Low Protein Intake Research Articles

Relevance of Protein Intake for Weaning in the Mechanically Ventilated Critically Ill: Analysis of a Large International Database.

The association between protein intake and the need for mechanical ventilation (MV) is controversial. We aimed to investigate the associations between protein intake and outcomes in ventilated critically ill patients. Analysis of a subset of a large international point prevalence survey of nutritional practice in ICUs. A total of 785 international ICUs. A total of 12,930 patients had been in the ICU for at least 96 hours and required MV by the fourth day after ICU admission at the latest. None. We modeled associations between the adjusted hazard rate (aHR) of death in patients requiring MV and successful weaning (competing risks), and three categories of protein intake (low: < 0.8 g/kg/d, standard: 0.8-1.2 g/kg/d, high: > 1.2 g/kg/d). We compared five different hypothetical protein diets (an exclusively low protein intake, a standard protein intake given early (days 1-4) or late (days 5-11) after ICU admission, and an early or late high protein intake). There was no evidence that the level of protein intake was associated with time to weaning. However, compared with an exclusively low protein intake, a standard protein intake was associated with a lower hazard of death in MV: minimum aHR 0.60 (95% CI, 0.45-0.80). With an early high intake, there was a trend to a higher risk of death in patients requiring MV: maximum aHR 1.35 (95% CI, 0.99-1.85) compared with a standard diet. The duration of MV does not appear to depend on protein intake, whereas mortality in patients requiring MV may be improved by a standard protein intake. Adverse effects of a high protein intake cannot be excluded.

Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013–2018

BackgroundDifferences in nutrient intakes by urbanization level in the Unites States is not well understood. ObjectiveDescribe, by urbanization level: 1) intake of protein, fiber, percent of energy from added sugars (AS) and saturated fat (SF), calcium, iron, potassium, sodium, and vitamin D; 2) the percent of the population meeting nutrient recommendations. MethodsTwenty-four-hour dietary recalls from 23,107 participants aged 2 y and over from the 2013–2018 National Health and Nutrition Examination Surveys were analyzed. Usual intakes were estimated, and linear regression models adjusted for age, sex, race and Hispanic origin, and whether family income met the 130% threshold examined intake differences by urbanization levels—large urban areas (LUA), small to medium metro areas (SMMA), and rural areas (RA). ResultsA small percentage of the population met the nutrient recommendations, except for protein (92.8%) and iron (70.5%). A higher percentage of the population met recommendations than SMMA and RA for fiber (11.8% compared with 8.1% and 5.3%, P < 0.001), AS (40.2% compared with 33.4% and 31.3%, P < 0.001), SF (26.8% compared with 18.2% and 20.1%, P < 0.001), and potassium (31.5% compared with 25.5% and 22.0%, P < 0.001). Mean protein intake were also higher in LUA than RA (80.0 g compared with 77.7 g, P = 0.003) and fiber intake higher in LUA than SMMA (16.5 g compared with 15.9 g, P = 0.01) and RA (16.5 g compared with 15.2 g, P = 0.001). In addition, contributions to energy intake were lower in LUA than SMMA for AS (11.3% compared with 12.0%, P < 0.001) and SF (11.5% compared with 11.7%, P < 0.001), and for LUA than RA for AS (11.3% compared with 12.9%, P < 0.001) and SF (11.5% compared with 11.8%, P < 0.001). ConclusionsRA had some markers of poorer diet quality—lower protein and fiber intake and higher AS intake—compared with LUA, and these differences persisted in adjusted regression models. These results may inform public health efforts to address health disparities by urbanization levels in the Unites States.

Effect of dietary protein intake on cognitive function in the elderly with chronic kidney disease: analysis of the National Health and Nutrition Examination Survey 2011–2014

Background Cognitive dysfunction is prevalent among the elderly diagnosed with chronic kidney disease (CKD). Low protein diets are used for retarding the progression of CKD in clinical practice. Nonetheless, the impact of dietary protein consumption on cognitive function in this population remains uncertain. Methods We recruited 2306 participants (≥60 years) from 2011 to 2014 National Health and Nutrition Examination Survey (NHANES). 24-h dietary recall questionnaire was utilized to evaluate protein intake. Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Participants’ characteristics were analyzed, and the interaction between protein consumption and CKD on cognitive impairment were analyzed using a logistic regression model. Results We divided participants into three groups based on CKD stages: no CKD, CKD stage G1 to G2 (19%), and CKD stage G3 to G5 (18%). The average protein intake was 0.97 g/(kg·d). In the higher protein intake group, CKD stages G1 to G2 elevated the risk of immediate memory impairment (OR: 2.441, 95% Cl: 1.161–5.132 for protein consumption in 1.0-1.2g/(kg·d); OR: 2.225, 95% Cl: 1.015–4.876 for protein consumption in >1.2 g/(kg·d)). However, no similar resuts were observed in the lower protein intake group. In addition, the interaction between CKD status and protein intake on immediate memory was statistically significant (p = .041). Conclusion A higher probability of cognitive impairment in the elderly with early-stage CKD may be linked to higher protein intake. Low protein diets may be a potential strategy to release cognitive impairment in the elderly with early-stage CKD.

The Order of Limiting Amino Acids in a Wheat–Sorghum-Based Reduced-Protein Diet for Laying Hens

Understanding the order of limiting amino acids (AA) in reduced-protein (RP) diets for laying hens will facilitate precise feed formulation and ensure that AA requirements are met cost-effectively. The order of the first three limiting AAs—lysine (Lys), methionine (Met), and threonine (Thr)—has been well established in RP laying hen diets. This study aimed to determine the priority order of eight additional limiting AAs (critically important AAs) when formulating wheat–sorghum-based RP diets for laying hens: tryptophan (Trp), valine (Val), isoleucine (Ile), arginine (Arg), leucine (Leu), histidine (His), phenylalanine (Phe), and glycineequivalent (Gly). A total of 330 Hy-Line Brown laying hens were randomly assigned to 11 dietary treatments (30 replicates of individual birds per treatment) from 20 to 39 weeks of age (WOA). Treatments were a standard-protein (17.24% CP) diet as the control (SP); a reduced-protein (15.00% CP) diet with sufficient levels of Lys, Met, and Thr but insufficient levels of the eight experimental essential AA (RP); a reduced-protein diet with sufficient levels of all essential AAs (RP-EAA); and eight subsequent dietary treatments of the RP-EAA diet with one of the experimental essential AAs removed: Trp (RP-EAA-Trp), Val (RP-EAA-Val), Ile (RP-EAA-Ile), Arg (RP-EAA-Arg), Leu (RP-EAA-Leu), His (RP-EAA-His), Phe (RP-EAA-Phe), and Gly (RP-EAA-Gly). Eggs were collected and weighed daily, and feed intake and feed conversion ratio (FCR) were calculated weekly. External and internal egg quality was measured at 29 and 39 WOA. Nutrient digestibility, serum uric acid concentration, caecal microbiota composition, and tibia parameters were measured at 40 WOA. Overall, hens fed the RP-EAA-Val, RP-EAA-Ile, and RP diets presented significantly lower egg mass compared to hens fed the SP, RP-EAA-His, and RP-EAA-Gly diets (p &lt; 0.001). Hens fed the RP diet and RP-EAA-Val diet had a higher FCR compared to those offered the RP-EAA, RP-EAA-Leu, RP-EAA-Phe, and RP-EAA-Gly diets (p = 0.046). Lower protein intake and excretion were observed in hens offered the RP diets compared to hens fed the SP diet (p = 0.001 and 0.018, respectively). Based on the egg mass, Ile may be considered the fourth and Val the fifth limiting AA, after Lys, Met, and Thr, in laying hens fed wheat–sorghum-based RP diets during peak lay. However, if ranked based on FCR, Val may be considered the fourth limiting AA, followed by Trp, Ile, Arg, and His as the co-fifth limiting AAs. Leu, Phe, and Gly may be considered as non-essential AAs for laying hens fed RP diets.

Restriction of dietary protein slows the development and progression of Alzheimer’s disease in 3xTg mice

AbstractBackgroundCaloric restriction (CR) promotes health and longevity in diverse species and has been successful in ameliorating Alzheimer’s disease (AD) pathology in mouse models and non‐human primates. However, CR may be difficult to adhere to, which makes the reduction of specific macronutrients without restricting calories an attractive alternative. Low protein intake is associated with healthy aging and reduced mortality in humans, and protein restriction (PR) extends the lifespan and healthspan of many mouse models. In this study, we examined the effects of PR on metabolic health and AD pathology in the 3xTg mouse model of AD.MethodWe placed male and female 3xTg mice as well as non‐transgenic (NTg) controls on either a Control diet (21% of calories from protein) or a PR diet (7% of calories from protein) starting at 6 months of age. We assessed the effect of PR on metabolic health, cognition, and AD neuropathology along with targeted metabolomics on plasma samples to identify the abundance of metabolites and dysregulated metabolic pathways.ResultWe found that a long‐term PR diet had substantial metabolic benefits for both male and female 3xTg and NTg mice, promoting leanness and glycemic control. We also found that consumption of low protein diet significantly improved cognitive performance and reduced multiple aspects of AD neuropathology including tau phosphorylation, Aß plaques and gliosis. Phosphorylation of the mTORC1 substrate S6K1 was decreased and the major autophagy cargo receptor P62 was increased in PR‐fed 3xTg mice, which suggests that reduced mTORC1 signaling may mediate the beneficial effects of PR on AD pathology. Targeted metabolomics revealed that several metabolites involved in nucleic acid metabolism and amino acid metabolism were altered between control fed and PR fed mice in a sex specific manner.ConclusionOur findings suggest that lowering dietary protein may be a novel way to slow or even prevent AD. In addition, drugs that mimic the effects of PR may be an effective pharmaceutical approach to combat AD pathology.

Dietary Tyrosine Intake (FFQ) Is Associated with Locus Coeruleus, Attention and Grey Matter Maintenance: An MRI Structural Study on 398 Healthy Individuals of the Berlin Aging Study-II

Background and ObjectiveIt is documented that low protein and amino-acid dietary intake is related to poorer cognitive health and increased risk of dementia. Degradation of the neuromodulatory pathways, (comprising the cholinergic, dopaminergic, serotoninergic and noradrenergic systems) is observed in neurodegenerative diseases and impairs the proper biosynthesis of key neuromodulators from micro-nutrients and amino acids. How these micro-nutrients are linked to neuromodulatory pathways in healthy adults is less studied. The Locus Coeruleus–Noradrenergic System (LC-NA) is the earliest subcortical structure affected in Alzheimer's disease, showing marked neurodegeneration, but is also sensitive for age-related changes. The LC-NA system is critical for supporting attention and cognitive control, functions that are enhanced both by tyrosine administration and chronic tyrosine intake. The purpose of this study was to 1) investigate whether the dietary intake of tyrosine, the key precursor for noradrenaline (NA), is related to LC signal intensity 2) whether LC mediates the reported association between tyrosine intake and higher cognitive performance (measured with Trail Making Test–TMT), and 3) whether LC signal intensity relates to an objective measure of brain maintenance (BrainPAD). MethodsThe analyses included 398 3T MRIs of healthy participants from the Berlin Aging Study II to investigate the relationship between LC signal intensity and habitual dietary tyrosine intake-daily average (HD-Tyr-IDA - measured with Food Frequency Questionnaire - FFQ). As a control procedure, the same analyses were repeated on other main seeds of the neuromodulators' subcortical system (Dorsal and Medial Raphe, Ventral Tegmental Area and Nucleus Basalis of Meynert). In the same way, the relationships between the five nuclei and BrainPAD were tested. ResultsResults show that HD-Tyr-IDA is positively associated with LC signal intensity. Similarly, LC disproportionally relates to better brain maintenance (BrainPAD). Mediation analyses reveal that only LC, relative to the other nuclei tested, mediates the relationship between HD-Tyr-IDA I and performance in the TMT and between HD-Tyr-IDA and BrainPAD. ConclusionsThese findings provide the first evidence linking tyrosine intake with LC-NA system signal intensity and its correlation with neuropsychological performance. This study strengthens the role of diet for maintaining brain and cognitive health and supports the noradrenergic theory of cognitive reserve. Within this framework, adequate tyrosine intake might increase the resilience of LC-NA system functioning, by preventing degeneration and supporting noradrenergic metabolism required for LC function and neuropsychological performance.

Mobility and strength training with and without protein supplements for pre-frail or frail older adults with low protein intake: the Maximising Mobility and Strength Training (MMoST) feasibility randomised controlled trial protocol

Background Frailty is a common syndrome affecting older people and puts them at risk of hospitalisation, needing care or death. First signs of frailty include reduced muscle strength and mobility decline. A key cause of mobility decline as we age is sarcopenia (age related reduction in muscle strength and mass). Poor nutrition contributes to sarcopenia. A shortfall in protein is associated with reduced muscle mass and strength. This may be due to inadequate intake but also because older people have higher protein needs, especially those with multimorbidity. We need to develop effective treatment to reduce or slow the onset of frailty and mobility decline. Exercise is a recommended treatment. Protein supplements to address the shortfall in protein have the potential to enhance the benefit of regular exercise in frail or pre-frail older adults. This has yet to be definitively demonstrated. Aim To establish the feasibility of conducting an RCT evaluating mobility and strength training with or without protein supplements for people over 60 years old who are frail or pre-frail with a low protein intake. Methods A multicentre, parallel, 2-group, feasibility RCT. Participants (recruitment target = 50) with problems walking, low protein intake and classified as frail or pre-frail will be recruited from four NHS Physiotherapy community services. Participants will be randomised (secure computer-generated: 1:1) to receive 24 weeks of mobility and strength training (delivered in 16 group sessions plus home exercises) or 24 weeks of mobility and strength training with daily protein supplements. Primary feasibility objectives are to estimate 1) ability to screen and recruit eligible participants, 2) intervention fidelity, adherence, and tolerance and 3) retention of participants at follow up. Secondary objectives are to 1) test data collection procedures, 2) assess data completeness and 3) confirm sample size calculation for a definitive RCT. Registration ISRCTN Registry (ISRCTN30405954; 18/10/2022).

The effect of tissue mobilization and stage of lactation on energy partitioning in lactating sows: an analysis of commercial data

AbstractThe objective of this paper was to investigate how the predicted level of body energy mobilized and the stage of lactation affects performance and energy partitioning in lactating sows kept under commercial conditions. Seventy-seven lactating sows from three consecutive batches were weaned at 28 d and all measures were taken over the first 20 d. Total feed consumption was measured and sows’ live weight was registered when entering the lactation facilities and at 21 d of lactation. Blood samples were collected at farrowing and once a week thereafter. Net energy (NE) mobilization or loss was calculated by difference using the general NRC equation for ME partitioning. Compared to low mobilizers (low NE loss values), high mobilizing sows had lower feed intake and higher loss of live weight, body fat and body protein. High mobilizers also weaned more piglets and had heavier litters than low mobilizers. Energy mobilization (NE loss) was higher from day 1 to 10 of lactation compared to day 11 to 20, and the difference in mobilized energy between high and low mobilizing sows was also higher in the first than in the second half of lactation. Body weight and back fat thickness losses were significantly correlated with NE loss. A more accurate prediction of the changes in live weight or back fat thickness over lactation should help better predict total amount of energy mobilized, and more research is needed to assess the relative contribution of lean and fat to mobilized tissue.

L-Lysine supplementation affects dietary protein quality and growth and serum amino acid concentrations in rats

Single amino acid (AA) supplementations in foods are increasing, however their potential nutritional and physiological impacts are not fully understood. This study examined the effects of l-lysine (Lys) supplementation on protein quality of diets, serum AA concentrations and associations between the ratio of supplemental Lys to dietary protein (X) with body weight gain (BWG) in Sprague–Dawley male rats. Rats were fed one of 10 diets containing either 7% or 20% casein and supplemented with 0% (Control), 1.5%, 3%, 6% Lys or 6% Lys + 3% l-arginine (Arg) (8 rats/diet group) for 1 week. Lys supplementation reduced the protein quality of the casein-based diets (p < 0.01). BWG was reduced by supplemental Lys when X > 0.18. Free Lys supplementation dose-dependently increased serum Lys levels (p < 0.01), while increased protein-bound Lys (1.4% vs 0.52%) had little effect on serum Lys (p > 0.05). In the 7% casein diets, ≥ 1.5% supplemental Lys reduced serum alanine, asparagine, glycine, isoleucine, leucine, serine, tyrosine, valine, carnitine, ornithine, and increased urea. Supplementation of ≥ 3% Lys additionally reduced tryptophan and increased histidine, methionine and α-aminoadipic acid (α-AAA) compared to the Control (p < 0.05). In the 20% casein diets, addition of ≥ 1.5% Lys reduced serum asparagine and threonine, and ≥ 3% Lys reduced leucine, proline, tryptophan, valine, and ornithine, and 6% Lys reduced carnitine, and increased histidine, methionine, and α-AAA. Overall, this study showed that free Lys supplementation in a Lys-sufficient diet reduced the protein quality of the diets and modified the serum concentrations of many amino acids. Excess free Lys intake adversely affected growth and utilization of nutrients due to AA imbalance or antagonism. Overall lower protein intake increases susceptibility to the adverse effects of Lys supplementation.

PROMISE: effect of protein supplementation on fat-free mass preservation after bariatric surgery, a randomized double-blind placebo-controlled trial

IntroductionProtein malnutrition after bariatric surgery is a severe complication and leads to significant morbidity. Previous studies have shown that protein intake and physical activity are the most important factors in the preservation of fat-free mass during weight loss. Low protein intake is very common in patients undergoing bariatric surgery despite dietary counseling. Protein powder supplements might help patients to achieve the protein intake recommendations after bariatric surgery and could therefore contribute to preserve fat-free mass. This double-blind randomized placebo-controlled intervention study aims to assess the effect of a daily consumed clear protein powder shake during the first 6 months after bariatric surgery on fat-free mass loss in the first 12 months after laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods and analysisInclusion will take place at the outpatient clinic of the bariatric expertise center for obesity of the Maasstad Hospital. Patients will be randomly assigned to either the intervention or control group before surgery. The intervention group will receive a clear protein powder shake of 200 ml containing 20 g of whey protein dissolved in water which should be taken daily during the first 6 months after LRYGB on top of their normal postoperative diet. The control group will receive an isocaloric, clear, placebo shake containing maltodextrine. Postoperative rehabilitation and physiotherapeutical guidance will be standardized and similar in both groups. Also, both groups will receive the same dietary advice from specialized dieticians. The main study parameter is the percentage of fat-free mass loss 6 months after surgery, assessed by multi-frequency bioelectrical impedance analysis (MF-BIA).Ethics and disseminationThe protocol, version 2 (February 20, 2022) has been approved by the Medical Research Ethics Committees United (MEC-U) (NL 80414.100.22). The results of this study will be submitted to peer-reviewed journals.Trial registrationClinicalTrials.gov NCT05570474. Registered on October 5, 2022.

Factors Affecting Patterns of Fast Food Consumption in Students of Medical Study Program Faculty of Medicine Tanjungpura University

Medical students who are in their late teens and are affected by high stress due to academic loads experience changes in nutritional intake behavior, namely changes in eating patterns with a tendency to consume fast food (fast food). The purpose of this study was to determine the factors that influence fast food consumption patterns in students of the Medical Study Program, Faculty of Medicine, Tanjungpura University. This study uses a type of observational analytic research with a cross-sectional design. This study used data on weight and height measurements, a 3x24-hour Food Record, and a questionnaire on 46 students of the Medical Study Program class of 2022. The results showed low consumption of calories, protein and carbohydrates, and high consumption of fat. The overall average intake of energy, fat and carbohydrates is normal, while protein intake is low. There is no effect of all variables on consumption of energy, protein, fat, carbohydrates, and nutritional status. However, action on fast food has a significant effect on energy consumption. Students often consume fast food which is processed by frying process. Low protein intake and high fat consumption indicate the need for education for food selection in reducing the negative impact on the health of medical students.&#x0D; Keywords: Fast food, medical students, consumption patterns, factors

The Effect of Dietary Advice Aimed at Increasing Protein Intake on Oral Health and Oral Microbiota in Older Adults: A Randomized Controlled Trial.

Nutrition and oral health are closely related, especially in older adults in whom poor nutrition may lead to oral microbial perturbations, exacerbating poor oral health. In a 6-month randomized controlled trial, we evaluated the effects on oral microbiota and on oral health of dietary advice aimed at increasing protein intake to ≥1.2 g/kg adjusted body weight/day (g/kg aBW/d) in community-dwelling older adults with low habitual protein intake (<1.0 g/kg aBW/d). Food intake was measured via 24 h dietary recalls, oral health was measured via questionnaires, and oral microbial composition was assessed via the 16S rRNA sequencing of tongue swabs. Mean baseline protein intake was 0.8 g/kg aBW/day in both groups. In the high protein group (n = 47), participants increased their protein intake to mean 1.2 g/kg aBW/day at the 6-month follow-up. Protein intake in the control group (n = 43) remained at 0.9 g/kg a BW/day. The intervention did not affect self-reported oral health. While it caused moderate shifts in oral microbiota alpha- and beta-diversity measures, abundances of individual bacterial taxa were not affected. In conclusion, our intervention did not affect self-reported oral health within a period of 6 months, nor did it substantially affect the tongue microbiota composition.

Ultra-processed food consumption, nutrition quality, and obesity prevalence in Israel

Abstract Obesity is associated with chronic disease and burdens individuals and health systems heavily. Obesity prevalence has increased globally in recent decades. Concurrently, consumption of natural and home-prepared foods has decreased while that of industrial and ultra-processed foods (UPFs) that may play a role in obesity etiology, has increased. Our aim was to assess the extent of UPF consumption, nutrition quality and obesity prevalence in Israel, using data from a cross-sectional National Health and Nutrition survey conducted in 2014-16 on a representative sample of 25-64Y individuals who were face-to-face interviewed and anthropometrically measured. Participants reported 24h dietary intake. Consumed foods were coded into 4 groups based on the NOVA method which classifies foods by their level of processing, from unprocessed foods to UPFs. Obesity prevalence was determined by body mass index (≥30Kg/m2), relative fat mass and waist circumference. Univariable and multivariable logistic regression models adjusted for potential confounders were used to assess associations between UPFs consumption and obesity prevalence. In 2,563 participants (mean age=42.2±11.1Y, 46.8% males), average UPFs consumption was 34.5% of total energy intake. Highest quartile of UPFs consumption was associated with younger age (p = 0.0015), lower physical activity (p &amp;lt; 0.001) and current smoking (p = 0.0162). High consumption of UPFs was significantly associated with higher intake of energy, carbohydrates, saturated fat, and thiamin, and lower intake of protein, monounsaturated fatty acids, dietary fiber, folic acid, vitamin B12, Vitamin C, zinc and total fats. No association was found between UPFs consumption and obesity prevalence. In conclusion, high consumption of UPFs is associated with higher likeliness of unhealthy behaviors and lower nutrition quality in 25-64Y Israeli individuals. No association was found between UPFs consumption and obesity prevalence. Key messages • Consumption of ultra-processed foods is associated with lower nutrition quality. • Consumption of ultra-processed foods was not associated with obesity prevalence.

Lower Intakes of Key Nutrients Are Associated with More School and Workplace Absenteeism in US Children and Adults: A Cross-Sectional Study of NHANES 2003-2008.

The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003-2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.

Minimum dietary diversity and the concurrence of stunting and overweight among infants and young children in Yogyakarta, Indonesia

PurposeThis study aims to examine the association between minimum dietary diversity (MDD) and the concurrence of stunting and overweight (CSO) among children aged 6–23 months.Design/methodology/approachA cross-sectional study was conducted in Sedayu Subdistrict, Bantul District, Daerah Istimewa Yogyakarta. The authors assessed the concurrence of stunting (height-for-age Z-score below −2 standard deviations SD) and overweight/obesity (Body mass index BMI-for-age Z-score above +2 SD) among a total of 189 children aged 6–23 months as the primary outcome. The authors defined MDD as consuming at least four out of seven food groups using a single 24-h recall. The authors also included other covariates, including sociodemographic characteristics, exclusive breastfeeding history and complementary feeding practices. To identify the factors associated with CSO, this study conducted multiple logistic regression across the study variables using STATA 16.1.FindingsIn the adjusted model, children who met the MDD criterion were associated with a reduced risk of CSO (adjusted odds ratios [OR]: 0.14; 95%confidence interval CI: 0.03–2.43). Compared to boys, girls were more likely to experience CSO (adjusted OR: 5.23; 95%CI: 1.02–26.9). Middle economic status was a protective factor for CSO (adjusted OR: 0.10; 95%CI: 0.01–0.98). This study did not find a significant relationship between CSO and the child’s age, low birth weight, exclusive breastfeeding, energy intake, protein intake, parental education and parental occupation.Practical implicationsThis study suggests future programs and policies that promote dietary diversity to reduce the risk of CSO.Originality/valueThis study reveals the association between MDD and the coexistence of stunting and overweight.

66 The PROMOTe study: prebiotic supplementation improves cognition versus placebo in healthy older twins

Abstract Background There is a growing body of evidence linking the microbiota in the human gut, to the brain and to physical function. Animal and human studies have shown that inducing changes in the microbiota can alter muscle physiology and cognitive behaviour, indicating causative pathways. The PROMOTe trial aimed to test whether the gut microbiome mediates anabolic resistance to protein in older adults. A secondary objective was to test whether modulation of the gut microbiome using a pre-biotic food supplement, improved cognition versus placebo. Methods This placebo-controlled double-blinded randomised controlled trial used twin pairs, recruited from the TwinsUK cohort. Those aged &amp;gt; = 60, with low baseline protein intake, and access to a computer (due to remote trial delivery) were included. One twin received protein supplementation plus placebo and the other received protein supplementation plus a gut microbiome modulator (prebiotic). Intervention period was 12 weeks. Participants were advised to take 1 supplement sachet daily, and to undertake resistance exercises. The primary outcome was muscle strength as measured using chair-rise time. Cognition (CANTAB battery) was a secondary outcome. Linear mixed effects regression models were used to compare intervention groups (arm 1 vs arm 2; blinded). Twin clustering was considered as random effects, both family identifier and zygosity, and treatment group as fixed effect. Results Target sample size was 70 individuals. We screened 626 and randomised 72 participants (36 pairs). More adverse events occurred in the prebiotic group (n = 8 versus n = 2 in placebo group; p = 0.041), but compliance remained high in both groups (% adherence &amp;gt;78% in each group; p = 0.37). There was no significant difference between arms for the primary outcome of chair rise time (coefficient 0.184; 95% CI -0.569-0.938; p = 0.631). The prebiotic intervention arm had an improved cognition factor score versus the placebo group (coefficient 0.482; 95% CI 0.823–0.141; p = 0.014). Conclusion Prebiotic food supplementation improves cognition versus placebo in a cohort of healthy older twins.

Proinflammatory Dietary Intake Relates to Pain Sensitivity in Chronic Nonspecific Low Back Pain: A Case-Control Study

Nonspecific chronic low back pain (nCLBP) has been associated with nutrition. Yet, it is not clear how nutritional factors and nCLBP relate to one another. Therefore, the aim of the present study was to investigate differences in diet quality and dietary intake levels between nCLBP patients and healthy controls (HCs) and explore the association between nutritional factors and pain sensitivity in nCLBP. In this case-control study, 106 participants (ie, n = 53 nCLBP and n = 53 HCs) were recruited and completed a 3-day food diary to assess their dietary intake, which allowed to generate individual diet quality scores (ie, the Healthy Eating Index-2015 and Dietary Inflammatory Index). Additionally, each participant underwent an experimental pain assessment (quantitative sensory testing) and filled out self-reported pain questionnaires. Compared to HCs, the nCLBP group showed significantly lower diet quality, higher inflammatory scores, and a lower intake of total protein, total fat, dietary fiber, omega-3 fatty acids, vitamin B6, vitamin A, beta-carotene, vitamin E, and magnesium. Pain sensitivity mainly showed a negative correlation with nutritional intakes known for anti-inflammatory properties (ie, vitamins E, D, A, B6, B12, and zinc). Interestingly, total fat, cholesterol, saturated, and monounsaturated fat intakes were found to be inversely associated with pain sensitivity. Overall, patients with nCLBP have a lower diet quality, eat more proinflammatory, have less intake of nutrients known for their anti-inflammatory and antioxidative properties, and drink less water compared to HCs. Accordingly, pain sensitivity was mainly found to be positively associated with proinflammatory dietary intake. PerspectiveThis study emphasizes the association between a proinflammatory diet and nCLBP. Among nCLBP patients, positive association between increased pain sensitivity and the proinflammatory potential of a diet, highlighting the potential for individualized pain management strategies and leading to the development of novel therapeutic methods.

Dietary protein intake and all-cause mortality: results from The Kawasaki Aging and Wellbeing Project

BackgroundIncreased protein intake has been recommended to prevent sarcopenia/frailty, reports on the quantity and quality of protein intake needed and the associated prognosis, particularly in the aging population of Asia, are limited. In this study, we aimed to investigate the relationship between protein intake and mortality in Japanese individuals, aged 85 years and older.MethodsThe data were obtained from The Kawasaki Aging and Wellbeing Project, which is a prospective cohort study of older adults aged between 85 and 89 years with no physical disability at baseline. Of the 1,026 adults in the cohort, 833 were included in the analysis, after excluding those who had not completed a brief, self-administered diet history questionnaire or those who scored less than 24 on the Mini-Mental State Examination. The participants were grouped into quartiles based on protein intake: Q1 (protein < 14.7, %Energy), Q2 (14.7 ≤ protein < 16.7, %Energy), Q3 (16.7 ≤ protein < 19.1, %Energy), and Q4 (≥ 19.1, %Energy). Multivariate Cox proportional hazards models were utilized to evaluate the association between protein intake and all-cause mortality. Kaplan–Meier survival curves were employed to investigate the relationship between protein intake and all-cause mortality.ResultsThe mean protein intake of our study population was 17.0% of total energy. Animal protein intake, particularly fish intake, increased significantly along with total protein intake. The study had an average observation period of 1,218 days and recorded 89 deaths. After adjusting for age, sex, skeletal muscle mass index, cardiovascular disease, cancer, education, and serum albumin levels, a lower risk of all-cause mortality was observed in the highest protein intake (Q4) group than in the lowest protein intake (Q1) group (hazard ratio: 0.44, 95% confidence interval: 0.22–0.90, p-value: 0.020).ConclusionProtein intake is associated with a reduced risk of all-cause mortality in older adults (aged ≥ 85 years) who engage in independent activities of daily living. This association may impact all-cause mortality independent of muscle mass.

Novel Microbial Signatures in the Faecal Microbiome Associated with Severe Alcoholic Hepatitis: Bacteroides Finegoldii and Veillonella Dispar

Background: Alcoholic hepatitis is associated with dysbiosis, resulting in compositional changes in the gut microbiome, endotoxin transfer to the portal vein, and activation of inflammatory signalling pathways in the liver. However, the microbiome signature of severe alcoholic hepatitis (AH) patients of Indian origin is unknown. Aim: To investigate the microbiome diversity of Indian AH patients in comparison to non-alcoholic healthy controls (HC). Methods: 16S rRNA amplicon-based metagenomics analysis of faecal samples at the time of AH diagnosis (n=12) was compared with HC (n=6), and correlation with survival status, co-occurrence networking, Linear Discriminant Analysis Effect Size (LEfSe), and the relationship between diet – microbiome were performed. Results: 16S rDNA data showed a significant abundance of the Enterobacteriaceae family belonging to the phylum Proteobacteria and a depletion of the phylum Firmicutes in AH. A species-level classification identified Klebsiella pneumonia, Klebsiella variicola, and Parabacteroides distasonis as having the highest predictive performance value with reference to mortality at 60 days. Apart from this, a unique finding was the abundance of Bacteroides finegoldii and Veillonella dispar in AH patients. Moreover, the co-occurrence networking analysis revealed a higher level of connectivity and complexity within the microbial community of AH patients compared to HC. Thus, indicating the significant positive association (Spearman r &gt; 0.7, p &lt; 0.01) among members of the Firmicutes, Bacteroidetes, and Proteobacteria phyla in AH. Wilcoxon-Rank Sum test (p &lt; 0.01) identified Firmicutes phyla occurrence associated with high carbohydrate intake and Actinobacteria phyla with low protein intake. Conclusion: The findings provide the baseline occurrence profile of the gut microbiome signature of liver damage and the diet-microbiome relationship in patients with severe AH. The study demonstrated an abundance of Proteobacteria phyla, indicating their role in inflammatory conditions, and further identified Bacteroides finegoldii and Veillonella dispar in severe AH patients. Additionally, Klebsiella pneumonia, Klebsiella variicola, and Parabacteroides distasonis were identified as mortality-predictive risk biomarkers.

Does protein intake correlate with tubular function in very preterm neonates?

Background High protein intake in very preterm neonates (VPN) is important for growth. However, preterm kidneys have fewer functional nephrons and many of the ones present may be immature. Studies have shown that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis, which lead to tubular injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker that is released during proximal tubular cell injury. The uNGAL to creatinine (uNGAL/Cr) ratio is commonly performed for normalization.&#x0D; Objective To assess for a possible association between protein intake and uNGAL/Cr ratio in VPN.&#x0D; Methods A prospective cohort study was conducted in two NICUs in Jakarta. Subjects’ urine specimens were collected at 0-48 hours, 72 hours, and 21 days after birth to determine uNGAL/Cr ratio as a biomarker of tubular injury. Protein was administered according to study sites NICU guidelines. Protein intake was recorded daily from 14-21 days of age for formula and measured twice with a human milk analyzer for breast milk. ELISA was used to measure uNGAL concentration. Low protein intake was defined as &lt;3g/kg/day and high protein intake was defined as ?3g/kg/day. Maternal and perinatal variables were recorded from medical records.&#x0D; Results Fifty-nine VPN were recruited, of whom 39 completed the study. Median uNGAL/Cr ratio ranged from 0.32-104.11 ng/mg. The uNGAL/Cr ratio was not correlated with protein intake but was inversely correlated with gestational age and birth weight [r = -0.320, P=0.019 for the 72-hr (T2) urinary collection]. Higher uNGAL/Cr levels were associated with maternal infection [14.4 (range 4.4-104.1) vs 7.2 (range 0.5–32.4) ng/mg, P=0.004 at the 0-48-hr (T1)], maternal anemia [6.9 (range 1.2–66.6) vs 1.7 (range 0.3–89.2) ng/mg, P=0.001 at the 21-day (T3)] and nephrotoxic medication [15.9 (range 1.3–63.8) vs 1.0 (range 0.4–8.6) ng/mg, P=0.026 at the 72-hr].&#x0D; Conclusion Protein intake according to current nutritional guidelines does not correlate with tubular injury in VPN, as measured by uNGAL/Cr ratio. Maternal infection, maternal anemia, lower birth weight, and nephrotoxic medication, were associated with higher uNGAL/Cr levels in VPN.