Clinical Nutrition - Articles in Press

Endothelial Function and Other Biomarkers of Cardiovascular Risk in Frequent Consumers of Street Food - Accepted Manuscript

2012-05-18

Abstract: Background & Aims: Street food (SF) is defined as out-of-home food consumption, and generally consists of energy dense meals rich in saturated fats, and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with endothelial function has not been considered.Methods: Participants were recruited among those who took part in a previous study of ours, done in Palermo, Italy, which investigated the association between consumption of SF and health in 1,002 people. In that study, a score of SF consumption was obtained by categorizing each of ten foods consumed less than or more than once a month (0= never consumed, 1= once a month or less, 2= more than once a month; thus, the sum of single scores could range from 0 and 20). Based on the interquartile values of SF score distribution, in the present study we included low SF consumers, defined on the basis of the first interquartile SF score range (range: 0-1), and high SF consumers, who were those in the forth interquartile range of the SF score (range: 7-20). The group of low SF consumers had 12 participants (median value of SF score: 1; range: 0-1), that of high SF consumers had 13 (median value of SF score: 11; range: 10-16). The brachial artery flow-mediated dilatation (FMD), a measure of endothelial function, and other cardiovascular biomarkers were investigated.Results: High SF consumers had higher BMI (P= 0.026), larger waist circumference (P= 0.041), higher levels of cholesterol (P= 0.013) and uric acid serum concentrations (P= 0.002) compared with low SF consumers. The high SF consumers had a significantly lower FMD (5.4 ± 2.1 versus 8.8 ± 2.8 %; ANCOVA with BMI and waist circumpherence as covariates: P= 0.025) than the high consumers. Other cardiovascular biomarkers did not significantly differ between the two groups.Conclusions: This study suggests that high SF consumption in Palermo may be associated with endothelial dysfunction in healthy people, probably indicating that this category of foods should be limited, especially in people at high cardiovascular risk.

Development of quality of care interventions for adult patients on home parenteral nutrition (HPN) with a benign underlying disease using a two-round Delphi approach - Accepted Manuscript

2012-05-17

Summary: Background and aims: HPN patients with benign diseases deserve professional care as they have to deal with complex techniques and risk potentially dangerous complications. The aim was to highlight main outcome quality indicators and to develop a set of key interventions to direct multidisciplinary teams in providing qualitative care.Methods: A two-round Delphi approach was used to build consensus on the most important outcome indicators and on 59 interventions identified in existing guidelines on HPN. Comments and interventions newly identified in the first round were co-evaluated in the second round.Results: 29 experts from 9 countries completed the two-round Delphi approach. The outcome indicators rated as the most important are 1) incidence of catheter-related infections, 2) incidence of readmission and quality of life (shared second place) and 3) incidence of dehydration. Sixty eight of a total of 89 interventions were considered as important for the quality of care, of which 46 are based on published guidelines and 22 were newly suggested by the Delphi panel.Conclusions: Using a two-round Delphi approach, consensus was reached for the majority of interventions concerning HPN patients with benign diseases. This set of 68 interventions could be of use as a starting point for quality-improvement programs.

Estimation of percent body fat based on anthropometric measurements in children and adolescents with congenital adrenal hyperplasia due 21-hydroxylase deficiency - Accepted Manuscript

2012-05-17

Summary: Background & Aim: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is associated with a high risk for obesity. Anthropometric measures are simple and inexpensive methods to assess body fat. However, the accuracy of alternative methods in these patients is unknown. This study aim to develop and evaluate the accuracy of predictive anthropometric equations in the estimation of percent body fat in individuals with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.Methods: A total of 31 female and 22 male patients, aged 7 to 20 years, were evaluated. Dual-energy X-ray absorptiometry was used as the reference method for body fat, and anthropometric measurements were performed.Results: Three new predictive equations showed similar results: Equation 1 (R2 = 0.85; SEE = 2.89%), Equation 2 (R2 = 0.86; SEE = 2.82%), and Equation 3 (R2 = 0.86; SEE = 2.81%). Internal cross-validation procedures showed a high R2 (range, 0.84-0.85) and low SEE (< 3%). The limits of agreement ranged from -5.6% to 5.6% and no trend was observed.Conclusion: In children and adolescents with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, three new predictive equations were validated for the estimation of percent body fat, with dual-energy X-ray absorptiometry as the reference method.

Meta-analysis of B vitamin supplementation on plasma homocysteine, cardiovascular and all-cause mortality - Accepted Manuscript

Tao Huang, Ying Chen, Bin Yang, Jing Yang, Mark L. Wahlqvist, Duo Li — 2012-05-14

Abstract: Background: & Aims: Results from randomized controlled trials (RCT) of B vitamin supplementation on risk of cardiovascular disease (CVD) were inconclusive. The aim of the present study was to systematically review the effects of B vitamin supplementation on plasma homocysteine (Hcy), cardiovascular and all-cause mortality in RCT.Methods: RCT publications on the effect of B vitamin supplementation on plasma Hcy, cardiovascular and all-cause mortality were searched from PubMed and web of science database. Data were independently abstracted by 2 investigators using a standardized protocol. The results were pooled with a fixed-effects model using Stata software.Results: Data from 19 studies including 47921participants were analyzed using a fixed-effects model. The overall relative risks with 95% confidence intervals of outcomes for patients treated with B vitamin supplementation compared with placebo were 0.98 (0.94-1.03) for CVD, 0.98 (0.92-1.05) for coronary heart disease (CHD), 0.97 ( 0.90- 1.05) for myocardial infarction (MI), 0.88 (0.82-0.95) for stroke, and 0.97 (0.91-1.02) for cardiovascular death, 0.99 (0.95- 1.04) for all-cause mortality. Blood Hcy levels were decreased in all included RCTs.Conclusions: B vitamin supplementation has a significant protective effect on stroke, but none on the risk of CVD, MI, CHD, cardiovascular death, or all-cause mortality.

Enhanced anabolic response to milk protein sip feeding in elderly subjects with COPD is associated with a reduced splanchnic extraction of multiple amino acids - Accepted Manuscript

Engelen MPKJ, De Castro CLN, Rutten EPA, Wouters EFM, Schols AMWJ, Deutz NEP — 2012-05-14

Abstract: Background: & Aims: We previously observed in elderly subjects with Chronic Obstructive Pulmonary Disease (COPD) an enhanced anabolic response to milk protein sip feeding, associated with reduced splanchnic extraction (SPE) of phenylalanine. Milk proteins are known for their high Branched-chain Amino Acids (BCAA) content, but no information is present about splanchnic extraction and metabolism of the individual BCAA in COPD.Objective: To investigate whether BCAA metabolism and SPE of the individual BCAA are altered in COPD during milk protein sip feeding.Design: In elderly subjects with COPD and in healthy age-matched elderly SPE, endogenous rate of appearance (Raendo) of the leucine (LEU), isoleucine (ILE) and valine (VAL) were measured before and during sip feeding of a Whey protein meal. To study the effect of aging, the healthy elderly were compared to a group of healthy young subjects. Stable isotopes of L-[2H3]-LEU, L-[1-13C]-ILE and L-[1-13C]-VAL were given on two separate test days orally or intravenously. Simultaneously, L-[ring-2H5]-phenylalanine (PHE) and L-[ring-2H2]-tyrosine (TYR) were given to determine the whole body protein breakdown (WbPB), synthesis (WbPS) and NetPS.Results: SPE of all BCAA, TYR, and PHE (p<0.01) were lower in the COPD group, and the increase in netPS during feeding was higher in the COPD group (P<0.01) due to higher values for PS (P<0.001). Raendo of all BCAA, PHE and TYR were higher in the COPD than the healthy elderly group (P<0.05) before and during feeding (P<0.001). Sip feeding resulted in a reduction of Raendo of PHE, ILE and VAL (P<0.05). Postabsorptive Raendo was not different for any of the measured amino acids between the healthy elderly and young group, while sip feeding resulted in a reduction of Raendo of PHE. Only SPE of TYR was higher in the elderly (P<0.05) and the increase in netPS during sip feeding was independent of aging.Conclusion: The enhanced anabolic response to milk protein sip feeding in normal-weight COPD patients is associated with a reduced splanchnic extraction of multiple amino acids including all branched-chain amino acids.

The prevalence of vitamin deficiency in clinical practice is assay dependent - Accepted Manuscript

2012-05-14

Abstract: Background and aim: Vitamin D deficiency is an important concern in clinical settings and recently, international agencies have recognised the importance of 25-OHD assays in defining vitamin D status. Thus, our aim was to assess the consistency of different vitamin D assays in clinical practice.Methods: 25-OH-vitamin D was measured in 332 patients by ultra-fast liquid chromatography (UHPLC) and two immunoassays (Liaison Total 25(OH) and ADVIA Centaur Vitamin D Total Assay). Samples from the Vitamin D External Quality Survey (DEQAS) and the Standard Reference Material SRM 972 were used for analytical quality control.Results: All methods displayed an acceptable performance with DEQAS samples but immunoassays showed a significant bias against certified materials. Compared to UHPLC, differences were significant for both immunoassays in the deficiency interval but the systematic bias was higher for the ADVIA assay throughout the whole range of concentrations. Conclusion: The prevalence of vitamin D deficiency in clinical practice is assay-dependent and physicians should be aware of the uncertainty associated with vitamin D assessment.

Resting energy expenditure in malnourished older patients at hospital admission and three months after discharge: predictive equations versus measurements - Accepted Manuscript

2012-05-14

Abstract: Background: Predicting resting energy expenditure (REE) in malnourished hospitalized older patients is important for establishing optimal goals for nutritional intake. Measuring REE by indirect calorimetry is hardly feasible in most clinical settings.Objective: To study the most accurate and precise REE predictive equation for malnourished older patients at hospital admission and again three months after discharge.Design: Twenty-three equations based on weight, height, gender, age, fat free mass (FFM) and/or fat mass (FM) and eleven fixed factors of kcal/kg were compared to measured REE. REE was measured by indirect calorimetry. Accuracy of REE equations was evaluated by the percentage patients predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias) and the Root Mean Squared prediction Error (RMSE).Results: REE was measured in 194 patients at hospital admission (mean 1473 kcal/d) and again three months after hospital discharge in 107 patients (mean 1448 kcal/d). The best equations predicted 40% accuracy at hospital admission (Lazzer, FAO/WHO-wh and Owen) and 63% three months after discharge (FAO/WHO-wh). Equations combined with FFM, height or illness factor predicted slightly better. Fixed factors produce large RMSE’s. All predictive equations showed proportional bias, with overestimation of low REE values and underestimation of high REE values. Correction by regression analysis did not improve results.Conclusions: The REE predictive equations are not adequate to predict REE in malnourished hospitalized older patients. There is an urgent need for either a new accurate REE predictive equation, or accurate easy-to-use equipment to measure REE in clinical practice.

Vitamin K status in patients with short bowel syndrome - Accepted Manuscript

2012-05-14

Summary: Background & aims: Available evidence suggests that patients with short bowel syndrome (SBS) might be at risk of vitamins A, D, E and B1 deficiency. However, there is little clinical data describing the vitamin K status. Therefore, in the present study we aimed to assess the body resources of vitamin K in a subset of SBS patients.Methods: The study comprised 33 patients aged 1 month to 16 years. PIVKA II concentrations were determined in all subjects.Results: In all studied subjects, coagulation parameters were normal. PIVKA-II levels indicative of vitamin K deficiency was found in 3 (9.1%) SBS patients. One patient had been receiving an additional intravenous vitamin K dose of 5mg/week. In all SBS patients with cirrhosis and cholestasis, PIVKA II concentrations were low (<2 ng/ml). However, all patients with severe liver disease were receiving vitamin K several times a month.Conclusions: Vitamin K deficiency may appear in SBS patients.

The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients - Accepted Manuscript

2012-05-14

Abstract: Background & Aims: In cardiac surgical patients, undernutrition increases the risk of adverse clinical outcome. We investigated whether the bioelectrical impedance phase angle is an indicator of undernutrition and clinical outcome in cardiac surgery.Methods: In 325 cardiac surgical patients, we prospectively analyzed the associations between a preoperative low phase angle, measured by bioelectrical impedance spectroscopy, and well-established indicators of undernutrition such as body mass index (kg/m2), unintended weight loss, and fat free mass index (kg/m2), and muscle strength (handgrip strength (kg)), immune function (C-reactive protein and albumin), and adverse clinical outcomes.Results: A low phase angle (<5.38°) was present in 29.8% (n=96) of the patients, and was associated with low body mass index (p<0.001), low fat free mass index (p<0.001), and less handgrip strength (p=0.063), but not with unintended weight loss or immune function. Furthermore, a preoperative low phase angle was associated with a prolonged intensive care unit and hospital stay (adj.hazard ratio: 0.68; 95%CI: 0.49-0.94; p=0.020 and adj.hazard ratio: 0.74; 95%CI: 0.55-0.99; p=0.048, respectively).Conclusions: A preoperative low bioelectrical impedance phase angle is associated with undernutrition, and increases the risk of adverse clinical outcome after cardiac surgery. The phase angle might help to identify undernourished cardiac surgical patients.

Normal protein anabolic response to hyperaminoacidemia in insulin-resistant patients with lung cancer cachexia - Accepted Manuscript

Aaron Winter, Jacqueline MacAdams, Stéphanie Chevalier — 2012-05-14

Abstract: Background & Aims: Insulin resistance of protein anabolism has been speculated to underlie the skeletal muscle wasting characteristic of cancer cachexia. We tested whether insulin resistance is present in cachectic lung cancer patients and if a sustained, physiological elevation of amino acids with hyperinsulinemia would compensate for it.Methods: Whole-body [13C]leucine and [3H]glucose kinetics were assessed in 10 male non-small cell lung cancer (NSCLC) patients and 10 healthy matched controls during a euglycemic, hyperinsulinemic clamp under conditions of isoaminoacidemia followed by hyperaminoacidemia.Results: Postabsorptive glucose and protein kinetics were comparable between groups. Glucose uptake was significantly lower in NSCLC patients during hyperinsulinemia. During concurrent isoaminoacidemia, protein breakdown was suppressed in both, but rates were elevated in NSCLC; rates of synthesis did not change, resulting in reduced net protein balance (synthesis - breakdown) in response to insulin in NSCLC. With subsequent hyperaminoacidemia, synthesis increased significantly with no further change in breakdown, resulting in similar increase in net balance between groups.Conclusions: NSCLC patients with moderate cachexia showed considerable insulin resistance of glucose and of whole-body protein anabolism. Their anabolic protein response was stimulated normally by hyperaminoacidemia. Thus, ample provision of amino acids is a feasible strategy to overcome the protein anabolic failure of cancer cachexia.

Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN - Accepted Manuscript

2012-05-14

Abstract: Background & Aims: Indications and timing for referral for intestinal transplantation (ITx) were investigated through a review of the literature on home parenteral nutrition (HPN) for benign intestinal failure and a benchmarking to the results of a prospective European survey which evaluated the appropriateness of the current indications for ITx.Methods: Manuscripts reporting outcomes of adults and children on HPN were retrieved through a PubMed search. Data from the European survey were compared with those on HPN reported in the literature, and with those on ITx reported by the USA registry and by the Pittsburgh center.Results: HPN is a safe treatment with a high probability of survival. The risk of death during HPN is increased by the absence of a specialist team, and appears greater during the early period of treatment. Survival probability is decreased in patients with: age > 40 or < 2 years, very short bowel remnant, presence of a stoma, chronic intestinal pseudo-obstruction of myopathic origin,systemic sclerosis, radiation enteritis, intra-abdominal desmoids, necrotizing enterocolitis, congenital mucosal diseases. Liver failure is the HPN-related complication with the greatest risk of death. Death related to venous catheter complications is rare. The benchmarking supported the results of the European survey.

Sensitive period in flavor learning: effects of duration of exposure to formula flavors on food likes during infancy - Accepted Manuscript

Julie A. Mennella, Sara M. Castor — 2012-05-14

Summary: Background & Aims: Emerging research has revealed the existence of periods in which the developing brain has heightened sensitivity to environmental influences. We discovered a sensitive period, <4 months of age, when exposure to the flavor of extensively hydrolyzed protein hydrolysate formulas (ePHF) determines its hedonic tone. This formula has pronounced bitter, sour, and savory tastes compared to cow-milk-based formulas (CMF). This study aimed to determine the effects of duration of exposure during the sensitive period on a food containing an exemplar of the savory flavor.Methods: Formula-fed infants were randomized into four groups at age 0.5 months: one control group fed the control cow-milk formula (CMF) for 8 months, and three groups fed ePHF for 1, 3, or 8 months and CMF otherwise. When infants were 8.5 months, their acceptance of a savory and plain broth was measured.Results: Infants fed hydrolysate formula for 3 or 8 months, but not 1 month, showed greater acceptance of the savory broth relative to the plain broth (p<0.01) and consumed it at a faster rate (p=0.01).Conclusions: The duration of flavor exposure affects infants’ earliest responses to foods: a 3-month exposure to this formula shifted the hedonic tone for savory flavor.

Protein recommendations in the ICU: g protein/kg body weight – which body weight for underweight and obese patients? - Uncorrected Proof

Peter Weijs, Hans Sauerwein, Jens Kondrup — 2012-05-11

In the ESPEN guideline for parenteral nutrition in the ICU, it is recommended to provide 1.3–1.5 g protein or amino acids per kg ideal body weight (IBW) per day. The purpose is to avoid over-feeding of protein in patients who are either severely obese or oedematous. However, a guide to estimating IBW was not given. In the ICU, the Devine equation based on height is often used, e.g. for deciding tidal volume.

Factors that influence Staphylococcus epidermidis growth in parenteral nutrition with and without lipid emulsion: A study framework to inform maximum duration of infusion policy decisions - Uncorrected Proof

Peter D. Austin, Kieran S. Hand, Marinos Elia — 2012-05-11

Summary: Background & aims: Recommendations limit infusion of parenteral nutrition (PN) from bags with lipid to 24 h (48 h if lipid free) because lipid putatively encourages contaminant growth. This study aimed to examine these recommendations and identify factors affecting Staphylococcus epidermidis growth in PN.Methods: S. epidermidis growth was assessed in quadruplicate in 12 PN regimens, with and without lipid and varying glucose concentrations.Results: Baseline colony forming units (cfu)/mL (32.6) less than doubled at 48 h in all infusates. In PN infusates (pH 6.2 + 0.02(SEM)) growth was independently increased by the presence of 5% w/v lipid (14.2 cfu/mL; P = 0.028), and glucose concentration (25.6 cfu/mL per 10% increase in w/v glucose; P = 0.003). In a separate analysis growth was stimulated by energy density (27.7 cfu/1000 kcal non-nitrogen energy in 2 L; P = 0.002), without a significant effect of % non-protein energy from lipid (−2.6 cfu/ml per 10%).Conclusions: Using a framework developed to examine growth of potential contaminants in PN, no evidence was found to support the specific recommendation to restrict the maximum infusion duration of lipid containing PN to a greater extent than lipid free PN. S. epidermidis growth was not only affected by the presence of lipid, but also glucose concentration and energy density.

The energy balance positively regulates the levels of circulating TNF-related apoptosis inducing ligand in humans - Uncorrected Proof

Gianni Biolo, Paola Secchiero, Sara De Giorgi, Veronica Tisato, Giorgio Zauli — 2012-05-10

Summary: Background & aims: Although decreased levels of circulating TRAIL have been associated to cardiovascular risk and overall mortality, the mechanisms controlling TRAIL levels in physiopathological conditions are currently unknown. The aim of the present study was to investigate whether changes in the energy intake and insulin sensitivity may influence circulating TRAIL, and to analyze potential relationships between circulating TRAIL and changes in fat mass in healthy subjects receiving hypocaloric or hypercaloric diets.Methods: Three distinct groups of participants were studied, at the end of a 14-day (n = 9), 35-day (n = 30) or 60-day (n = 16) period of experimental bed rest to induce insulin resistance and during controlled ambulation, after receiving eucaloric, hypocaloric or hypercaloric diets.Results: After bed rest conditions, energy restriction significantly decreased circulating TRAIL, while overfeeding significantly increased TRAIL levels with respect to eucaloric control subjects. Moreover, a positive correlation was found between levels of circulating TRAIL and energy intake as well as between circulating TRAIL and energy balance, as determined by changes in fat mass in these subjects.Conclusions: Circulating levels of TRAIL exhibit a clear-cut positive correlation with the energy intake and balance in healthy subjects during experimental physical inactivity.

Use of body mass index percentile to identify fat-free mass depletion in children with cystic fibrosis - Uncorrected Proof

2012-05-04

Summary: Background & aims: Nutritional failure in children with cystic fibrosis (CF) has a negative effect on their morbidity and survival. It is unknown if determination of fat-free mass is a better screening method for nutritional failure than the currently recommended body mass index (BMI) alone.Methods: This cross-sectional study in 77 children with CF (age: 14.8 ± 2.9 y) measured fat-free mass, fat mass, bone mineral content and density using dual-energy X-ray absorptiometry. Nutritional failure was defined as BMI <10 percentile and/or fat-free mass index <5th percentile. Statistics were done using ANOVA and t-tests.Results: Thirty-one percent (31%) of the patients with CF was characterized by nutritional failure, and 14% had low fat-free mass index with preserved values for BMI (hidden depletion). Only 52% of the patients with fat-free mass depletion was detected when using the criteria BMI <10 percentile. Patients with fat-free mass depletion had reduced values for forced expiratory volume in 1 s (FEV1), independent of body mass index (P < 0.05), and lower values for bone mineral density in whole body, spine and hip, and spine bone mineral apparent density (P < 0.01). BMI ≤20 percentile was associated with a large drop in fat-free mass, a reduced FEV1, and in bone mineral loss.Conclusions: Depletion of fat-free mass enhances morbidity in children with CF and is undetected in many of these children when only BMI percentile is used as screening method. BMI percentile of 20 should be considered as the new critical threshold for nutritional failure in CF if body composition techniques are not available.

Cost-effectiveness of nutritional intervention on healing of pressure ulcers - Uncorrected Proof

Akinori Hisashige, Takehiko Ohura — 2012-05-04

Summary: Background & aims: Pressure ulcers not only affect quality of life among the elderly, but also bring a large economic burden. There is limited evidence available for the effectiveness of nutritional interventions for treatment of pressure ulcers. In Japan, recently, a 60-patient randomized controlled trial of nutritional intervention on pressure ulcers demonstrated improvement in healing of pressure ulcers, compared with conventional management. To evaluate value for money of nutritional intervention on healing of pressure ulcers, cost-effective analysis was carried out using these trial results.Methods: The analysis was carried out from a societal perspective. As effectiveness measures, pressure ulcer days (PUDs) and quality-adjusted life years (QALYs) were estimated. Prevalence of pressure ulcers was estimated by the Kaplan–Meier method. Utility score for pressure ulcers is derived from a cross-sectional survey among health professionals related to pressure ulcers. Costs (e.g., nutritional interventions and management of pressure ulcers) were estimated from trial data during observation and follow-up. Stochastic and qualitative sensitivity analyses were performed to examine the robustness of results.Results: For observation (12 weeks) and follow-up (12-week observation plus 4-week follow-up), nutritional intervention reduced PUDs by 9.6 and 16.2 per person, and gained 0.226 × 10−2 QALYs and 0.382 × 10−2 QALYs per person, respectively. In addition, costs were reduced by $542 and $881 per person, respectively. This means nutritional intervention is dominant (cost savings and greater effectiveness). The sensitivity analyses showed the robustness of these results.Conclusion: Economic evaluation of nutritional intervention on healing pressure ulcers from a small randomized controlled trial showed that this intervention is cost saving with health improvement. Further studies are required to determine whether this is a cost-effective intervention for widespread use.

Investigation of essential trace and toxic elements in biological samples (blood, serum and scalp hair) of liver cirrhotic/cancer female patients before and after mineral supplementation - Uncorrected Proof

2012-05-04

Summary: Background & aims: The aim of present study was to compare the levels of essential trace and toxic elements in biological samples (blood, serum and scalp hair) of female liver cirrhotic/cancer patients (n = 132), of two age groups (20–45 years) and (46–60 years), before and after sixty days treatment with mineral supplementation. For comparison purpose, same biological samples were also collected from healthy female subjects (n = 75) of same age groups.Methods: The biological samples were oxidized by 65% HNO3: 30% H2O2 (2:1) in microwave oven. The digests of all biological samples were analyzed for arsenic (As), cadmium (Cd), selenium (Se) and zinc (Zn) by electrothermal atomic absorption spectrometry.Results: The levels of Se and Zn were lower in liver cirrhotic/cancer patients as compared to healthy individuals (p < 0.001). The patients of liver cirrhosis/cancer have two folds higher As and Cd levels in biological samples as related to age matched referents. Moreover, negative correlation was observed between essential and toxic elements.Conclusions: The pathogenesis of liver cirrhosis/cancer has been associated with changes in the balance of certain essential trace and toxic elements. It was observed that the status of Se and Zn in addition to some biochemical parameters was improved in biological samples of both groups of patients after sixty days treatment with mineral supplementation.

Patterns of physical activity and sedentary behavior in normal-weight, overweight and obese adults, as measured with a portable armband device and an electronic diary - Corrected Proof

Tineke Scheers, Renaat Philippaerts, Johan Lefevre — 2012-04-27

Summary: Background & aims: Accurate data on domain-specific physical activity and sedentary behavior among normal-weight, overweight and obese adults are scarce. This study described a comprehensive physical (in)activity profile and examined variations in activity across the week.Methods: Physical activity was measured in 442 Flemish adults (41.4 ± 9.8 years) for 7 days using the SenseWear Armband and an electronic diary. Differences in (in)activity between BMI subgroups were examined using one-way analyses of variance.Results: Physical activity level decreased with increasing BMI in men (1.77–1.46 MET) and women (1.67–1.31 MET). Sedentary time was higher in obese than normal-weight men (+1.09 h/day) and overweight and obese than normal-weight women (+1.04 and +1.88 h/day). Total hours of moderate-to-vigorous activity and bouts of moderate-to-vigorous activity were lower in overweight and obese than normal-weight subjects. The average duration of a sedentary bout and the number of breaks in sedentary time were only different between female BMI groups. The intensity of domain-specific activities decreased with increasing BMI. Activity patterns across the week differed between subgroups, with the difference most pronounced on Saturday for the male BMI groups.Conclusions: This study described activity patterns among normal-weight, overweight and obese adults. The results should be used to design obesity prevention strategies.

Changes in adipokines after transjugular intrahepatic porto-systemic shunt indicate an anabolic shift in metabolism - Corrected Proof

2012-04-20

Summary: Background & aims: Decompressing the portal hypertension by inserting a transjugular intrahepatic porto-systemic shunt (TIPS) in undernourished liver cirrhosis patients results in gains in body weight. It is important to understand whether this reflects an advantageous or unfavourable shift in nutrition status. This to some extent can be judged from the changes in the patients' adipokine patterns. We, therefore, examined the circulating levels of the most important adipokines before and after the TIPS procedure.Methods: Twenty-five liver cirrhosis patients were examined before TIPS insertion and followed for six months after the procedure. Their body composition was determined by the bioimpedance technique. The serum concentrations of adiponectin, retinol binding protein 4 (RBP4), and leptin were measured.Results: The TIPS procedure induced a 12% increase in body cell mass (P = 0.03) but did not change the body fat mass. At six months, serum adiponectin was increased by 60% (mean ± SD, 10.7 ± 6.1 vs. 16.9 ± 8.9 mg/L; P = 0.001), serum RBP4 was decreased by 45% (28.6 ± 20.0 vs. 16.3 ± 9.6 mg/L; P = 0.01), and the leptin levels remained unchanged.Conclusions: The TIPS-related tissue build up was accompanied by increased adiponectin and decreased RBP4. Such changes are associated with an anabolic condition where the adipose tissue possesses residual capacity for energy storage. TIPS, therefore, can be considered to be nutritionally beneficial to cirrhosis patients.

Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects - Corrected Proof

Ursula G. Kyle, Esther P. Soundar, Laurence Genton, Claude Pichard — 2012-04-20

Summary: Background & aims: Low phase angle (PhA) by bioelectrical impedance analysis (BIA), is associated with increased morbidity and nutritional risk. This study determined the cut-off values for PhA compared to Nutritional Risk Screening (NRS-2002) and Subjective Global Assessment (SGA) in patients at hospital admission, and evaluated the association between PhA and serum albumin.Methods: PhA was determined in patients (Men (M)/Women (W)=382/267), and healthy age-, sex- and height-matched controls. Sensitivity and specificity were calculated for PhA compared to NRS-2002, SGA and serum albumin. The cut-off values were assessed by receiver operator characteristics area under the curve (ROC–AUC).Results: The best PhA cut-offs were 5.0° and 4.6° in M/W. The sensitivity for NRS-2002 was 70.0/58.1% (M/W); SGA: 73.3/64.5%; albumin: 58.8/23.5%; specificity for NRS-2002: 85.1/81.7% (M/W); SGA: 76.6/76.1% and albumin: 93.2/96.6%. The PhA showed a ROC–AUC for NRS-2002 of 0.85/0.80 (M/W); SGA: 0.83/0.80 and albumin: 0.85/0.91. Patients with albumin levels <35g/L had a relative risk of 7.5 to have low PhA compared to patients with ≥35g/LConclusions: The consistent sensitivity and specificity between PhA and three screening tools strengthens the validity of our study. PhA appears to be a useful screening tool to assess nutritional risk without having to measure weight or height.

Cinnamon in glycaemic control: Systematic review and meta analysis - Corrected Proof

Rajadurai Akilen, Amalia Tsiami, Devasenan Devendra, Nicola Robinson — 2012-04-20

Summary: Background & aims: Cinnamon seems to be highly bioactive, appearing to mimic the effect of insulin through increased glucose uptake in adipocytes and skeletal muscles. This systematic review and Meta analysis examined the effect of cinnamon on glycaemic control in patients with Type 2 Diabetes mellitus.Methods: A systematic literature search was conducted from the earliest possible date through to 01 August 2011. Search terms included free text terms, MeSH and Medline medical index terms such as: “cinnamon”, “cinnamomum”, “cinnamomum cassia”, “cinnamomum zeylanicum”, “type 2 diabetes mellitus”. Each was crossed with the term “diabetes mellitus”. In addition, references of key articles were hand searched.Results: A total of 6 clinical trials met the strict inclusion criteria and considered a total of 435 patients; follow up between 40 days–4 months, doses ranging from 1 g to 6 g per day. Meta-analysis of RCTs showed a significant decrease in mean HbA1c [0.09%; 95% CI was 0.04–0.14] and mean FPG [0.84 mmol/l; 95% CI was 0.66–1.02].Conclusions: Use of cinnamon showed a beneficial effect on glycaemic control (both HbA1c and FPG) and the short term (<4 months) effects of the use of cinnamon on glycaemic control looks promising.

Trace elements and antioxidant enzymes associated with oxidative stress in the pre-eclamptic/eclamptic mothers during fetal circulation - Corrected Proof

2012-04-18

Summary: Background & aims: Pre-eclampsia is associated with oxidative stress in the maternal circulation. The aim of the study was to access the oxidative stress status by quantification of byproducts generated during lipid peroxidation; deficient antioxidant activity and inadequate trace elements during oxidative damage in the umbilical cord blood of pre-eclamptic/eclamptic mothers and its effect on the fetal outcome.Methods: In a case control study umbilical cord blood samples were collected during delivery from cases of pre-eclamptic/eclamptic mothers and from normotensive (uncomplicated pregnancy) subjects as controls. Concentrations of malondialdehyde, trace elements (Zn, Cu, Se, Mg) and antioxidant enzymes (SOD, GPx) were determined.Results: Decreased levels of Zinc (p < 0.001), Copper (p < 0.001), Selenium (p < 0.005), Magnesium (p < 0.05), Superoxide dismutase (p < 0.001), Glutathione Peroxidase (p < 0.001) and elevated levels of malondialdehyde (marker of lipid peroxidation) in the umbilical cord blood of pre-eclamptic and eclamptic pregnancies were observed. Positive correlation between Zn and SOD (Pearson r = 0.581, p < 0.001), Cu and SOD (Pearson r = 0.576, p < 0.001) and Se and GPx (Pearson r = 0.445, p < 0.005) was also observed.Conclusions: The reduced levels of trace elements associated with inadequate amount of antioxidant enzymes may be important contributing factor associated with oxidative stress leading to endothelial dysfunction in pre-eclamptic/eclamptic mothers.

Iodine intake in the adult population. Di@bet.es study - Corrected Proof

2012-04-16

SUMMARY: Background & aims: To date no nation-wide study has yet been undertaken in Spain to estimate the iodine deficiency. The aim was to evaluate iodine intake and its conditioning factors in a representative sample of the whole adult population.Methods: The Di@bet.es Study is a national, cross-sectional, population-based survey conducted in 2009–2010 in Spain.Results: The median urinary iodine (UI) was 117.2μg/L. Iodized salt (IS) was consumed by 43.9% of the population. The median UI in those who consumed IS and in those who did not consume IS was 131.1 and 110.8μg/L respectively (p<0.0001). The likelihood of having UI levels above 100μg/L was significantly associated with the intake of IS (OR=1.47) and milk at least once a day (OR=1.22). Within each individual autonomous communities, the median UI levels in those who consumed IS correlated significantly with the median levels of those who did not consume IS (r=0.76, p=0.001).Conclusions: Though strictly speaking, Spain should be considered within the category of a country having an adequate iodine intake, the current value is too close to the cut point and does not guarantee that those groups with a greater need for iodine will have the required intake of iodine.

Is there a difference in bloodstream infections in critically ill patients associated with ready-to-use versus compounded parenteral nutrition? - Corrected Proof

2012-04-13

Summary: Background & aims: Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodstream infections in critical care patients receiving parenteral nutrition (PN) prepared via conventional compounding versus premixed multichamber bags.Methods: Records in the Premier Perspective™ database for all in patients ≥ 18 years of age, with a minimum 3-day intensive care unit stay, who received PN between 2005 and 2007 were analyzed (n = 15,328). Statistical analysis of data, grouped according to preparation method, compared differences in both observed bloodstream infection rates and adjusted rates, using logistic regression to examine the impact of hospital and patient baseline characteristics.Results: Patients receiving compounded parenteral nutrition had longer intensive care unit stays (11.3 vs. 9.1 days) and longer hospital stays (22.6 vs. 19.4 days); both P < .001. After adjusting for baseline differences, the probability for bloodstream infections was 19% higher when using compounded parenteral nutrition vs. multichamber bags (29.6 vs. 24.9%; odd ratio = 1.29; 95% confidence interval = 1.06–1.59).Conclusion: In this retrospective review of a large patient database the adjusted probability of bloodstream infection was significantly lower in patients receiving multichamber bags than compounded parenteral nutrition. These findings need to be investigated further in high quality observational studies and prospective clinical trials.

l-Carnitine: An adequate supplement for a multi-targeted anti-wasting therapy in cancer - Uncorrected Proof

2012-04-09

Summary: Background & aims: Tumour growth is associated with weight loss resulting from both adipose and muscle wasting.Methods: Administration of l-carnitine (1 g/kg body weight) to rats bearing the AH-130 Yoshida ascites hepatoma, a highly cachectic rat tumour.Results: The treatment results in a significant improvement of food intake and in muscle weight (gastrocnemius, EDL and soleus). These beneficial effects are directly related to improved physical performance (total physical activity, mean movement velocity and total travelled distance). Administration of l-carnitine decreases proteasome activity and the expression of genes related with this activity, such as ubiquitin, C8 proteasome subunit and MuRF-1. Interestingly, l-carnitine treatment also decreases caspase-3 mRNA content therefore suggesting a modulation of apoptosis. Moreover, addition of 50 μM of l-carnitine to isolated EDL muscles results in a significant decrease in the proteolytic rate suggesting a direct effect.Conclusions: It can be concluded that l-carnitine supplementation may be a good approach for a multi-targeted therapy for the treatment of cancer-related cachexia.

Poor performance of mandatory nutritional screening of in-hospital patients - Corrected Proof

Nina Rica Wium Geiker, Sisse Marie Hørup Larsen, Steen Stender, Arne Astrup — 2012-04-05

Summary: Background & aims: Since 2006 it has been mandatory at Copenhagen University Hospital Gentofte to screen all patients for nutritional risk within 24 h of admittance. Audits conducted by department staff estimate that 70–80% of assessments are correctly executed, but the validity of this estimate is unknown. The aim of the present study was to discover the true proportion of hospitalized patients receiving nutritional risk screening within the stipulated time limit and to evaluate the validity of the screening by comparison with medical records.Methods: Retrospective examination of medical records of all patients (N = 3278) hospitalized in September 2008 in 11 different medical specialities were analysed in 2009–2010.Results: Of 2393 medical records 24% of the patients were screened, of these only 65% were screened within the stipulated time limit. Half of the conducted screenings were inaccurate, the most common error being underestimation of nutritional status. Forty-six percent of patients required a secondary nutritional risk screening and 30% were found to be nutritionally at risk.Conclusion: Only 8% of patients received the mandatory nutritional risk screening without procedural errors. We conclude that pre-scheduled, self-conducted audits are not viable as the basis of an assessment of the use of nutritional risk screening.

Factors associated with poor nutritional status among the oldest-old - Corrected Proof

Luxi Ji, Hongdao Meng, Birong Dong — 2012-04-05

Summary: Background & aims: Older adults are at increased risk for malnutrition. The aim was to investigate the prevalence of and risk factors for poor nutritional status in oldest-old Chinese.Methods: Community-living Chinese aged 90 and over were included in the study. Nutritional status was evaluated by using the Mini Nutritional Assessment short-form (MNA-SF). Demographic and socioeconomic status, health status, cognitive, behavioral, and lifestyle factors were collected via structured questionnaires during face-to-face interviews.Results: 632 individuals (424 F, 208 M, 94 ± 3 y) were included. We found that 36 (5.7%) participants were classified as being malnourished (MNA-SF < 7), 445 (70.4%) were classified as being at risk for malnutrition (8 ≤ MNA-SF ≤ 11), and 151 (23.9%) were considered as well-nourished (MNA-SF ≥ 12). Ordinal logistic regression showed that significant risk factors for poor nutritional status included older age, poor cognitive function, gastrointestinal (GI) system disease, poor self-rated health, and lower serum albumin level.Conclusion: The findings suggest that the majority of the Chinese oldest-old were at risk for malnutrition. Nutritional assessment should be incorporated into regular geriatric screening among community-living oldest-old in China. Interventions targeting those at risk for malnutrition should be developed to improve health outcomes among this vulnerable population.

The effect of a controlled 8-week metabolic ward based lysine supplementation on muscle function, insulin sensitivity and leucine kinetics in young men - Corrected Proof

2012-04-05

Summary: Background & aims: The 2007 FAO/WHO/UNU lysine requirement is 30mgkg−1d−1. Developing country populations may be at risk of lysine deficiency, with effects on muscle and its function. The effect of an 8wk lysine supplementation diet on muscle mass and function was assessed.Methods: Healthy, under and well-nourished men were studied before and after 8wk, during which low (n=20) and high (n=20) lysine diets were consumed. The low lysine diets (∼25 and ∼40mgkg−1d−1 for under and well-nourished respectively) were based on the subjects’ habitual lysine intake, while the high lysine diet supplied 80mgkg−1d−1. Anthropometry, muscle function, insulin sensitivity (IS) and leucine kinetics were measured before and after the experimental period.Results: The high lysine diet had a small positive effect (about +7.5%) on muscle strength, but no effect on other parameters. Over the 8wk period in the whole group, the change in muscle strength correlated with the change in muscle mass (r=0.5, P=0.001), while the change in muscle mass correlated with the change in IS (r=0.3, P=0.04), but there were no intake specific differences.Conclusion: Over an 8wk controlled feeding period, an intake of 80mglysinekg−1d−1 had a small positive effect on muscle strength, but no other effects.

The relationship between nutritional status of hip fracture operated elderly patients and their functioning, comorbidity and outcome - Corrected Proof

2012-04-05

Summary: Background & aims: Malnutrition is common in hip fracture elderly patients. The purpose of this study was to examine the relationship between the Mini Nutrition Assessment Short Form (MNA-SF) and cognitive, functional status, comorbidity and outcome of operated patients.Methods: Clinical data, MNA, functioning, cognition were prospectively determined. Retrospectively, the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) were applied.Results: The study consisted of 95 well-nourished (WN), 95 at risk of malnutrition (ARM) and 25 malnourished (MN) patients. More WN patients were independent vs. partially or fully dependent; more WN patients were cognitively normal vs. cognitively impaired (p < 0.001). CIRS-G was higher in MN vs. WN patients and CCI was higher in MN and ARM vs. WN patients (p < 0.001). During a 6 month period, 100 patients were readmitted, with less readmissions in the WN group (p = 0.024). During a 36 month follow-up, 79 patients died. The mortality rate was lower in the WN group (p = 0.01). Stepwise regression analysis found that the only independent variables for mortality were CCI and functioning (p < 0.01).Conclusions: Patients with higher cognitive and functional status were in superior nutritional condition. Poor nutritional status was associated with higher comorbidity indices, mortality and readmissions. However, we found that only comorbidity and low functioning can predict long-term mortality.

Probiotics in necrotizing enterocolitis: More questions than answers - Corrected Proof

Walter A. Mihatsch, Frank Pohlandt — 2012-04-04

We thank Dr. Das for having thoroughly studied our systematic review on the routine use of probiotics in preterm infants. Blinding and allocation concealment are very important. In our review number coded blinding was regarded as the gold standard. However, blinding by randomization into two groups and providing two virtually indistinguishable study products (verum and placebo) was regarded as appropriate. In order to exclude potential risks of bias for obvious reasons, the principal investigators, study team, immediate patient caretakers, and in addition the milk bank team all have to be blinded, at best until the end of the study.

Conjugated linoleic acid modulates immune responses in patients with mild to moderately active Crohn's disease - Corrected Proof

2012-04-04

Summary: Background & aims: Conjugated linoleic acid (CLA) has demonstrated efficacy as an immune modulator and anti-inflammatory compound in mouse and pig models of colitis. We investigated the immunoregulatory efficacy of CLA in patients with mild to moderate Crohn's disease (CD).Methods: Thirteen patients with mild to moderately active CD were enrolled in an open-label study of CLA (6 g/d orally) for 12 weeks. Peripheral blood was collected at baseline, 6 and 12 weeks after treatment initiation for isolation of peripheral blood mononuclear cells for functional analyses of lymphoproliferation and cytokine production. Disease activity was calculated using the CD activity index (CDAI) and quality of life was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ).Results: CLA significantly suppressed the ability of peripheral blood CD4+ and CD8+ T cell subsets to produce IFN-γ, TNF-α and IL-17 and lymphoproliferation at week 12. There was a statistically significant drop in CDAI from 245 to 187 (P = 0.013) and increase in IBDQ from 141 to 165 (P = 0.017) on week 12.Conclusion: Oral CLA administration was well tolerated and suppressed the ability of peripheral blood T cells to produce pro-inflammatory cytokines, decreased disease activity and increased the quality of life of patients with CD.

Comparison between dual-energy X-ray absorptiometry and skinfolds thickness in assessing body fat in anorexia nervosa before and after weight restoration - Corrected Proof

2012-04-02

Summary: Background & aims: The aim of the study was to evaluate the correspondence between body fat mass composition (percentage) measured with dual-energy X-ray absorptiometry (DXA) and estimated by means of skinfold thicknesses (ST) measurement in patients with anorexia nervosa (AN), before and after weight gain.Methods: Percentage body fat (%BF) was measured with DXA and estimated by ST measurements using Siri, Brozek, and Heyward equations in 27 adult patients with AN before and after weight gain (pre- and post-treatment) achieved with inpatient treatment and in 42 healthy age-matched controls.Results: Due to Lohman criteria and Bland Altman plot there is no correspondence between the %BF measured with DXA and the %BF estimated by predictive equations based on ST measurements in patients with AN before and after weight gain, with the exception of Brozek equation which showed a mild agreement in pre-treatment AN. However, a correspondence was observed between the two procedures in healthy controls.Conclusions: Our data supporting the use of ST measurements do not appear to be an alternative to DXA in estimating body fat percentage, before and after weight gain in patients with AN.

Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients - Uncorrected Proof

2012-04-02

Summary: Background & aims: To assess the medico-economic impact of malnutrition in patients who underwent surgery for colorectal cancer.Methods: We performed post-hoc analyses of data from the Alves et al. prospective study. Using standard criteria of malnutrition, 2 groups were created a posteriori: Well-nourished (WN) and Mal-nourished (MN) patients. The 2 groups were statistically adjusted for age, cancer status, and scheduled surgery. Individual costs were valued using the French National Cost Study. Postoperative morbidity, mortality, hospital length-of-stay (LOS), and discharge setting were compared. We defined 3 scenarios, the most accurate estimate and its upper and lower limits, to assess the economic impact of malnutrition.Results: 453 patients were included in the analyses. Complication and mortality rates were not significantly different between the 2 groups. MN patients had a mean LOS 3.41 days significantly longer than WN patients (p = 0.017). In MN patients, the cost of hospital stay was increased by around 3360 €, creating an annual impact of 10,159,436 € for French non-profit hospitals.Conclusions: Malnutrition in colorectal cancer surgical patients is associated with an increased LOS resulting in significant budget impact. Further studies are needed to investigate this impact and the related cost-benefit of perioperative specialized nutritional support and implementation of the ERAS protocol in this homogeneous category of patients.

N-3 PUFAs attenuate ischemia/reperfusion induced intestinal barrier injury by activating I-FABP-PPARγ pathway - Corrected Proof

Xinying Wang, Liya Pan, Jun Lu, Ning Li, Jieshou Li — 2012-03-29

Summary: Background & aims: This study was designed to investigate whether n-3 PUFAs attenuate ischemia/reperfusion (I/R) induced intestinal barrier injury by activating I-FABP-PPARγ pathway.Methods: 24 Male Sprague-Dawley rats were assigned to 4 groups: control group, I/R group, pretreated with n-3 PUFAs for 7 days before I/R (group 3), pretreated with peroxisome proliferator-activated receptor (PPARγ) agonist 30 min before I/R (group 4). The serum and intestinal mucosa samples were collected.Results: I/R disrupted the structure of intestinal tight junctions (TJs) and reduced occludin expression. The intestinal fatty acid binding protein (I-FABP) was elevated in plasma while decreased in cells. PPARγ expression in nucleus of intestinal mucosa was attenuated. N-3 PUFAs attenuated the damaged TJ structure and elevated occludin, intracellular I-FABP and PPARγ expression. A PPARγ agonist had the same effect as n-3 PUFAs.Conclusions: The intestinal barrier is severely damaged after I/R, which is related to the redistribution of I-FABP. Our findings firstly indicate that n-3 PUFAs protect the intestinal barrier by modifying intracellular I-FABP, activating the PPARγ pathway, and then upregulating TJ protein expression.

A flexible diet using an insulin to carbohydrate ratio for adolescents with type 1 diabetes – A pilot study - Corrected Proof

2012-03-14

Summary: Background & aims: There is significant interest in the utility of flexible meal plans for individuals with type 1 diabetes. However, there is a paucity of data examining this approach in adolescents. The aim of this study was to assess glycemic control, weight status and quality of life over 12 months in adolescents with type 1 diabetes, who were commenced on a flexible meal plan using an insulin to carbohydrate ratio.Methods: 38 adolescents with type 1 diabetes were recruited and 28 completed the study. Glyceamic control, weight status and quality of life were measured using haemoglobin A1c, BMI and the Diabetes Quality of Life –Youth questionnaire.Results: Nine months after the adolescents were transitioned to a flexible meal and insulin plan, mean BMI SDS decreased (by 0.15 ± 0.20; P < 0.001) and haemoglobin A1c increased (by 0.7 ± 0.83%; P = 0.001). Adolescents reported no change in the impact or concerns about diabetes. However, mean life satisfaction scores increased (5.5 ± 9.5; P = 0.008).Conclusions: On a flexible meal and insulin plan glycemic control deteriorated although weight status and life satisfaction, two outcomes which may be important to the adolescents, improved. A flexible meal and insulin plan warrants further investigation as a management option.

Probiotics in necrotizing enterocolitis: More questions than answers? - Corrected Proof

Rashmi Ranjan Das — 2012-03-14

I read with great interest the article by Mihatsch WA, et al. The authors in their informative meta-analysis suggested some recommendation on the use of probiotics for necrotizing enterocolitis (NEC) and sepsis in preterm infants. There are few points in the article that need comment.

Growth velocity in infancy influences resting energy expenditure in 12–14 year-old obese adolescents - Corrected Proof

M. Batisse-Lignier, S. Rousset, A. Labbé, Y. Boirie — 2012-03-14

Summary: Background & aims: : To determine if rapid growth between 0 and 2 years of life influences body composition and resting energy expenditure (REE) measured at 12–14 years in a population of obese children.Methods: REE and body composition were measured in 107 obese children aged 12–14 years in whom weight at birth and 2 years was recorded.Results: 46 obese children had a rapid growth between birth and 2 years (>0.67 SD). Rapid weight gain was positively correlated with weight and height at 12–14 years but not with body mass index (BMI). Fat mass (FM) to fat free mass (FFM) ratio was not significantly different at 12–14 years in children with rapid or normal growth velocity. REE in 12–14 year-old children with rapid growth (1765±222kcal/24h) was significantly higher than children with normal growth velocity (1586±216kcal/24h) (P<0.001). REE adjusted for FFM was similar in the two groups.Conclusions: Rapid weight gain between 0 and 2 years of life is associated with higher weight, height, FFM, FM and REE in 12–14 year-old obese children despite identical BMI. These data demonstrate that growth velocity affects later body composition and REE in obese adolescents but relationship between REE and FFM is preserved.

Fuzzy linguistic model for bioelectrical impedance vector analysis - Corrected Proof

Bruna Bronhara, Antonio Piccoli, Júlio César R. Pereira — 2012-03-09

Summary: Backgrounds & aims: The boundaries between the categories of body composition provided by vectorial analysis of bioimpedance are not well defined. In this paper, fuzzy sets theory was used for modeling such uncertainty.Methods: An Italian database with 179 cases 18–70 years was divided randomly into developing (n = 20) and testing samples (n = 159). From the 159 registries of the testing sample, 99 contributed with unequivocal diagnosis. Resistance/height and reactance/height were the input variables in the model. Output variables were the seven categories of body composition of vectorial analysis. For each case the linguistic model estimated the membership degree of each impedance category. To compare such results to the previously established diagnoses Kappa statistics was used. This demanded singling out one among the output set of seven categories of membership degrees. This procedure (defuzzification rule) established that the category with the highest membership degree should be the most likely category for the case.Results: The fuzzy model showed a good fit to the development sample. Excellent agreement was achieved between the defuzzified impedance diagnoses and the clinical diagnoses in the testing sample (Kappa = 0.85, p < 0.001).Conclusions: fuzzy linguistic model was found in good agreement with clinical diagnoses. If the whole model output is considered, information on to which extent each BIVA category is present does better advise clinical practice with an enlarged nosological framework and diverse therapeutic strategies.

Prognosis in 41 severely malnourished anorexia nervosa patients - Corrected Proof

Daniel Rigaud, Isabelle Tallonneau, Marie-Claude Brindisi, Bruno Vergès — 2012-03-09

Summary: Background & aims: To report the prognosis in 41 anorexia nervosa (AN) patients suffering from very severe malnutrition (mean BMI: 10.1 ± 0.57 kg/m2).Patients and methods: Compared with 443 less malnourished AN patients, the 41 patients were older (27.8 ± 5.4 vs 22.4 ± 2.1 yrs), their AN was longer (9.6 ± 3.4 vs 5.0 ± 1.5 yrs) and more often of the restrictive subtype (P < 0.05).Results: In 27% of the patients, all nutritional marker levels were in normal range. All patients received a prudent tube-refeeding: energy was increased from 12 to 40 kcal/kg/day, protein from 1.0 to 1.5 g/kg/day within 10 days. During stay, 1 patient died, 2 others suffered from myocardial infarction, 2 others from acute pancreatitis, and 5 from mental confusion. Compared with the other 443 AN patients, the 40 remaining patients had worse 6-yr prognosis: 2 died (7% vs 1.2%), 29% had severe outcome (vs 10%), and only 41% recovered (vs 62%).Conclusion: In AN patients with BMI < 11 kg/m2, a prudent tube-refeeding could avoid short-term mortality, but long-term prognosis was bad.

Perioperative perturbations in carnitine metabolism are attenuated by preoperative carbohydrate treatment: Another mechanism by which preoperative feeding may attenuate development of postoperative insulin resistance - Corrected Proof

Sherif Awad, Francis Stephens, Chris Shannon, Dileep N. Lobo — 2012-03-07

Summary: Background & aims: Fasting increases lipid flux into mitochondria causing excessive β-oxidation, carnitine acylation and impaired cellular glucose uptake. Preoperative carbohydrate treatment (PCT) attenuates postoperative insulin resistance, but mechanisms underlying this and the effects on carnitine metabolism remain largely unknown.Methods: Pre-, intra- and-postoperative (day 1) plasma, and intraoperative rectus muscle mitochondrial free (FC), acyl (AC) and total (TC) carnitine concentrations were determined radioenzymatically in non-diabetic patients undergoing laparoscopic cholecystectomy in a post hoc analysis of a randomised double-blind study (NCT00662376). Patients received 600 ml of a carbohydrate-based drink (ONS, Fresenuis Kabi, N = 15, 50 g carbohydrate, 15 g glutamine and antioxidants/300 ml) or placebo (N = 15, 0 g carbohydrate) the evening before surgery, and 300 ml 3–4 h pre-anaesthesia.Results: No intra- or intergroup differences occurred in pre- or intraoperative plasma FC, TC or AC concentrations. Postoperatively, plasma TC and FC concentrations increased in the placebo group (p = 0.005 and p = 0.013). In the ONS group, postoperative increases occurred in plasma TC (p = 0.048). Increases in postoperative plasma TC and FC concentrations were attenuated in the ONS group (p = 0.013 and p = 0.044, respectively). No intergroup differences occurred in intraoperative mitochondrial carnitine concentrations.Conclusions: Preventing excessive/incomplete mitochondrial β-oxidation, characterised by perturbed carnitine metabolism, may be a mechanism by which PCT attenuates the reduction in postoperative insulin sensitivity.

Guidelines recommendations on care of adult patients receiving home parenteral nutrition: A systematic review of global practices - Corrected Proof

2012-03-05

Summary: Background & aims: Because home parenteral nutrition (HPN) in adult patients can give rise to a variety of complications, good guidance is necessary. To achieve this, clarity and consistency in guidelines are essential. The aim of this review is to identify and compare evidence-based guidelines, and to compile a list of main recommendations, according to their evidence-based grade.Methods: We searched Medline and the international guideline database for HPN guidelines, performed a content analysis of retrieved guidelines, and evaluated their quality. We then compiled a comparative table of guideline recommendations along with their assigned level of evidence.Summary of results: Six systematically developed evidence-based guidelines and one expert opinion-based standard for home care were retrieved. Of these guidelines, two were exclusively devoted to HPN. Although the guidelines generally covered the same topics, most did not provide information on intravenous medication, bone metabolic disease, and indications in patients with malignant disease. Moreover, we found grading discrepancies among various guidelines, as identical recommendations were often labeled with different grades.Conclusion: Our comparison of guidelines and standards for HPN revealed substantial differences among recommendations. Identification of these discrepancies and omissions should facilitate the development of more comprehensive and better justified guidelines in the future.

The effect of perioperative glucose control on postoperative insulin resistance - Corrected Proof

2012-03-01

Summary: Background & aims: Postoperative insulin resistance and the consequent hyperglycemia affects clinical outcome. Insulin sensitivity may be modulated by preoperative nutrition, adequate pain management and minimal invasive surgery. This study aims to disclose the impact of perioperative glucose control on postoperative insulin resistance.Methods: Twenty patients scheduled for elective open hepatectomy were enrolled in this prospective, randomized study. In the treatment group (n = 9) insulin was administered intravenously to keep blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 8) received insulin if blood glucose >14 mmol/l. Insulin sensitivity was measured by a hyperinsulinemic normoglycemic clamp (0.8 mU/kg/min), performed on all patients both on the day before surgery and immediately postoperatively. Plasma cortisol, insulin and C-peptide were measured.Results: There was a significant difference in mean glucose value during surgery. In the control group 8.8 mmol/l (SD 1.5) vs. 6.9 mmol/l (SD 0.4) in the treated group, p = 0.003. In the control group insulin sensitivity decreased to 21.9% ± 16.2% of the preoperative value and in the insulin treated group to 46.8 ± 15.5%, p < 0.005. Insulin levels were significantly higher in the treatment group as well as consequently lower C-peptide levels.Conclusions: This trial revealed a significant difference in postoperative insulin resistance in the group treated with insulin during surgery.

Low cardiometabolic risk in Parkinson's disease is independent of nutritional status, body composition and fat distribution - Corrected Proof

2012-02-27

Summary: Background & aims: To investigate if the reduced cardiometabolic risk in Parkinson's disease (PD) is independent of nutritional status, body composition and fat distribution.Methods: We designed a case–control study comparing 80 non underweight PD patients with 80 controls matched for sex, age and body mass index (BMI). Nutritional assessment included: anthropometry (BMI and waist circumference [WC]), body composition estimated by impedance and biochemistry (fasting glucose, serum lipids and transaminases). The presence of arterial hypertension, diabetes mellitus and metabolic syndrome (MetS) were noted.Results: Compared to controls and independently of gender, PD patients showed lower percentage of body fat (P < 0.001) and biochemical parameters (glucose, P < 0.001; total cholesterol, P < 0.001; LDL, P < 0.001; triglycerides, P = 0.002; alanine aminotransferase, P < 0.001 and aspartate aminotransferase, P = 0.015) but similar WC (P = 0.324). The prevalence of hypertension and MetS was similar in the two groups, as well as the frequency and the number of MetS criteria. The relationship between PD and low cardiometabolic profile was independent of age, gender, current smoking and BMI. After adjusting for WC and body fat, most of the associations remained significant.Conclusions: PD patients seem to have a more favorable cardiometabolic risk profile, independently of nutritional status, body composition and fat distribution.

Intestinal permeability parameters in obese patients are correlated with metabolic syndrome risk factors - Corrected Proof

2012-02-27

Summary: Background & aims: Altered intestinal permeability has been shown to be associated with metabolic alterations in animal models of obesity, but not in humans. The aim of this study was to assess intestinal permeability in obese women and verify if there is any association with anthropometric measurements, body composition or biochemical variables.Methods: Twenty lean and twenty obese females participated in the study. Anthropometric measurements, body composition and blood pressure were assessed and biochemical analyses were performed. Administration of lactulose and mannitol followed by their quantification in urine was used to assess the intestinal permeability of volunteers.Results: The obese group showed lower HDL (p < 0.05), higher fasting glucose, insulin, HOMA index and lactulose excretion than the lean group (p < 0.05), suggesting increased paracellular permeability. Lactulose excretion showed positive correlation (p < 0.05) with waist and abdominal circumference. Blood insulin and the HOMA index also increased with the increase in mannitol and lactulose excretion and in the L/M ratio (p < 0.05). L/M ratio presented a negative correlation with HDL concentration (p < 0.05).Conclusions: We demonstrated that intestinal permeability parameters in obese women are positively correlated with anthropometric measurements and metabolic variables. Therapeutic interventions focused on intestine health and the modulation of intestinal permeability should be explored in the context of obesity.

Disease-related malnutrition in outpatients with systemic sclerosis - Corrected Proof

2012-02-27

Summary: Background & aim: Disease-related malnutrition is known to negatively affect clinical outcomes. The aim of the present study was to evaluate the prevalence of malnutrition in a cohort of outpatients affected by Systemic Sclerosis (SSc) and its association with clinical variables.Methods: One hundred sixty SSc patients were consecutively evaluated. The following clinical variables were assessed: disease duration, activity and severity, treatments, functional status, gastrointestinal involvement. Nutritional assessment included: body mass index (BMI), weight loss (WL) history, nutritional intakes and serum prealbumin. Malnutrition was defined as BMI <20 kg/m² and/or previous 6-month WL ≥ 10%.Results: Prevalence of malnutrition was 15% (10–21%). Logistic regression showed that malnutrition was independently associated with disease activity (OR 3.72; p < 0.001) and low serum prealbumin (OR 8.58; p < 0.001). The association with gastrointestinal involvement was not statistically significant, although a trend was detected (OR 1.88).Conclusion: Malnutrition is common in SSc outpatients. It appears associated with disease activity and not influenced by nutritional intakes; gastrointestinal involvement might contribute to its development over time. Serum prealbumin could be an early marker of malnutrition in SSc, whose role should be confirmed by further longitudinal investigations. Prospective studies are also required to clarify the clinical significance of the association between malnutrition and disease activity in SSc.

Time-dependent aroma changes in breast milk after oral intake of a pharmacological preparation containing 1,8-cineole - Corrected Proof

Frauke Kirsch, Jonathan Beauchamp, Andrea Buettner — 2012-02-23

Summary: Background & aims: This study investigates time-dependent aroma changes in human milk after intake of an odorant-containing pharmaceutical preparation by correlating sensory evaluation with quantitative results.Methods: Human milk donors ingested 100 mg of encapsulated 1,8-cineole. 21 milk samples from 12 participants underwent sensory analysis, of which 14 samples were quantified by stable isotope dilution assay (SIDA) analysis. Furthermore, several consecutive breast milk and exhaled breath gas samples from one volunteer after intake of 1,8-cineole were analysed by proton-transfer-reaction mass spectrometry (PTR-MS) and sensory evaluation on three separate days.Results: The emergence of the characteristic eucalyptus-like odour of 1,8-cineole in exhaled breath after capsule ingestion coincided with its transfer into milk; its presence in breath was therefore used to indicate the time at which milk should be expressed for gathering samples. Odorant transfer could not be confirmed by sensory analysis in 7 of the 21 milk samples, most likely due to disadvantageous timing of milk expression. The other 14 samples exhibited a distinct eucalyptus-like odour. Quantitative results matched these observations with <20 μg/kg 1,8-cineole in the odourless samples and 70 to an estimated 2090 μg/kg 1,8-cineole in the other samples.Conclusions: Transfer of 1,8-cineole into human milk after oral intake is time dependent and exhibits large inter and intra-individual differences.

Effect of curcumin and quercetin on lysosomal enzyme activities in streptozotocin-induced diabetic rats - Corrected Proof

Mallikarjun B. Chougala, Jamuna J. Bhaskar, M.G.R. Rajan, Paramahans V. Salimath — 2012-02-23

Summary: Background & aims: Diabetes causes impairment of various enzyme activities in the physiological system, including lysosomal enzymes. The effect of feeding curcumin, quercetin and aminoguanidine on lysosomal enzyme activities viz., N-acetyl-β-d-glucosaminidase, β-d-glucuronidase, β-d-galactosidase and acid phosphatase were studied in different tissues of streptozotocin-induced diabetic rats.Method: Rats were divided into four control groups and four diabetic groups. Experimental groups were fed with diet supplemented with curcumin (0.5%) or quercetin (0.1%) or aminoguanidine (0.05%). Lysosomal enzyme activities were determined in various tissues.Results: The specific activity of N-acetyl-β-d-glucosaminidase in liver of diabetic rats was decreased when compared to control rats and was ameliorated with curcumin and quercetin treatment by 67% and 78%, respectively. On the other hand, β-d-glucuronidase activity was higher in the brain of diabetic rats (0.90 ± 0.04 nmol/mg protein/min), when compared to control rats (0.45 ± 0.02 nmol/mg protein/min) and was decreased in curcumin (0.75 ± 0.05 nmol/mg protein/min) and quercetin (0.74 ± 0.11 nmol/mg protein/min) treated rats. β-d-galactosidase activity in spleen of curcumin and quercetin fed diabetic group rats was ameliorated by 68% and 58%, respectively, in comparison to diabetic rats. Acid phosphatase activity in diabetic rats decreased in testis when compared to control.Conclusion: Curcumin and quercetin feeding modulated lysosomal enzyme activities in different tissues during diabetes and the effect was comparable to well-known anti-glycative agent - aminoguanidine.

Long term metabolic impact of high protein neonatal feeding: A preliminary study in male rat pups born with a low birth weight - Corrected Proof

2012-02-23

Summary: Background & aims: Nutrition received in early life may impact adult health. The aim of the study was to determine whether high protein feeding in neonatal period would have long term metabolic effects in an animal model of low birth weight infants.Methods: Male rat pups born from dams receiving a low protein diet during gestation were separated from their mothers, and equipped with gastrostomy tubes to receive as their sole feeding a milk formula of either adequate protein (AP; n = 14; 8.7 g protein/dL; total energy: 155 kcal/100 g), or high protein content (HP; n = 14; 13.0 g protein/dL; total energy: 171 kcal/100 g) between the 7th (D7) and 21st day (D21) of life. Rats were then weaned to standard chow until sacrificed at adulthood.Results: At D18, HP feeding was associated with higher estimated rates of protein turnover (p = 0.007) and synthesis (p = 0.051), as assessed using l-[U-13C]valine infusion. HP milk feeding in early life was associated with an increase in weight gain from puberty through adulthood, along with an increase in food intake, serum insulin (179 ± 58 vs. 55 ± 7 pmol/L; means ± SE), pancreatic β-cell number, plasma triglycerides (95 ± 8 vs. 73 ± 9 mg/dL), serum leptin (9.7 ± 1.0 vs. 5.5 ± 1.2 ng/mL), mesenteric fat mass, and adipocyte size.Conclusions: In an animal model of low birth weight infants, high protein neonatal feeding may have a lasting effect on fat and glucose metabolism, potentially leading to “metabolic syndrome” in adulthood.

Central venous catheter related sepsis in children on parenteral nutrition: A 21-year single-center experience - Corrected Proof

2012-02-23

Summary: Background & aims: The aim was to assess the rate of central venous catheter (CVC) related sepsis in patients on parenteral nutrition (PN) at our hospital center during a period of 21 years.Methods: Data on all children hospitalized at our tertiary hospital center during the 1989-2010 period, who received PN for more than 4 weeks (n = 62) were retrospectively analyzed.Results: The mean age at the time of introducing PN was 2.9 years (range 6 days–17.4 years), male/female ratio 26/36. Out of these 62 patients, nine (14.5%) patients continued home PN (HPN) after discharge from the hospital. Altogether 86 CVCs were used (mean 1.39 per patient) and total CVC time was 21,459 days, which makes 243.9 days per CVC. During the study period, there were 36 CVC related sepsis episodes (1.7/1000 days of PN). Total number of septic episodes was significantly lower in HPN compared to hospital PN (0.94/1000 vs. 2.75/1000 days of PN; P < 0.001). Septic episodes led to removal of 11 (12.8%) catheters. Two patients died due to CVC related septic shock (0.93 deaths/10,000 days of PN), one in HPN patient (0.79 per 10,000 days of HPN).Conclusion: The rate of CVC related sepsis in our PN cohort was exceptionally low in both hospital and home setting.