 108 CFU/mL of LcS for the 12-week intervention period, whereas the control group (n = 493) was not given any. The incidence of constipation, diarrhea, ARI, and anthropometry in children was determined at baseline, after 4, 8, and 12-week intervention, and after the 4-week follow-up period. RESULTS Probiotic drink decreased the incidence of constipation after the 12-week intervention period (12.0% vs. 32.0%, OR = 0.28 (95% CI: 0.21-0.40), p < 0.001), tended to decrease the incidence of diarrhea (4.9% vs. 7.9%, OR = 0.60 (95% CI: 0.35-1.01), p = 0.068), and prevented the occurrence of ARI (15.9% vs. 24.5%, OR = 0.58 (95% CI: 0.42-0.79), p < 0.001), when compared with the control group. In contrast, no probiotic effects were observed for the duration of diarrhea or ARI. Weight gain was higher in the probiotic group than in the control group after 4, 8, and 12-week intervention and after the 4-week follow-up period (p < 0.05). CONCLUSIONS Daily intake of fermented milk containing LcS strongly prevented the incidence of constipation and ARI in Vietnamese children. This study also revealed the potential effects of the use of a probiotic drink on diarrhea prevention as well as nutritional status improvement.
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Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial.
Roberts, SB, Franceschini, MA, Silver, RE, Taylor, SF, de Sa, AB, Có, R, Sonco, A, Krauss, A, Taetzsch, A, Webb, P, et al
BMJ (Clinical research ed.). 2020;370:m2397
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Undernutrition during childhood may contribute to brain impairments resulting in reduced learning and understanding, which may be irreversible. Foods that are fortified with added vitamins and minerals may help to promote brain regeneration in those who are malnourished. This randomised control trial aimed to assess the effects of a new fortified food on memory and an iron rich component of blood in 1059 children aged 15 months to 7 years. The results showed that memory improved in children under 4 years old, but this was not observed in children over 4 years. Iron rich components of the blood were also increased in children under the age of 4 years but again remained unchanged in those over 4 years old. It was concluded that food fortification was of benefit to memory, brain function and iron rich blood components in children under the age of 4 years old. Although tested in a low-income country, these results may be translatable into middle and affluent countries where children are malnourished due to an unhealthy diet. This study could be used by healthcare professionals to understand the importance of a balanced nutritious diet for a child’s learning and the possibility of recommending fortified foods to children who are malnourished.
Abstract
OBJECTIVE To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition. DESIGN Randomized controlled trial. SETTING 10 villages in Guinea-Bissau. PARTICIPANTS 1059 children aged 15 months to 7 years; children younger than 4 were the primary population. INTERVENTIONS Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast). MAIN OUTCOME MEASUREMENTS The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models. RESULTS Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (-0.23, -0.43 to -0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm2, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10-8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03). CONCLUSIONS Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03017209.