Economic analysis of nutrition interventions for chronic disease prevention: methods, research, and policy

Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study

The purpose of this study was to identify circulating biomarkers of recurrent non-infectious anterior uveitis (NIAU), and to address the anti-inflammatory effects of triglyceride containing docosahexaenoic acid (DHA-TG). A prospective multicenter study was conducted in 72 participants distributed into: patients diagnosed with recurrent NIAU in the quiescence stage (uveitis group (UG); n = 36) and healthy controls (control group (CG); n = 36). Each group was randomly assigned to the oral supplementation of one pill/day (+) containing DHA-TG (n = 18) or no-pill condition (−) (n = 17) for three consecutive months. Data from demographics, risk factors, comorbidities, eye complications and therapy were recorded. Blood was collected and processed to determine pro-inflammatory biomarkers by bead-base multiplex assay. Statistical processing with multivariate statistical analysis was performed. The mean age was 50, 12 (10, 31) years. The distribution by gender was 45% males and 55% females. The mean number of uveitis episodes was 5 (2). Higher plasma expression of interleukin (IL)-6 was detected in the UG versus the CG (p = 5 × 10⁻⁵). Likewise, significantly higher plasma levels were seen for IL-1β, IL-2, INFγ (p = 10⁻⁴), and TNFα (p = 2 × 10⁻⁴) in the UG versus the CG. Significantly lower values of the above molecules were found in the +DHA-TG than in the -DHA-TG subgroups, after 3 months of follow-up, TNFα (p = 10⁻⁷) and IL-6 (p = 3 × 10⁻⁶) being those that most significantly changed. Signatures of circulating inflammatory mediators were obtained in the quiescent stage of recurrent NIAU patients. This 3-month follow-up strongly reinforces that a regular oral administration of DHA-TG reduces the inflammatory load and may potentially supply a prophylaxis-adjunctive mediator for patients at risk of uveitis vision loss.

Clinical and Molecular-Genetic Insights into the Role of Oxidative Stress in Diabetic Retinopathy: Antioxidant Strategies and Future Avenues

Reactive oxygen species (ROS) overproduction and ROS-signaling pathways activation attack the eyes. We evaluated the oxidative stress (OS) and the effects of a daily, core nutritional supplement regimen containing antioxidants and omega 3 fatty acids (A/ω3) in type 2 diabetics (T2DM). A case-control study was carried out in 480 participants [287 T2DM patients with (+)/without (-) diabetic retinopathy (DR) and 193 healthy controls (CG)], randomly assigned to a daily pill of A/ω3. Periodic evaluation through 38 months allowed to outline patient characteristics, DR features, and classic/OS blood parameters. Statistics were performed by the SPSS 24.0 program. Diabetics displayed significantly higher circulating pro-oxidants (p = 0.001) and lower antioxidants (p = 0.0001) than the controls. Significantly higher plasma malondialdehyde/thiobarbituric acid reactive substances (MDA/TBARS; p = 0.006) and lower plasma total antioxidant capacity (TAC; p = 0.042) and vitamin C (0.020) was found in T2DM + DR versus T2DM-DR. The differential expression profile of solute carrier family 23 member 2 (SLC23A2) gene was seen in diabetics versus the CG (p = 0.001), and in T2DM + DR versus T2DM - DR (p < 0.05). The A/ω3 regime significantly reduced the pro-oxidants (p < 0.05) and augmented the antioxidants (p < 0.05). This follow-up study supports that a regular A/ω3 supplementation reduces the oxidative load and may serve as a dietary prophylaxis/adjunctive intervention for patients at risk of diabetic blindness.

Growth and survival of microencapsulated probiotics prepared by emulsion and internal gelation

Efficient microencapsulation of probiotics by most existing methods is limited by low throughput. In this work, Saccharomyces boulardii and Enterococcus faecium were microencapsulated by a method based on emulsion and internal gelation. The growth and survival of microencapsulated microbes under different stressors were investigated using free non-encapsulated ones as a control. The results showed that the prepared micro-beads by emulsion and internal gelation exhibited a spherical and smooth shape, with sizes between 300 and 500 μm. Both S. boulardii and E. faecium grew well and survived better when encapsulated in micro-beads. The survival rates were increased 25% and 40% for microencapsulated S. boulardii and E. faecium respectively when compared with non-encapsulated controls under high temperature and high humidity. The increases of survival rates were 60% for microencapsulated S. boulardii and 25% for E. faecium in simulated gastric juice. And the increases were 15% and 20% respectively when the survival rates of the microencapsulated S. boulardii and E. faecium were determined in simulated intestinal juice. The microencapsulation by emulsion and internal gelation offers an effective way to protect microbes in adverse in vitro and in vivo conditions and is promising for the large-scale production of probiotics microencapsulation.

Patient Education and Discharge Planning to Prevent Functional Decline in the Older Adult

The population in the United States is aging, and persons older than 65 years account for over 50% of healthcare costs. Preventing functional decline in older adults through patient education and optimal discharge planning is one way we can succeed in decreasing healthcare costs, readmissions, and mortality in this population. The aim of this article is to present viable healthcare policy options to prevent or minimize functional decline in the older adult, regardless of what health-related facility the person enters. Policy objectives include mandating functional screening tests on all persons 65 years and older, addressing functional status as a required element of discharge planning, tracking and reporting patient outcomes, and utilizing advanced practice nurses to the full extent of their education and scope of practice. Three policy options are presented, analyzed, and compared. The summary concludes with a recommended policy option.

Critical review of economic evaluation studies of interventions promoting low-fat diets

Various national and local policies encouraging healthy eating have recently been proposed. The present review aims to summarize and critically assess nutrition-economic evaluation studies of direct (e.g., diet counseling) and indirect (e.g., food labeling) interventions aimed at improving dietary habits. A systematic literature review was performed by searching 5 databases (PubMed, Ovid Medline, EconLit, Agricola, and Embase) using a combination of diet-related (fat, diet, intake, nutrition) and economics-related (cost-effectiveness, cost-benefit, cost-utility, health economics, economic evaluation) key words. The search yielded 36 studies that varied in target population, study design, economic evaluation method, and health/economic outcome. In general, all provide limited experimental evidence and adopt the framework of economic evaluations in healthcare. Certain important aspects were not well considered: 1) the non-health-related effects of nutrition interventions on well-being; 2) the private nature of food expenditures; 3) the distributional effects on food expenditures across socioeconomic groups; and 4) the general economic implications (e.g., agrofoods, import/export) of such interventions. Overall, the methodology for the economic evaluation of nutrition interventions requires substantial improvement.

Trends in research on energy balance supported by the National Cancer Institute

Over the past decade, the body of research linking energy balance to the incidence, development, progression, and treatment of cancer has grown substantially. No prior NIH portfolio analyses have focused on energy balance within one institute. This portfolio analysis describes the growth of National Cancer Institute (NCI) grant research on energy balance-related conditions and behaviors from 2004 to 2010 following the release of an NCI research priority statement in 2003 on energy balance and cancer-related research. Energy balance grants from fiscal years (FY) 2004 to 2010 were identified using multiple search terms and analyzed between calendar years 2008 and 2010. Study characteristics related to cancer site, design, population, and energy balance area (physical activity, diet, and weight) were abstracted. From FY2004 to FY2010, the NCI awarded 269 energy balance-relevant grants totaling $518 million. In FY2010, 4.2% of NCI's total research project grants budget was allocated to energy balance research, compared to 2.1% in FY2004. The NCI more than doubled support for investigator-initiated research project grants (R01) and increased support for cooperative agreement (U01, U54) and exploratory research (R21) grants. In the portfolio, research examining energy balance areas in combination accounted for 41.6%, and observational and interventional studies were equally represented (38.3% and 37.2%, respectively). Breast cancer was the most commonly studied cancer. Inclusion of minorities rose, and funding specific to cancer survivors more than doubled. From FY2004 to FY2010, NCI's investment in energy balance and related health behavior research showed growth in funding and diversity of mechanisms, topics, and disciplines-growth that reflects new directions in this field.

Vitamin/trace mineral supplements for the elderly

The fraction of population that is elderly has been increasing, as has the consumption of vitamin/trace mineral supplements, which is now a multibillion dollar industry. Yet the rationale for such supplement intake by the majority may be questioned. Some of the current recommendations for micronutrient intake by the elderly are extrapolations from recommendations made for younger adults, whereas other recommendations are based on measurements of biochemical indices not proven to reflect a deficient level in the elderly. Suggestions that the elderly need more than the recommended daily allowances largely rest on the assumption that they should have biochemical indices similar to younger adults despite decreased energy intake with decreased physical and metabolic activities of the elderly. Although some individuals require supplementation because of problems with intake, absorption, or metabolism, there is little or no proof that boosting micronutrient intake above what can be achieved in well-balanced diets, some of which already contain fortified foods, will lead to a healthier outcome for most elderly individuals. There is not only the potential for unnecessary and occasionally harmful excess administered to some, but there is a cost that now runs in the billions of dollars and adds to the costs of covering multiple chronic disease conditions. Hence, some caution should be exercised in public health promulgations concerning routine use of supplements for those in this age group (>65 y of age) and of both sexes until more research establishes clear connections between the need for micronutrients and nutrient-related health in the elderly.