Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial.
Plain language summary
Obesity is related to the increased risk for chronic diseases and to nutrient insufficiencies, a paradox that has been characterised as the “double burden of malnutrition”. The aim of this study was to examine the effectiveness of a computerised decision-support tool as a means of childhood obesity management. The effectiveness of the decision-support tool was assessed through a pilot randomised controlled intervention trial. The study recruited a total sample of 80 children (obese or overweight) with an age range between 6 and 12 years. The participants were allocated to two study groups – intervention group and control group. Results indicate that a computerised decision-support tool, designed to assist paediatric healthcare professionals in providing personalised nutrition and lifestyle optimisation recommendations to overweight or obese children and their parents, can result in favourable changes to certain dietary intake and anthropometric indices in the children that received the intervention. Authors conclude that the computerised decision-support tool resulted in improvement of the children’s dietary intake and body mass index. Hence, the tool can support clinicians to improve the effectiveness of care.
We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6⁻12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children's hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and -4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by -0.1 and -0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by -0.4 kg/m². However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.
Nutritional Interventions to Improve Clinical Outcomes in Ovarian Cancer: A Systematic Review of Randomized Controlled Trials.
Plain language summary
Ovarian cancer is one of the most common cancers worldwide and it has the highest mortality rate of all gynaecologic cancers. The aim of the study was to examine the impact of several types of nutrition interventions on clinical outcomes in ovarian cancer patients. The study is a systemic review of fourteen randomised controlled trials (RCTs) focusing on nutritional interventions during chemotherapy or during the perioperative period. The majority of RCTs reported improved clinical outcomes after nutritional interventions. Most RCTs show a reduction in length of hospital stay and ameliorated intestinal recovery after surgery. Authors conclude that it is important to find nutritional interventions in order to improve patient’s survival since the ovarian mortality rate is one of the highest among malignancies.
undefined: Among all gynaecological neoplasms, ovarian cancer has the highest rate of disease-related malnutrition, representing an important risk factor of postoperative mortality and morbidity. Hence, the importance of finding effective nutritional interventions is crucial to improve ovarian cancer patient's well-being and survival. This systematic review of randomized controlled trials (RCTs) aims at assessing the effects of nutritional interventions on clinical outcomes such as overall survival, progression-free survival, length of hospital stay (LOS), complications following surgery and/or chemotherapy in ovarian cancer patients. Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until December 2018. A total of 14 studies were identified. Several early postoperative feeding interventions studies ( = 8) were retrieved mainly demonstrating a reduction in LOS and an ameliorated intestinal recovery after surgery. Moreover, innovative nutritional approaches such as chewing gum intervention ( = 1), coffee consumption ( = 1), ketogenic diet intervention ( = 2) or fruit and vegetable juice concentrate supplementation diet ( = 1) and short-term fasting ( = 1) have been shown as valid and well-tolerated nutritional strategies improving clinical outcomes. However, despite an acceptable number of prospective trials, there is still a lack of homogeneous and robust endpoints. In particular, there is an urgent need of RCTs evaluating overall survival and progression-free survival during ovarian oncology treatments. Further high-quality studies are warranted, especially prospective studies and large RCTs, with more homogeneous types of intervention and clinical outcomes, including a more specific sampling of ovarian cancer women, to identify appropriate and effective nutritional strategies for this cancer, which is at high risk of malnutrition.
The Effect of Nutrition Intervention with Oral Nutritional Supplements on Pancreatic and Bile Duct Cancer Patients Undergoing Chemotherapy.
Plain language summary
Despite the advantages of chemotherapy, it can cause cancer-related malnutrition leading to both reduced quality of life and reduced survival rate. Oral nutritional supplements (ONSs) provide balanced nutrients, calories, and protein to complement insufficient oral intake, and ONS provision during treatment may improve nutritional status. The aim of this study was to investigate the impact of ONS on nutritional status in patients undergoing chemotherapy for pancreatic and bile duct cancer. Patients were randomly allocated to the ONS group (15) and non-ONS group (19) and dietary intake and body weight were assessed at weeks 1, 2, 4 and 8. Body composition and quality of life was assessed at baseline and week 8. This study found the supply of ONS helped promote health by increasing body fat mass, improving quality of life and decreasing fatigue symptoms in pancreatic and bile duct cancer patients. These results were more pronounced in patients in the first cycle of chemotherapy. Based on these results, the authors conclude ONS may improve nutritional status by increasing fat mass and/or maintaining the body composition of patients undergoing chemotherapy.
undefined: Chemotherapy may negatively affect nutritional status and quality of life (QOL) in pancreatic cancer patients. Our aim was to investigate the beneficial effects of oral nutrition supplements (ONS) on pancreatic and bile duct cancer patients undergoing chemotherapy. Among patients with progressive pancreatic and bile duct cancer receiving chemotherapy, the ONS group ( = 15) received two packs of ONS daily for 8 weeks while the non-ONS group ( = 19) did not. Anthropometric measures, dietary intake, nutritional status, and quality of life were assessed. ONS significantly increased daily intakes of energy, carbohydrates, proteins, and lipids at 8 weeks compared to the baseline. After 8 weeks, fat mass significantly increased in the ONS group. For patients in their first cycle of chemotherapy, body weight, fat-free mass, skeletal muscle mass, body cell mass, and fat mass increased in the ONS group but decreased in the non-ONS group. Fat mass increased in second or higher cycle only in the ONS group. Patient-generated subjective global assessments (PG-SGA) and fatigue scores in the Quality of Life Questionnaire Core 30 (QLQ-C30) improved in the ONS group. ONS might improve nutritional status by increasing fat mass and/or maintaining the body composition of pancreatic and bile duct cancer patients with chemotherapy, especially those in the first cycle, and alleviate fatigue symptoms.
Association between eating behaviour and diet quality: eating alone vs. eating with others.
Nutrition journal. 2018;17(1):117
Plain language summary
Selecting foods for a day is easily influenced by the social environment and eating together or alone plays a big role in that decision. The study aims to evaluate the association between diet quality of the modern Korean adult population based on the eating behaviour and the socioeconomic factors that influence their diet quality. The study is a cross-sectional study which included 3365 men and 5258 women aged between 19 and 64 years. The study included demographic, socioeconomics, and health behaviour factors as covariates. Results indicate that diet quality is influence by eating behaviour. Authors observed that when Korean adults ate without a companion, their diet quality was significantly lower than those who consistently ate with others. Furthermore, from the higher education to lower education level, the diet quality declined when they eat alone. Authors conclude that many Korean adults are experiencing low diet quality when they eat alone. The study provides evidence to promote interventions to improve diet quality among the public.
BACKGROUND To discover the association between eating alone and diet quality among Korean adults who eat alone measured by the mean adequacy ratio (MAR), METHODS The cross-sectional study in diet quality which was measured by nutrient intakes, indicated as MAR and nutrient adequacy ratio (NAR) with the Korean National Health and Nutrition Examination Survey (KNHANES) VI 2013-2015 data. Study population was 8523 Korean adults. Multiple linear regression was performed to identify the association between eating behaviour and MAR and further study analysed how socioeconomic factors influence the diet quality of those who eat alone. RESULTS We found that the diet quality of people who eat alone was lower than that of people who eat together in both male (β: - 0.110, p = 0.002) and female participants (β: - 0.069, p = 0.005). Among who eats alone, the socioeconomic factors that negatively influenced MAR with the living arrangement, education level, income levels, and various occupation classifications. CONCLUSIONS People who eat alone have nutrition intake below the recommended amount. This could lead to serious health problems not only to those who are socially disadvantaged but also those who are in a higher social stratum. Policy-makers should develop strategies to enhance diet quality to prevent potential risk factors.
Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise.
The Journal of nutrition. 1999;129(11):2028-36
Plain language summary
Elderly people are at risk of nutritional deficiencies for a variety of reasons including reduced appetite, increased medication, and alterations in the absorption and metabolism of vitamins and minerals with age. The aim of this study was to measure the influence of exercise, and supplementing the diet with vitamins and minerals, on indicators of nutritional and health status in frail elderly people. A 17-week randomised controlled trial was carried out on 145 frail elderly people living in the community. Participants were given either; 1) food products enriched with vitamins D, E, thiamine, riboflavin, B6, folic acid, B12, calcium, magnesium, zinc, iron and iodine; 2) an exercise programme; 3) both enriched food products and exercise programme; or 4) food products that had not been enriched and a social programme (the control group). At the end of the study, significant improvements in the blood levels of vitamins B6, B12, C and D were detected in the groups receiving the enriched food products compared to the controls. There was no additional benefit to be gained from exercise. The improvement in nutritional status did not appear to influence several other biological indicators of health, perhaps because these indicators were already within normal levels at the start of the study. Despite this, the authors concluded that long-term supplementation may help to maintain optimal vitamin and mineral levels in elderly people, and therefore reduce the chance of this population developing health problems related to malnutrition.
A decline in dietary intake due to inactivity and, consequently, development of a suboptimal nutritional status is a major problem in frail elderly people. However, benefits of micronutrient supplementation, all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly. A 17-wk randomized controlled trial was performed in 145 free-living frail elderly people (43 men, 102 women, mean age, 78 +/- 5.7 y). Based on a 2 x 2 factorial design, subjects were assigned to one of the following: 1) nutrient-dense foods, 2) exercise, 3) both (1) and (2) or 4) a control group. Foods were enriched with micronutrients, frequently characterized as deficient [25-100% of the recommended daily allowance (RDA)] in elderly people. Exercises focused on skill training, including strength, endurance, coordination and flexibility. Dietary intake, blood vitamin levels and nutritional and health indicators, including (pre)albumin, ferritin, transferrin, C-reactive protein, hemoglobin and lymphocytes were measured. At baseline, 28% of the total population had an energy intake below 6.3 MJ, up to a maximum of 93% having vitamin intakes below two thirds of the Dutch RDA. Individual deficiencies in blood at baseline ranged from 3% for erythrocyte glutathione reductase-alpha to 39% for 25-hydroxy vitamin D and 42% for vitamin B-12. These were corrected after 17 wk in the two groups receiving the nutrient-dense foods, whereas no significant changes were observed in the control or exercise group. Biochemical and hematologic indicators at baseline were within the reference ranges (mean albumin, 46 g/L; prealbumin, 0.25 g/L; hemoglobin, 8.6 mmol/L) and were not affected by any of the interventions. The long-term protective effects of nutrient supplementation and exercise, by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values, require further investigation. Other indicative functional variables for suboptimal nutritional status, in addition to those currently selected, should also be explored.
[Abnormal effect of nitrosation inhibitors in human gastric juice].
Voprosy onkologii. 1986;32(10):58-64
Plain language summary
Growth faltering in infancy establishes a trajectory for lifelong health of the individual and population. Stunted growth is due to the combined effect inadequate diet (malnutrition) and infection that affects the gut mucosal lining, with increased nutrient loss due to maldigestion and malabsorption, and increased nutritional requirements due to inflammation. Intestinal integrity in infants has been improved through supplementation with vitamin A and Zinc. Iron deficiency anemia may impair intestinal integrity. This study investigates the effects of complementary fortified food on gut integrity and systemic inflammation among Zambian infants age 6-18months. Infants of 6 months +/- 2 weeks old were randomised to either 50g/day richly fortified porridge mix or 50g basal porridge mix fortified with micronutrient levels planned for maize fortification in Zambia. At 18 months, the richly fortified porridge group had a significantly higher mean lactulose to mannitol ratio than the basal-fortified group, indicating they had significantly higher intestinal permeability. This effect was not modified by child’s sex, maternal HIV status, concurrent breast-feeding or baseline anaemia. The biological significance of this increase in intestinal permeability is questionable, however further research is warranted to understand the effect of iron supplementation on gut permeability in infants with normal iron status. In conclusion, a richly fortified complementary/replacement food did not benefit and may have worsened intestinal permeability. Further investigation into local interactions of key micronutrients with gut integrity, particularly in micronutrient-replete infants is needed.
The paper discusses the effect of vitamins C and E and Plantaglucide on nitroso compounds yield in the course of nitrosation of amines in human gastric juice. The study group included 56 subjects. The above drugs capable of inhibiting in vitro nitrosation produced an anomalous effect in gastric juice of some subjects, i.e. potentiated nitroso compounds yield in nitrosation of amines by sodium nitrite. The said action of vitamins C and E was apparent in dimethylamine and amidopyrine nitrosation but it was not in morpholine nitrosation. Sharply increased levels in nitroso compounds were observed in some mice fed precursors of nitroso compounds in combination with vitamin C and Plantaglucide. These data point to an anomalous effect of the drugs on the body.