Lower Caloric Intake Research Articles

Ultra-Processed Food Consumption and Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD): A Longitudinal and Sustainable Analysis

Background: The rising prevalence of metabolic-dysfunction-associated steatotic liver disease (MASLD) is a significant health challenge, and the consumption of ultra-processed foods (UPFs) could play a key role. Aim: The aim is assess the impact of UPF consumption changes on the development and progression of MASLD in adults. Design: This is a longitudinal study to assess how changes in UPF consumption affect liver fat and MASLD parameters over 6 months in 70 participants. Methods: Dietary intake was assessed using a validated food frequency questionnaire, and foods were classified according to the NOVA system. Participants were divided into three groups based on UPF consumption changes: maximum (T1), medium (T2), and minimum reduction (T3). Fatty liver parameters were assessed with magnetic resonance imaging and ultrasonography. Mediterranean diet (Med-diet) adherence and sociodemographic parameters were also recorded. The General Linear Model was used to determine relationships between UPF consumption, fatty liver disease parameters, and diet. Results: Participants in T1 experienced a 7.7% reduction in intrahepatic fat content (IFC) compared to 2.6% in T3. T1 showed increased Med-diet adherence and decreased meat and sweets consumption. The energy intake decreased by 605.3 kcal/day in T1, while T3 showed an increase of 209.5 kcal/day. Conclusions: Reducing UPF consumption leads to a decrease in IFC, associated with high Med-diet adherence and low calorie intake. Adopting these dietary patterns aligns with global sustainability goals and could further benefit MASLD patients by addressing environmental challenges alongside improving liver health.

Optimizing orthobiologic therapies with exercise, diet, and supplements.

Orthobiologic injections including platelet-rich plasma (PRP) and cell-based injections are becoming increasingly popular. Evidence suggests that these therapies can be effective in certain situations. The efficacy of these injections may be more dependent on the quality of the injectate, which given their autologous nature, may be dependent on lifestyle choices like exercise, diet, and supplements. The literature describing PRP injections shows that the number and activity of platelets can improve their efficacy. A multitude of lifestyle modifications can affect those factors. Exercise intensity appears to increase platelet count and increases adhesion as well as release of growth factors. Low inflammatory diets increase platelet counts and activity overall. Stress, some supplements, high cholesterol, or processed sugar diets can increase inflammation and potentially decrease platelet counts as well as quality of PRP injectate. Similarly, cell-based therapies can be affected by mesenchymal stromal cell (MSC) number and quality. Cell-based therapy is based upon limiting cellular senescence and increasing replication and differentiation. Exercise may limit senescence and improve replication and differentiation of these cell-based therapies, especially in older adult populations. There are a multitude of supplements that may potentiate these types of injections and patients should discuss the potential benefits and concerns when starting a supplement regimen. Certain foods as well as changes in oxygenation may limit cellular senescence and lower calorie intake may affect MSC viability and function as well. Overall, the current state of literature describes biologic plausibility of how exercise, diet and supplements might affect orthobiologic injection efficacy. Further translational research needs to be completed to describe the effect size and improve recommendations for clinical implementation.

Confronting food insecurity through agricultural interventions: the Farmer FIRST program in India.

Nutrition-sensitive agricultural interventions are crucial in addressing malnutrition and promoting food security. The Farmer, Farm, Innovation, Resources, Science, and Technology (FIRST) Program is a national-level agricultural intervention program that was started in 2016 by the Indian Council of Agricultural Research (ICAR). Its primary objective is to transform the lives and livelihoods of Indian farmers, with a focus on income and livelihood security. This program envisages agricultural interventions ensuring national food security goals, with improved agricultural practices, enhanced food production, and increased access to nutritious food, especially for vulnerable populations. This study aims to investigate the food security improvement resulting from implementing nutrition-sensitive interventions introduced under the Farmer FIRST Program (FFP) in 15 agroecological zones. Four key indicators were employed to assess food security in the technology-focused field intervention: food availability, purchasing power, food gap, and food diversity. Food availability was measured at the macro level (state or national) using per capita food availability. However, at the micro level, particularly for farmers who produce their food and are secure in terms of availability, yield increases from the selected interventions under FFP served as an alternative measure. Purchasing power was assessed by the additional income generated to buy food during the off-season. The food gap was assessed using the cereal equivalent quantity (CEQ), which captures an aspect of consumers' nutritional security. Its impact in India was evaluated using the propensity score matching technique with difference-in-difference (D-i-D) measure to estimate the unbiased overall effect on food security. Food diversity was captured using Barry's index. A sample of 2,282 respondents were interviewed from 2016 to 2020 to elicit data on the prevalence of undernutrition in India, which is 16.3%. The results revealed that post-intervention of the FFP, cereal availability increased by 147.74% in the Northern Plain, while pulses recorded over 200% growth in three regions. The incremental per capita farm income exceeded INR 20,000 in several zones, with the Northern Plain showing an increase of over 21 times. Food diversity improved marginally, supported by the integrated farming system. Overall, FFP interventions transformed nutritional security, benefiting 1,915 households, particularly in regions with historically low calorie intake, thereby demonstrating substantial gains in food security and living standards. The Farmer FIRST Program (FFP) has significantly improved dietary intake among participating households, enhancing food security. Nutrition-sensitive agricultural interventions under the FFP have reduced undernutrition by increasing food availability, boosting purchasing power, and narrowing the food gap.

Opening Pandora's Box: Exploring Body Image Perceptions and Influencing Factors in Women-An Interpretative Phenomenological Analysis.

Background/Objectives: Body dissatisfaction among women has been on the rise, prompting an urgent need to understand the underlying factors influencing their body image. This study explores the perceptions and influencing factors of body image among women in Greek society. Methods: Six in-depth interviews were conducted and analyzed using Interpretative Phenomenological Analysis. Results: The findings reveal that negative comments from parents and romantic partners, pregnancy, and peer influences are key factors affecting women's perceptions about their body. Body dissatisfaction was primarily driven by social media and a desire to feel attractive to the opposite gender, leading to extreme behaviors such as excessive exercise, low-calorie intake, and surgical procedures. The aspiration to undergo cosmetic surgeries was significantly influenced by social media portrayals of beauty. On the one hand, the ideal physique for women was characterized by curves and toned muscles, but on the other hand, women described the ideal self as being reconciled with their bodies and less self-critical. Conclusions: This study highlights the complex interplay of personal relationships and societal pressures in shaping women's body image and underscores the need for more qualitative research in this area. Understanding these dynamics is crucial for developing interventions to mitigate the negative physical and mental health repercussions associated with body dissatisfaction.

A Plant-Based Food Guide Adapted for Low-Fat Diets: The VegPlate Low-Fat (VP_LF)

Strong evidence supports the paramount importance of the composition of the diet for health. Not only diet should provide nutritional adequacy, but some foods and dietary components can also support the management of common chronic diseases, with mechanisms independent of nutritional adequacy. Among the various intervention diets, low-fat vegan diets have been shown to be effective for cardiometabolic health, mainly influencing insulin resistance, adiposity, and blood lipids. This type of diet relies on reducing or eliminating all added fats and choosing low-fat foods, mainly unprocessed whole-plant foods. We hereby propose a tool for planning low-fat vegan diets, the VegPlate Low-Fat (VP_LF), which has been obtained from a specific adaptation of the VegPlate method, which was already presented in previous publications for adults and some life stages and situations. The reduction in fats in the diet, which ranges between 10% and 15% of total energy, and the varied inclusion of foods from plant groups make it easier to provide adequate amounts of all nutrients with a normal- or lower-calorie intake, in comparison with diets that do not limit fat intakes. We expect that this new proposal will help nutrition professionals embrace low-fat diets as a first-line intervention for individuals affected by different health conditions who can benefit from these diets.

Long-Term Yo-Yo Dieting Exaggerates Liver Steatosis and Lesions but Preserves Muscle Performance in Male Zebrafish.

Weight regain within one year after weight loss is frequently observed and is referred to as yo-yo dieting or weight cycling. In this study, we explore the effects of yo-yo dieting on the liver, adipose tissue, and muscle characteristics of male zebrafish. Four-month-old AB wild-type male zebrafish were randomly assigned to three groups: high-calorie intake (H, seven meals per day), low-calorie intake (L, two meals per day), and yo-yo diet (the low- and high-calorie alternation switched every two weeks) groups. Feeding the fish the H diet for over 8 weeks led to steatosis and damage to the liver. The yo-yo diet reduced liver lipid accumulation at week eight but caused a similar degree of lipid accumulation as the H diet thereafter. It was found that twenty weeks of yo-yo dieting actually exacerbated hepatic damage. Compared to the L diet, feeding the fish on the yo-yo and H diets for a period of 20 weeks significantly increased the size of muscle fibers, resulting in higher speed during burst swimming and a significant increase in the size and number of adipocytes in the abdominal tissue. To summarize, short-term yo-yo dieting was found to attenuate hepatosteatosis and maintain fast-twitch muscle function. Long-term yo-yo dieting preserved fast-twitch muscle function and muscle fiber size; however, it exacerbated the pathological changes in the liver.

Caloric requirement targets for nutritional support in adult autoimmune encephalitis: a retrospective cohort study.

Autoimmune encephalitis (AE) is a severe neurological disease often accompanied by consciousness disturbances, severe swallowing difficulties, and gastrointestinal dysfunction, increasing the risk of malnutrition. However, the optimal caloric intake target during the acute phase of AE remains unclear. This study aims to evaluate the impact of caloric intake on short-term clinical outcomes in AE patients, specifically focusing on the improvement in Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores, to provide recommendations for nutritional support during the acute phase. A retrospective study analyzed clinical data from 128 adult AE patients requiring nutritional support, admitted to West China Hospital, Sichuan University, from January 2020 to January 2024. Patients were categorized into low-calorie intake (below 70% of requirements), standard-calorie intake (70-100% of requirements), and high-calorie intake (above 100% of requirements) groups. Multivariate linear and logistic regression models were used to quantify the associations. Higher caloric intake was significantly associated with improved CASE scores (β = 8.58, SE = 3.75, 95% CI = 1.14 to 16.03, p = 0.02). Low caloric intake negatively impacted the improvement of CASE scores (p = 0.049), particularly in seizures and speech problems. The low-calorie intake group had significantly longer hospital stays and nutrition therapy durations (45.79 ± 30.98 days, p < 0.01; 40.39 ± 31.92 days, p = 0.02). Adequate caloric intake has a significant positive impact on the short-term clinical outcomes of AE patients, suggesting that meeting or exceeding caloric requirements may promote neurological recovery in AE patients. Future prospective studies are needed to validate these findings and further optimize nutritional support strategies.

A 1-month ketogenic diet in patients with migraine gives a clinical beneficial effect associated with increased latency of somatosensory thalamo-cortical activity

ObjectiveSince the habituation deficit of evoked potentials could be related to abnormal thalamocortical drive, we searched for a modulatory effect of ketogenic diet (KD) on somatosensory-evoked thalamo-cortical activity. KD is effective in preventing migraine. Previous studies showed that KD normalises habituation of somatosensory and visual cortical evoked responses in parallel with a decrease in of migraine attack frequency. MethodsWe electrically stimulated the median nerve at the wrist to record somatosensory high-frequency oscillations (HFOs) in twenty patients with episodic migraine with and without aura before and after one month of normo- (n = 9) or hypocaloric KD (n = 11). For pre-synaptic thalamocortical and post-synaptic cortical HFOs, we measured the latency of the negative oscillatory maximum, the intra-burst frequency, the number of negative peaks, and the maximum peak-to-peak amplitude. ResultsIn the total group of patients, the one-month KD significantly increased the latency of the negative oscillatory maximum in pre-synaptic, i.e. thalamocortical activity (t = 2.70, p = 0.015) and in post-synaptic HFOs, i.e. cortical activity (t = 3.08, p = 0.006). This effect could be attributed to hypo-caloric KD, as it was not found after normo-caloric KD. Other HFO parameters, such as amplitude, duration, or number of oscillations, were not affected. ConclusionsA 1-month hypo-caloric KD is able to delay the propagation of neuronal activity through the thalamo-cortical network. This effect does not seem to be correlated with the therapeutic efficacy of KD, but rather to low-calorie intake. SignificanceOur results imply that consuming a restricted amount of calories could alter the balance between central excitation and inhibition in migraine.

Low Caloric Intake Confers Cardiovascular Protection and Improves Functional Capacity Without Affecting Immunological Response in Sedentary Older Adults.

Aging is characterized by a decline in the cardiovascular hemodynamic response, which may be aggravated by undernutrition. However, no study has evaluated whether low caloric intake may affect cardiovascular hemodynamics and its possible relation with functional capacity and immune response in older adults. Sixty-one older adults of both genders were enrolled in this study and were classified as normocaloric (n = 18) and hypocaloric (n = 43). All volunteers were evaluated for cardiovascular hemodynamics using impedance cardiography (PhysioFlow®); functional capacity by the 1' sit-to-stand test with SpO2 monitoring; whole-blood analysis using an automated hematocytometer (Sysmex®); and levels of IL-6, TNF-alpha, IL-10, and Klotho by ELISA. The hypocaloric group presented impaired functional capacity, measured by a reduced number of sit-to-stand repetitions (p < 0.0251) and impaired delta of SpO2 (p < 0.0307). In contrast, the hypocaloric group presented an improved stroke volume (p < 0.0352), systemic vascular resistance (p < 0.0075), and systemic vascular resistance index (p < 0.0184). In addition, no changes were observed in the whole-blood analysis (p > 0.05) or for IL-6 (p > 0.05), TNF-alpha (p < 0.05), IL-10 (p < 0.05), and Klotho (p > 0.05). A long-term hypocaloric diet in eutrophic older adults' resulted in an enhanced cardiovascular hemodynamic response but was associated with reduced functional capacity without changes in the immune response.

A whole food, plant-based diet reduces amino acid levels in patients with metastatic breast cancer.

Amino acids are critical to tumor survival. Tumors can acquire amino acids from the surrounding microenvironment, including the serum. Limiting dietary amino acids is suggested to influence their serum levels. Further, a plant-based diet is reported to contain fewer amino acids than an animal-based diet. The extent to which a plant-based diet lowers the serum levels of amino acids in patients with cancer is unclear. Patients with metastatic breast cancer (n=17) were enrolled in a clinical trial with an ad libitum whole food, plant-based diet for 8 weeks without calorie or portion restriction. Dietary changes by participants were monitored using a three-day food record. Serum was collected from participants at baseline and 8 weeks. Food records and serum were analyzed for metabolic changes. We found that a whole food, plant-based diet resulted in a lower intake of calories, fat, and amino acids and higher levels of fiber. Additionally, body weight, serum insulin, and IGF were reduced in participants. The diet contained lower levels of essential and non-essential amino acids, except for arginine (glutamine and asparagine were not measured). Importantly, the lowered dietary intake of amino acids translated to reduced serum levels of amino acids in participants (5/9 essential amino acids; 4/11 non-essential amino acids). These findings provide a tractable approach to limiting amino acid levels in persons with cancer. This data lays a foundation for studying the relationship between amino acids in patients and tumor progression. Further, a whole-food, plant-based diet has the potential to synergize with cancer therapies that exploit metabolic vulnerabilities. The clinical trial was registered with ClinicalTrials.gov identifier NCT03045289 on 2017-02-07.

8684 Lifetime Duration of Amenorrhea Is Associated With Monetary Decision-Making and Hedonic Eating In Females With a Low-Weight Eating Disorder

Abstract Disclosure: F. Plessow: None. M. Wronski: None. M. Rogers: None. M.G. Turley: None. E.R. Golden: None. M. Slattery: None. J.J. Thomas: None. E.A. Lawson: None. M. Misra: None. K.T. Eddy: None. Background: Low estrogen levels and oligomenorrhea are common characteristics in females with a low-weight eating disorder (LWED). In animal models, estrogen status is associated with neural activity in dopaminergic reward pathways affecting reward processing and decision-making. Whether a similar link exists in humans is unknown but important to understand, as reduced reward-driven behavior and an increased delay of gratification driving decision-making hinder recovery from a LWED. To fill this knowledge gap, we studied the relationship between lifetime duration of amenorrhea and hedonic eating and monetary decision-making in a group of females with a LWED. We hypothesized that longer lifetime duration of amenorrhea is associated with reduced hedonic food intake and a smaller delay discounting rate (indicating an increased delay of gratification) in females with a LWED (independent of age and illness severity). Methods: Fifty-six females with a LWED (mean age±SD: 19.84±2.98 years, range: 13.6-23.5 years) and 34 female healthy controls (HC; 19.08±2.41 years, 13.4-22.2 years) underwent a menstrual history to determine the number of missed menses since menarche, Eating Disorder Examination (EDE) to assess ED psychopathology, anthropometric measurements to calculate body mass index (BMI), Cookie Taste Test as a laboratory-based assessment of reward-related eating beyond satiety, and a monetary Delay Discounting Task to determine their delay discounting rate. Between-group differences were tested using Mann-Whitney U-tests, and associations between duration of amenorrhea and caloric intake at the Cookie Taste Test and delay discounting rate in the LWED group were examined using partial Spearman correlations adjusted for age and BMI as a marker for illness severity. Results: By study design, females with a LWED had a lower BMI (17.97±2.16 vs. 21.71±2.57 kg/m2, U=1,802.50, p&amp;lt;0.001, r=0.75) and more pronounced ED psychopathology (EDE Global Score: 2.38±2.50 vs. 0.00±0.00, U=22.50, p&amp;lt;0.001, r=0.83) than HC. They had missed 16.50±22.64 menses since menarche. When controlling for age and BMI, longer lifetime duration of amenorrhea was correlated with lower caloric intake in the Cookie Taste Test (rs=-0.34, p=0.011) and a smaller delay discounting rate indicating an increased delay of gratification (rs=-0.40, p=0.004). Conclusions: This is the first demonstration that lifetime duration of amenorrhea is associated with hedonic food intake and monetary decision-making in females with a LWED, pointing towards a potential role of cumulative estrogen status in reward processing and decision-making in this population. Future research avenues include investigating whether estrogen replacement can increase reward responsiveness and reduce delay of gratification to promote a faster recovery from a LWED. Presentation: 6/1/2024

8684 Lifetime Duration of Amenorrhea Is Associated With Monetary Decision-Making and Hedonic Eating In Females With a Low-Weight Eating Disorder

Abstract Disclosure: F. Plessow: None. M. Wronski: None. M. Rogers: None. M.G. Turley: None. E.R. Golden: None. M. Slattery: None. J.J. Thomas: None. E.A. Lawson: None. M. Misra: None. K.T. Eddy: None. Background: Low estrogen levels and oligomenorrhea are common characteristics in females with a low-weight eating disorder (LWED). In animal models, estrogen status is associated with neural activity in dopaminergic reward pathways affecting reward processing and decision-making. Whether a similar link exists in humans is unknown but important to understand, as reduced reward-driven behavior and an increased delay of gratification driving decision-making hinder recovery from a LWED. To fill this knowledge gap, we studied the relationship between lifetime duration of amenorrhea and hedonic eating and monetary decision-making in a group of females with a LWED. We hypothesized that longer lifetime duration of amenorrhea is associated with reduced hedonic food intake and a smaller delay discounting rate (indicating an increased delay of gratification) in females with a LWED (independent of age and illness severity). Methods: Fifty-six females with a LWED (mean age±SD: 19.84±2.98 years, range: 13.6-23.5 years) and 34 female healthy controls (HC; 19.08±2.41 years, 13.4-22.2 years) underwent a menstrual history to determine the number of missed menses since menarche, Eating Disorder Examination (EDE) to assess ED psychopathology, anthropometric measurements to calculate body mass index (BMI), Cookie Taste Test as a laboratory-based assessment of reward-related eating beyond satiety, and a monetary Delay Discounting Task to determine their delay discounting rate. Between-group differences were tested using Mann-Whitney U-tests, and associations between duration of amenorrhea and caloric intake at the Cookie Taste Test and delay discounting rate in the LWED group were examined using partial Spearman correlations adjusted for age and BMI as a marker for illness severity. Results: By study design, females with a LWED had a lower BMI (17.97±2.16 vs. 21.71±2.57 kg/m2, U=1,802.50, p&amp;lt;0.001, r=0.75) and more pronounced ED psychopathology (EDE Global Score: 2.38±2.50 vs. 0.00±0.00, U=22.50, p&amp;lt;0.001, r=0.83) than HC. They had missed 16.50±22.64 menses since menarche. When controlling for age and BMI, longer lifetime duration of amenorrhea was correlated with lower caloric intake in the Cookie Taste Test (rs=-0.34, p=0.011) and a smaller delay discounting rate indicating an increased delay of gratification (rs=-0.40, p=0.004). Conclusions: This is the first demonstration that lifetime duration of amenorrhea is associated with hedonic food intake and monetary decision-making in females with a LWED, pointing towards a potential role of cumulative estrogen status in reward processing and decision-making in this population. Future research avenues include investigating whether estrogen replacement can increase reward responsiveness and reduce delay of gratification to promote a faster recovery from a LWED. Presentation: 6/1/2024

Educational Intervention Improves Female Athlete Triad Awareness in Female Collegiate Swimmers

Introduction: The Female Athlete Triad (Triad) is characterized by high energy expenditure and low caloric intake, leading to dysregulation of menstruation and bone metabolism. Triad-associated relative energy deficiency in sport (REDs) adversely affects performance and mental health. Risk factors are underrecognized in swimmers, who are less likely to present with bone stress injuries because of swimming’s non-weightbearing nature. Our objective was to quantify knowledge about the Triad and REDs among collegiate swimmers and demonstrate the value of educational intervention. Methods: Members of two Division III women’s varsity swim teams completed a Qualtrics survey, consisting of 35 Triad and REDs questions, and 13 demographics questions. Participants then attended an in-person, 20-minute educational session focused on Triad risk factors and prevention, after which they completed a post-session survey. The post-session survey contained 13 additional questions using a Likert scale, where 1=Strongly Agree and 5=Strongly Disagree. Pre- and post-session data were analyzed using Microsoft Excel. Results: Thirty-one swimmers were included. Pre-session, 9.7% of respondents named one or more Triad components, compared to 96.8% after (p&lt;0.0001). 9.7% could define the REDs acronym pre-session, compared to 87.1% after (p&lt;0.0001). Participants better understood the Triad post-session (mean Likert score=1.23) and found the session helpful (mean=1.23), but in a hypothetical scenario, felt relatively uncomfortable contacting medical staff about Triad symptoms (mean=1.87, p=0.0002). Of the 35.5% who believed they may be experiencing Triad components, 72.7% indicated the session motivated them to seek help. Conclusions: Female collegiate swimmers’ low baseline Triad and REDs knowledge improved significantly after an educational intervention. Survey responses highlighted the importance of heightened Triad awareness, but also its continued stigmatization. The session encouraged swimmers with self-identified Triad symptoms to seek help, underscoring the importance of continued education efforts, especially in sports where the Triad is underrecognized.

Low calorie intake may be associated with low skeletal muscle strength in Indian patients with cirrhosis

Low calorie intake may be associated with low skeletal muscle strength in Indian patients with cirrhosis

A Case Report of a Patient With Extreme Anorexia Nervosa and Hyper Prolactinoma: Complaints and Treatment

Objective: Anorexia nervosa (AN) is a severe psychiatric disorder, in which an individual suffers from severe weight loss, and disturbed physical and psychosocial functioning. It was previously diagnosed and reported in Western countries but its prevalence is on the rise in a Middle East country like Iran. This study aims to introduce a patient with AN with hyperprolactinoma. Methods: This study is a case report. A single, educated but not currently employed 32-year-old female patient was admitted with the chief complaint of a locked knee, weakness, and lethargy; she was hospitalized in the hematology ward due to electrolyte and hematological complications and then referred to the psychiatric service due to severe weight loss. Results: The etiology and severity of the disorder were evaluated; psychiatric, electrolyte, cardiopulmonary, endocrine, gastrointestinal, neurological, hematological, and renal systems were assessed. Low-calorie intake was considered according to the latest guidelines, which prevented relevant complications and caused the patient’s optimal compliance with treatment. Conclusion: AN is not necessarily caused by the patient’s body image, and physicians are advised not to rely on such misconceptions for diagnosis. Also, according to the results, the relationship between AN and hyperprolactinoma and pituitary microadenoma is observed. The measures taken led to the patient’s optimal compliance with the treatment.

Serum Albumin as a Marker of Metabolic Response to Injury and its Role with Calorie Intake Regarding Length of Stay, Readmission Rates and Hospital Survival

Background: Studies have shown a relationship between albumin level &amp; hospital mortality, but none have looked at low serum albumin, calorie intake and survival. Aim: To evaluate the relationship between serum albumin level, calorie intake, length of hospital stay (LOS), readmission rates and hospital mortality in a large population of disadvantaged and underinsured patients at a County of Los Angeles Medical Center. Design: Prospective observational study using data collected over a 6-year period of hospital survival, LOS and readmission rate in 11,441 patients. Calorie intake in those 400 patients with serum albumin &lt;1.5 g/dL was collected. Our hypothesis was to test if the relationship of admission serum albumin to mortality was linear or exponential. In addition, in those with a serum albumin &lt;1.5 g/dL, we evaluated calorie intake and hospital survival. Methods: A total of 11,441 patients were included in the dataset. ANOVA and regression analysis were performed. Calorie intake was extracted from dietary and intravenous intake data of each of the 400 patients with an albumin &lt;1.5 g/dL. Results: Serum albumin was obtained within the first 7 days of admission in all patients. Mortality increased in patients with admission serum albumin &lt;3.5 g/dL (8.8% vs 2.3%, p&lt;0.05). Serum albumin was exponentially related to mortality (mortality = 32 / albumin2; p &lt;0.01). The group of patients with albumin &lt;1.5 g/dL had the greatest mortality rate (18%), approximately seven times that of patients with normal serum albumin levels. These patients also had an average LOS of 14.7 days (p&lt;0.05), twice that of patients with normal albumin values. 30-day admission rates for this group were three times greater (6.3% vs. 1.9%, p&lt;0.05). Calorie intake was associated with a dose response curve with regards to hospital mortality. Conclusion: A single measurement of serum albumin identifies patients who are at high risk for prolonged hospital stay, readmission and mortality. Calorie intake may modify mortality risk, but prospective studies are needed.

Resting Metabolic Rate in Indian Adolescents and Youth with Type 1 Diabetes Mellitus: A Case Controlled Study.

Energy metabolism in type 1 diabetes (T1D) is known to be different. Resting metabolic rate (RMR) accounts for the largest portion of total energy needs. The objective of our study was to assess resting metabolic rate and its determinants in adolescents and young adults with T1D in comparison with age- and gender-matched healthy controls. This cross-sectional study included 97 children and young adults (10-19 years) with type 1 diabetes having a disease duration of at least 1 year. For the control population, 95 age- and gender-matched healthy adolescents were enrolled. Clinical examination and biochemical evaluation of parameters pertaining to diabetes and body composition were estimated, and RMR was measured using indirect calorimetry for both cases and controls. Adolescents with T1D were significantly shorter, and had significantly lower calorie intake, higher RMR and volume of oxygen consumed (VO2) as compared to the healthy controls (P < 0.05). RMR adjusted for weight showed a significant positive correlation with lean body mass (LBM) percentage, and energy intake and a negative correlation with disease duration. Those with a T1D duration of less than 5 years demonstrated a significantly higher RMR, lower body fat percentage, higher LBM percentage, carbohydrate and energy intake/kg body weight and higher calculated insulin sensitivity (IS) as compared to those with greater disease duration. Muscle mass percentage and higher energy intake were found to be significant positive predictors and advancing age/diabetes duration was a negative predictor of weight-adjusted RMR (P < 0.05), whereas IS and male gender tended towards significant negative association (P = 0.06). Indian children with type 1 diabetes had a higher resting metabolic rate as compared to healthy children. Muscle mass, energy intake and diabetes duration were observed to be important predictors of RMR in T1D. Reduction in RMR with advancing age/disease duration may predispose to weight gain and subsequent double diabetes in T1D.

Effect of dietary macronutrients and immune challenge on gut microbiota, physiology and feeding behaviour in zebra finches.

Macronutrients play a vital role in host immunity and can influence host-pathogen dynamics, potentially through dietary effects on gut microbiota. To increase our understanding of how dietary macronutrients affect physiology and gut microbiota and investigate whether feeding behaviour is influenced by an immune threat, we conducted two experiments. First, we determined whether zebra finches (Taeniopygia guttata) exhibit shifts in physiology and gut microbiota when fed diets differing in macronutrient ratios. We found the type and amount of diet consumed affected gut microbiota alpha diversity, where microbial richness and Shannon diversity increased with caloric intake in birds fed a high-fat diet and decreased with caloric intake in birds fed a high protein diet. Diet macronutrient content did not affect physiological metrics, but lower caloric intake was associated with higher complement activity. In our second experiment, we simulated an infection in birds using the bacterial endotoxin lipopolysaccharide (LPS) and quantified feeding behaviour in immune challenged and control individuals, as well as birds housed near either a control pair (no immune threat), or birds housed near a pair given an immune challenge with LPS (social cue of heightened infection risk). We also examined whether social cues of infection alter physiological responses relevant to responding to an immune threat, an effect that could be mediated through shifts in feeding behaviour. LPS induced a reduction in caloric intake driven by a decrease in protein, but not fat consumption. No evidence was found for socially induced shifts in feeding behaviour, physiology or gut microbiota. Our findings carry implications for host health, as sickness-induced anorexia and diet-induced shifts in the microbiome could shape host-pathogen interactions.

Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes.

Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients. Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection. A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended. Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.

Nutritional Issues in Children with Dysphagia.

(1) Background: Pediatric dysphagia presents significant nutritional challenges, often impacting growth and development due to reduced oral intake, increased nutritional needs, and gastrointestinal complications; (2) Methods: This prospective quasi-experimental study assessed 117 children under 14 years old (20 patients were under 1 year old, 80 were aged 1-7 years, and 17 were older than 7 years), diagnosed with swallowing disorders, to analyze their caloric, macro-, and micronutrient intake and identify potential deficiencies. The severity of dysphagia was established using functional oral intake scales, and dietary records were reviewed over a 3-day period; (3) Results: The study revealed that 39.8% of participants did not meet their total energy expenditure (TEE), highlighting a high prevalence of malnutrition among these children. Furthermore, patients using feeding devices exhibited a significantly lower caloric intake, and over half required significantly modified food textures. After individualized speech therapy and nutritional rehabilitation, participants showed significant improvements in caloric intake, with their energy coverage increasing from 958% to 1198% of the daily requirement. Rehabilitation also improved tolerance to a broader range of food textures; (4) Conclusions: This research underscores the importance of multidisciplinary, individualized nutritional strategies to address the specific challenges of pediatric dysphagia, emphasizing the role of enteral nutrition and therapeutic interventions in improving the quality of life and nutritional outcomes of these children. Further studies are recommended to assess the long-term impact of such strategies.