Nutrient Status Assessment in Individuals and Populations for Healthy Aging-Statement from an Expert Workshop

Protein and energy intake in intensive care unit survivors during the first year of recovery: A descriptive cohort study

BACKGROUND

Many intensive care unit (ICU) survivors suffer long-term health issues that affect their quality of life. Nutrition inadequacy can limit their rehabilitation potential. This study investigates nutrition intake and support during ICU admission and recovery.

METHODS

In this prospective cohort study, 81 adult ICU patients with stays ≥48 h were included. Data on dietary intake, feeding strategies, baseline and ICU characteristics, and 1-year outcomes (physical health and readmission rates) were collected. The number of patients achieving 1.2 gram per kilogram per day of protein and 25 kilocalories per kilogram per day at 3 months, 6 months, and 12 months after ICU admission was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutrition intake at 12 months were evaluated, along with the effect of inadequate intake on outcomes.

RESULTS

After 12 months, only 10% of 60 patients achieved 1.2 g/kg/day protein intake, whereas 28% reached the advised 25 kcal/kg/day energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (P = 0.003, P = 0.012, and P = 0.033, respectively) and energy intake at 3 months (P = 0.003). A positive relation was found between female sex and energy intake at 12 months after ICU admission (β = 4.145; P = 0.043) and taste issues were independently associated with higher protein intake (β = 0.363; P = 0.036). However, achieving upper-quartile protein or energy intake did not translate into improved physical health outcomes.

CONCLUSION

Continuous and improved nutrition care is urgently needed to support patients in reaching nutrition adequacy.

Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar-Thailand border

OBJECTIVE

This study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar-Thailand border according to the local diet.

SETTING

TB clinic along the Myanmar-Thailand border.

PARTICIPANTS

Cross-sectional surveys of 24-hour food recall were conducted with participants receiving anti-TB treatment. Participants were purposively selected to reflect proportion of age, sex and HIV co-infection based on historical patient records. Out of a total of 28 participants, 20 (71.4%) were men and 5 (17.9%) were co-infected with HIV.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome compared actual recorded intake to recommended intake. Secondary outcomes compared weight gain and body mass index (BMI) from diagnosis to time of survey.

RESULTS

There were no significant differences in macronutrient or micronutrient intake by sex or for patients supplementing their rations. Mean treatment length at time of survey was 20.7 weeks (95% CI: 16.5 to 24.8). A significantly higher proportion of women (8/8, 100%) met caloric requirements compared with men (9/20, 45.0%, p=0.010), but few participants met other macronutrient or micronutrient requirements, with no significant differences by sex or for patients supplementing their rations. From diagnosis to the time of the survey, participants averaged significant weight gain of 6.48 kg (95% CI: 3.87 to 9.10) and increased BMI of 2.47 kg/m² (95% CI: 1.45 to 3.49; p=0.0001 for both). However, 50% (14/28) still had mild or more severe forms of malnutrition.

CONCLUSIONS

This cross-sectional survey of nutritional intake in patients undergoing TB treatment in a sanatorium setting demonstrates the difficulty in sufficiently meeting nutritional demands, even when providing nutritional support.

Validation of the Dutch Eating Behavior Questionnaire in a Romanian Adult Population

(1) Background: Obesity, part of the triple global burden of disease, is increasingly attracting research on its preventive and curative management. Knowledge of eating behavior can be useful both at the individual level (to individualize treatment for obesity) and the population level (to implement more suitable food policies). The Dutch Eating Behavior Questionnaire (DEBQ) is a widely used international tool to assess eating behavior, i.e., emotional, external and restricted eating styles. The aim of this study was to validate the Romanian version of DEBQ, as obesity is a major concern in Romania. (2) Methods: Our study tested the psychometric properties of the Romanian version of DEBQ on an adult population and explored the associations of eating behavior with weight status (3) Results: The study showed a factor load similar to the original version of the questionnaire and a very good internal validity (Cronbach’s alpha fidelity coefficient greater than 0.8 for all scales of the questionnaire) for the Romanian version of DEBQ and showed that all of the scales positively correlated with body mass index in both men and women. (4) Conclusions: This study will enable the use of the DEBQ Romanian version on the adult population of Romania where the findings could be incorporated into developing better strategies to reduce the burden of nutrition-related diseases.

The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.

Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review

BACKGROUND

Anorexia nervosa is a serious health condition characterized by a significant low body weight and alteration in body composition components.

AIM

In the current paper, we aim to summarize the available literature concerning changes in body fat, lean, and bone masses, during anorexia nervosa and after complete weight restoration.

METHODS

Data were summarized using a narrative approach based on clinical expertise in the interpretation of the available evidence base in the literature.

RESULTS

The available data revealed three main findings. Firstly, anorexia nervosa causes a significant reduction in body fat mass, however it is completely restored after short-term weight normalization but with a central adiposity phenotype that does not seem to negatively influence treatment outcomes and appears to normalize after 1 year of normal weight maintenance. Secondly, anorexia nervosa causes a significant reduction in bone mineral density, but weight restoration is associated first (≈12 months) with stabilization of bone mineral density, followed by improvements (after ≈16 months); and finally, with complete normalization (after ≈30 months) after normal-weight maintenance. Thirdly, during anorexia nervosa loss of lean and skeletal body mass occurring in particular from the extremities rather than the central regions has been consistently reported, especially in patients with a Body Mass Index (BMI) ≤ 16.5 Kg/m2 however short-term weight restoration is associated with complete normalization.

CONCLUSION

Anorexia nervosa adversely affects body composition, however this medical complication seems to be reversible through the main treatment strategy of body weight restoration followed by normal weight maintenance, and this should be openly discussed with patients.

Effect of Manual Data Cleaning on Nutrient Intakes Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

BACKGROUND

Automated dietary assessment tools such as ASA24® are useful for collecting 24-hour recall data in large-scale studies. Modifications made during manual data cleaning may affect nutrient intakes.

OBJECTIVES

We evaluated the effects of modifications made during manual data cleaning on nutrient intakes of interest: energy, carbohydrate, total fat, protein, and fiber.

METHODS

Differences in mean intake before and after data cleaning modifications for all recalls and average intakes per subject were analyzed by paired t-tests. The Chi-squared test was used to determine whether unsupervised recalls had more open-ended text responses that required modification than supervised recalls. We characterized food types of text response modifications. Correlations between predictive energy requirements, measured total energy expenditure (TEE), and mean energy intake from raw and modified data were examined.

RESULTS

After excluding 11 recalls with invalidating technical errors, 1499 valid recalls completed by 393 subjects were included in this analysis. We found significant differences before and after modifications for energy, carbohydrate, total fat, and protein intakes for all recalls (P < 0.05). Limiting to modified recalls, there were significant differences for all nutrients of interest, including fiber (P < 0.02). There was not a significantly greater proportion of text responses requiring modification for home compared with supervised recalls (P = 0.271). Predicted energy requirements correlated highly with TEE. There was no significant difference in correlation of mean energy intake with TEE for modified compared with raw data. Mean intake for individual subjects was significantly different for energy, protein, and fat intakes following cleaning modifications (P < 0.001).

CONCLUSIONS

Manual modifications can change mean nutrient intakes for an entire cohort and individuals. However, modifications did not significantly affect the correlation of energy intake with predictive requirements and measured expenditure. Investigators can consider their research question and nutrients of interest when deciding to make cleaning modifications.

Motor function is the primary driver of the associations of sarcopenia and physical frailty with adverse health outcomes in community-dwelling older adults

Background

This study tested the hypothesis that sarcopenia and its constituent components, reduced lean muscle mass and impaired motor function, are associated with reduced survival and increased risk of incident disabilities.

Methods

1466 community-dwelling older adults underwent assessment of muscle mass with bioelectrical impedance analysis (BIA), grip strength, gait speed and other components of physical frailty and annual self-report assessments of disability. We used Cox proportional hazards models that controlled for age, sex, race, education and height to examine the associations of a continuous sarcopenia metric with the hazard of death and incident disabilities.

Results

Mean baseline age was about 80 years old and follow-up was 5.5 years. In a proportional hazards model controlling for age, sex, race, education and baseline sarcopenia, each 1-SD higher score on a continuous sarcopenia scale was associated with lower hazards of death (HR 0.70, 95%CI [0.62, 0.78]), incident IADL (HR 0.80,95%CI [0.70, 0.93]), incident ADL disability (HR 0.80 95%CI [71, 91]) and incident mobility disability (HR 0.81, 95%CI [0.70, 0.93]). Further analyses suggest that grip strength and gait speed rather than muscle mass drive the associations with all four adverse health outcomes. Similar findings were observed when controlling for additional measures used to assess physical frailty including BMI, fatigue and physical activity.

Conclusions

Motor function is the primary driver of the associations of sarcopenia and physical frailty with diverse adverse health outcomes. Further work is needed to identify other facets of muscle structure and motor function which together can identify adults at risk for specific adverse health outcomes.

The Use of SenseWear Armband for Assessment of Daily Energy Expenditure and the Relation to Body Fat Distribution and Nutritional Intake in Lean Women with Polycystic Ovary Syndrome

OBJECTIVE

To evaluate nutritional intake, energy expenditure, and segmental body composition in lean women with polycystic ovary syndrome (PCOS) and compare them with age- and body mass index- (BMI-) matched control women.

METHODS

32 nonobese patients with PCOS and 31 age- and BMI-matched healthy women were included in the study. Energy expenditure and physical activity level were assessed by metabolic Holter equipment (SenseWear Armband, SWA) which was never previously used in lean PCOS population. Food intake is recorded with 24 hours of food record. Segmental body composition analysis was assessed by bioelectrical impedance analyses (BIA).

RESULTS

Mean BMI was 22.64 ± 3.64 and 21.55 ± 2.77 kg/m2 (p=0.185) in PCOS and control groups, respectively. Mean age was 22.03 ± 4.21 and 21.71 ± 2.67 year (p=0.720), respectively. No significant differences were found in total energy intake and percentage of carbohydrates, fats, and other micronutrients (p > 0.05). Energy percentage of proteins (%12.73 ± 1.98, p=0.008) was statistically lower in subjects versus the control group. The measurements of physical activity duration (PAD) (1.40 ± 0.87/2.18 ± 0.99 hours, p=0.002), active energy expenditure (372.35 ± 198.32/494.10 ± 186.50 kcal, p=0.018), and step counting (9370.03 ± 3587.49/11730.90 ± 3564.31 steps, p=0.013) measurement of the PCOS group were lower than the control group, respectively.

CONCLUSIONS

New diagnosed women with PCOS had similar distribution and quantity of body fat parameters and nutritional status when compared to healthy women. Control subjects were found more active in energy expenditure.

The Newly Developed Elderly Nutrient-Rich Food Score Is a Useful Tool to Assess Nutrient Density in European Older Adults

Objective: To develop a nutrient-rich food (NRF) score that captures dietary reference values for older adults and to validate this against a diet index that was specifically designed to assess adherence to dietary guidelines for the older population. Design: A cross-sectional study within the Dutch National Food Consumption Survey (DNFCS, n = 735 men and women aged 70-94 years, enrolled between October 2010 and February 2012) and within the NU-AGE study (n = 250 men and women aged 65-79 years, enrolled between April 2012 and March 2013). Dietary intake was assessed by means of two non-consecutive dietary record assisted 24-h recalls and 7-day food records, respectively. Structured questionnaires collected data on lifestyle and socio-economic information. Anthropometrics were measured by trained dieticians or research assistants. We evaluated Elderly NRF (E-NRF) scores against the NU-AGE index, a measure of adherence to European dietary guidelines for the aging population. The E-NRF scores were composed of nutrients that: (1) have been shown to be of inadequate intake in the aging population (>20%), (2) were defined as nutrients of public health relevance, and (3) were associated with relevant health outcomes. Results: The E-NRF score that best predicted the NU-AGE index included seven nutrients to encourage (protein, dietary fiber, folate, vitamin D, calcium, magnesium, potassium) and three nutrients to limit (saturated fat, sodium and mono- and disaccharides) on a 100-kcal basis, the E-NRF7.3 score (model R2 0.27 in DNFCS and 0.41 in NU-AGE). Food groups contributing the most to the individual E-NRF7.3 scores were vegetables, bread, potatoes and milk and milk products. Conclusion: The E-NRF7.3 score is a useful tool for assessing nutrient density of diets within the older population. No index has previously been developed with the aim of evaluating nutrient density of diets and foods specifically capturing dietary reference values for older adults.

The role of the microbiome for human health: from basic science to clinical applications

The 2017 annual symposium organized by the University Medical Center Groningen in The Netherlands focused on the role of the gut microbiome in human health and disease. Experts from academia and industry examined interactions of prebiotics, probiotics, or vitamins with the gut microbiome in health and disease, the development of the microbiome in early-life and the role of the microbiome on the gut–brain axis. The gut microbiota changes dramatically during pregnancy and intrinsic factors (such as stress), in addition to extrinsic factors (such as diet, and drugs) influence the composition and activity of the gut microbiome throughout life. Microbial metabolites, e.g. short-chain fatty acids affect gut–brain signaling and the immune response. The gut microbiota has a regulatory role on anxiety, mood, cognition and pain which is exerted via the gut–brain axis. Ingestion of prebiotics or probiotics has been used to treat a range of conditions including constipation, allergic reactions and infections in infancy, and IBS. Fecal microbiota transplantation (FMT) highly effective for treating recurrent Clostridium difficile infections. The gut microbiome affects virtually all aspects of human health, but the degree of scientific evidence, the models and technologies and the understanding of mechanisms of action vary considerably from one benefit area to the other. For a clinical practice to be broadly accepted, the mode of action, the therapeutic window, and potential side effects need to thoroughly be investigated. This calls for further coordinated state-of-the art research to better understand and document the human gut microbiome’s effects on human health.

Validation (in Spanish) of the Mini Nutritional Assessment survey to assess the nutritional status of patients over 65 years of age

AIM

To validate the Mini Nutritional Assessment (MNA) in a Spanish population over 65 years of age with varying degrees of independence.

DESIGN

This cross-sectional validation study used the Chang nutritional assessment method as a reference test.

PARTICIPANTS

248 subjects (72.2% female), with a mean age of 81.3, completed the study. They were classified into three groups: (i) autonomous patients who were able to take part in activities outside their home; (ii) patients who require help with daily self-care; (iii) patients living in a residential health care facility.

SETTING

Three health centres and three residential care homes situated in Cordoba (Spain).

RESULTS

The kappa values for intra-observer and inter-observer agreement were 0.870 and 0.784, respectively. The intra-class correlation coefficient intra-observer was 0.874 and the inter-observer was 0.789. The sensitivity and specificity readings for the diagnostic accuracy of MNA were 63.2% and 72.9% in the total sample, respectively. The area under the curve was 0.726. For patients in the Group A, B and C, the sensitivity was 89.3%, 60.7% and 18.8%, and the specificity was 23.3%, 56.8% and 94.1%, respectively.

CONCLUSION

The results for the reliability of the survey were excellent, and its internal consistency was acceptable. The diagnostic accuracy, as measured by the sensitivity and specificity readings, was lower than that obtained with the original survey. It can therefore be considered more suitable for a population with limited autonomy, and less appropriate for independent patients. The results may not be relevant to patients outside of the Cordova region in Spain.

The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging

An increasing aging population worldwide accounts for a growing share of noncommunicable diseases (NCDs) of the overall social and economic burden. Dietary and nutritional approaches are of paramount importance in the management of NCDs. As a result, nutrition programs are increasingly integrated into public health policies. At present, programs aimed at reducing the burden of NCDs have focused mostly on the excess of unhealthy nutrient intakes whereas the importance of optimizing adequate essential and semi-essential nutrient intakes and nutrient-rich diets has received less attention. Surveys indicate that nutrient intakes of the aging population are insufficient to optimally support healthy aging. Vitamin and mineral deficiencies in older adults are related to increased risk of NCDs including fatigue, cardiovascular disease, and cognitive and neuromuscular function impairments. Reviewed literature demonstrates that improving intake for certain nutrients may be important in reducing progress of NCDs such as musculoskeletal disorders, dementia, loss of vision, and cardiometabolic diseases during aging. Current knowledge concerning improving individual nutrient intakes to reduce progression of chronic disease is still emerging with varying effect sizes and levels of evidence. Most pronounced benefits of nutrients were found in participants who had low nutrient intake or status at baseline or who had increased genetic and metabolic needs for that nutrient. Authorities should implement ways to optimize essential nutrient intake as an integral part of their strategies to address NCDs.

Public health relevance of drug-nutrition interactions

The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug–nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug–nutrition interactions. Experts and stakeholders should advocate for the integration of drug–nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.

Vitamin E: Emerging aspects and new directions

The discovery of vitamin E will have its 100th anniversary in 2022, but we still have more questions than answers regarding the biological functions and the essentiality of vitamin E for human health. Discovered as a factor essential for rat fertility and soon after characterized for its properties of fat-soluble antioxidant, vitamin E was identified to have signaling and gene regulation effects in the 1980s. In the same years the cytochrome P-450 dependent metabolism of vitamin E was characterized and a first series of studies on short-chain carboxyethyl metabolites in the 1990s paved the way to the hypothesis of a biological role for this metabolism alternative to vitamin E catabolism. In the last decade other physiological metabolites of vitamin E have been identified, such as α-tocopheryl phosphate and the long-chain metabolites formed by the ω-hydroxylase activity of cytochrome P-450. Recent findings are consistent with gene regulation and homeostatic roles of these metabolites in different experimental models, such as inflammatory, neuronal and hepatic cells, and in vivo in animal models of acute inflammation. Molecular mechanisms underlying these responses are under investigation in several laboratories and side-glances to research on other fat soluble vitamins may help to move faster in this direction. Other emerging aspects presented in this review paper include novel insights on the mechanisms of reduction of the cardiovascular risk, immunomodulation and antiallergic effects, neuroprotection properties in models of glutamate excitotoxicity and spino-cerebellar damage, hepatoprotection and prevention of liver toxicity by different causes and even therapeutic applications in non-alcoholic steatohepatitis. We here discuss these topics with the aim of stimulating the interest of the scientific community and further research activities that may help to celebrate this anniversary of vitamin E with an in-depth knowledge of its action as vitamin.

Nutrient Intake Is Associated with Longevity Characterization by Metabolites and Element Profiles of Healthy Centenarians

The relationships between diet and metabolites as well as element profiles in healthy centenarians are important but remain inconclusive. Therefore, to test the interesting hypothesis that there would be distinctive features of metabolites and element profiles in healthy centenarians, and that these would be associated with nutrient intake; the short chain fatty acids (SCFAs), total bile acids and ammonia in feces, phenol, p-cresol, uric acid, urea, creatinine and ammonia in urine, and element profiles in fingernails were determined in 90 healthy elderly people, including centenarians from Bama county (China)—a famous longevous region—and elderly people aged 80–99 from the longevous region and a non-longevous region. The partial least squares-discriminant analysis was used for pattern recognition. As a result, the centenarians showed a distinct metabolic pattern. Seven characteristic components closely related to the centenarians were identified, including acetic acid, total SCFA, Mn, Co, propionic acid, butyric acid and valeric acid. Their concentrations were significantly higher in the centenarians group (p < 0.05). Additionally, the dietary fiber intake was positively associated with butyric acid contents in feces (r = 0.896, p < 0.01), and negatively associated with phenol in urine (r = −0.326, p < 0.01). The results suggest that the specific metabolic pattern of centenarians may have an important and positive influence on the formation of the longevity phenomenon. Elevated dietary fiber intake should be a path toward health and longevity.

Dietary supplements and disease prevention - a global overview

Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.