Nutritional Tool Research Articles

Silicon-Enriched Meat Ameliorates Diabetic Dyslipidemia by Improving Cholesterol, Bile Acid Metabolism and Ileal Barrier Integrity in Rats with Late-Stage Type 2 Diabetes.

Silicon as a functional ingredient of restructured meat (RM) shows antidiabetic and hypocholesterolemic effects in a type 2 diabetes mellitus (T2DM) rat model. The present paper investigated the mechanisms involved in this cholesterol-lowering effect by studying the impact of silicon-RM consumption on bile acid (BA) and cholesterol metabolism. In addition, the main effects of cecal BA and short-chain fatty acids derived from the microbiota on intestinal barrier integrity were also tested. Rats were fed an RM high-saturated-fat, high-cholesterol diet (HSFHCD) combined with a low dose of streptozotocin plus nicotinamide injection (LD group) and for an 8 wk. period. Silicon-RM was included in the HSFHCD as a functional food (LD-Si group). An early-stage T2DM group fed a high-saturated-fat diet (ED group) was used as a reference. Silicon decreased the BA pool with a higher hydrophilic BA profile and a lower ability to digest fat and decreased the damaging effects, increasing the occludin levels and the integrity of the intestinal barrier. The ileal BA uptake and hepatic BA synthesis through CYP7A1 were reduced by FXR/FGF15 signaling activation. The silicon up-regulated the hepatic and ileal FXR and LXRα/β, improving transintestinal cholesterol (TICE), biliary BA and cholesterol effluxes. The inclusion of silicon in meat products could be used as a new therapeutic nutritional tool in the treatment of diabetic dyslipidemia.

Knowledge assessment tool for pediatric parenteral nutrition: A validation study.

Parenteral nutrition (PN) is a high-risk medication, and its prescription and administration requires extensive training. Difficulties inherent with bedside teaching have made teaching these concepts challenging. Currently, no knowledge assessment tools with validity evidence exist to test the effectiveness of new PN teaching interventions. We sought to develop and provide validity evidence for a pediatric PN knowledge test to measure the effectiveness of future teaching interventions. We created a multiple-choice question knowledge assessment tool that underwent content validation by PN experts and was emailed to potential participants. We evaluated the knowledge assessment tool for factorial validity, internal consistency reliability, and discriminant validity. We enrolled 103 medical students (40%), residents and fellow trainees (55%), and attending physicians (5%) into the study between October 2021 and October 2022. Five of the 30 questions performed poorly based on their nonsignificant contribution to the primary aim of assessing pediatric PN knowledge. Following the exclusion of those questions, the knowledge assessment tool demonstrated an acceptable model fit, and the root mean squared error of approximation was <5%. The omega coefficient was 0.829, indicating acceptable levels of reliability, and using an analysis of variance test (ANOVA) demonstrated significant differences between groups, showing good discrimination between levels of experience (F[2, 80] = 39.002; P < 0.001). We have developed and provided validity evidence for a multiple-choice question knowledge test that may be used by educators and programs to evaluate knowledge of pediatric PN in physicians and trainees.

48 Dietary functional fiber properties for improved health and disease outcomes in pigs

Abstract In swine production, using feed antibiotics as antimicrobial growth promotants has been reduced; thus, feed alternatives to manage gut health are required. Dietary fiber and similar carbohydrate structures such as resistant starch, oligosaccharides, and exopolysaccharides are nutritional tools that may enhance gut health in pigs. Dietary fiber may have a role to alleviate diarrheal diseases including in pigs post-weaning but can also reduce constipation in sows, but specific functionality depends on fiber properties. Antibiotics are hypothesized to influence gut health via modulation of intestinal microbial profiles; fermentation and intestinal inflammation are considered important mechanisms. Dietary fiber sources differ in a key functional property: fermentability. Rapid fermentation of fiber and oligosaccharides is associated with changes in microbial profiles and increased metabolite production. Recently, microbial composition was hypothesized to be less important and combined output of metabolites should be the focus. Fiber properties may also manipulate retention time and physico-chemical properties of the undigested residue; hence, non-fermentable fiber may prevent constipation in sows. The fiber-like structure resistant starch is not digested and acts as fermentable fiber but has unique properties, because it specifically increases intestinal abundance of bifidobacteria, which are associated with improved gut health. Using crop breeding, feed processing, and feed additives, the structure of fiber and starch can be altered thereby changing its degradation kinetics and affecting its prebiotic activity. Finally, fiber-like structures such as exopolysaccharides from Limosilactobacillus reuteri and unique oligosaccharides may serve as receptor analogues for pathogenic bacteria, e.g., enterotoxigenic Escherichia coli (ETEC). These receptor analogues block lectin domains of bacterial adhesins and thus prevent adherence of pathogens to the gut wall, thereby avoiding initiation of post-weaning diarrhea. In conclusion, dietary fiber and similar structures possess important functional properties that may also provide important solutions to maintain gut health in pigs.

Should a single growth standard be used to judge the nutritional status of children under age 5 y globally? Debate consensus

The participants in this debate agreed that: 1) target-based advocacy is required for ensuring countries’ engagement and political commitments toward reducing child malnutrition, and the tools used for monitoring progress should be accurate and pose no risk of harmful consequences; and 2) physical growth is not the only dimension of nutritional status to be monitored in clinical and public health practice; anthropometry is thus only one of the diagnostic indicators of nutritional status. Key disagreements included methodological approaches for developing a single growth standard to evaluate nutritional status globally; the relative utility of universal and contextual growth standards for clinical practice and public health; the balance of benefits, harms, and acceptability among stakeholders; and their use as a screening or a definitive tool in individual and public health nutrition. Noteworthy agreements for research priorities included comparison of benefits and harms of using universal compared with contextual growth standards/references and different stakeholders’ perception of expectations from and utility of growth standards.

Kefir recovered depressive-like behaviour in CantonS lineage of Drosophila melanogaster exposed to chronic unpredictable mild stress protocol.

Chronic unpredictable mild stress (CUMS) is a widely accepted method for inducing depressive-like states in animal models. We decided to explore the effects of CUMS on the CantonS lineage of Drosophila melanogaster, which differs from the OregonR lineage in various ways. Additionally, we wanted to investigate the potential benefits of kefir in treating these chronically stressed flies, as previous research has shown promising results in using kefir components for depression treatment. To begin, we exposed male CantonS flies to a 10-day CUMS protocol and compared them to non-stressed flies. Within the stressed group, we had two subgroups: one treated with kefir (CUMS+ Kefir group) and the other treated with sertraline (positive control). We then analysed various factors including serotonin levels, brain structure, markers of oxidative damage in lipids and proteins, and behavioural manifestations such as sociability, locomotor function, and anhedonic-like behaviour. Our results showed that flies exposed to CUMS experienced a decrease in serotonin levels without any signs of degeneration. They also exhibited reduced sociability, increased motor agitation, and decreased sucrose consumption, which are all indicative of stress-induced depressive-like behaviour. However, treatment with sertraline partially reversed these effects. Interestingly, treatment with kefir not only restored serotonin levels but also improved sociability and anhedonic-like behaviours. Additionally, flies in the CUMS+ Kefir group had a longer lifespan compared to their untreated counterparts. These findings suggest that kefir has multiple advantageous effects on flies subjected to the 10-day CUMS protocol. In conclusion, our study demonstrates that the CantonS lineage of D. melanogaster displays depressive-like manifestations after exposure to CUMS. Furthermore, kefir emerges as a powerful nutritional tool capable of reversing these effects and promoting beneficial outcomes in chronically stressed flies.

266 - An exploratory investigation into the use of different nutrition tools assessing non-nutritive sweetener intake

266 - An exploratory investigation into the use of different nutrition tools assessing non-nutritive sweetener intake

Visual Nutrition Tool to Improve the Adherence to Healthy Dietary Pattern in the Mexican Population With Chronic Kidney Disease

Visual Nutrition Tool to Improve the Adherence to Healthy Dietary Pattern in the Mexican Population With Chronic Kidney Disease

Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study

BackgroundThe incidence of clinically avoidable enteral nutrition interruptions is high. ICU nurses, as the implementers and monitors of enteral nutrition, have a close relationship between their cognitive level of enteral nutrition interruption and the incidence of enteral nutrition interruption. The level of ICU nurses’ cognition of enteral nutrition interruption and the key factors influencing the level of ICU nurses’ cognition of enteral nutrition interruption are not known.ObjectivesThis study aims to explore the cognitive level of ICU nurses on enteral nutrition interruption and delve into the key factors that affect their cognitive level from the perspective of management.DesignA sequential explanatory mixed methods research design was used.MethodsWith the convenience sampling method, an online survey questionnaire was distributed to ICU nurses in Chongqing, and 336 valid questionnaires were collected. After the survey, ICU managers were invited to participate in qualitative interviews, in which 10 participants from five hospitals completed face-to-face individual semi-structured interviews and were analyzed with thematic analysis.ResultsThe survey found that ICU nurses had a good level of cognition towards enteral nutrition interruption but poor knowledge about the definition, causes, and consequences of enteral nutrition interruption, as well as negative attitudes toward active learning, assessment, and communication. And the longer work time in the ICU, joining the nutrition team, receiving systematic training, and acquiring relevant knowledge from academic journals more frequently were favorable to improving ICU nurses’ knowledge level of enteral nutrition interruption. Personal interviews further identified the key factors affecting their cognitive level, including (1) lack of knowledge, (2) lack of proactive thinking, (3) lack of enteral nutrition management programs, and (4) lack of quality management tools for enteral nutrition interruption.ConclusionAlthough ICU nurses demonstrate a relatively high level of cognition, there is still room for improvement. ICU administrators must take specific measures to improve the knowledge of ICU nurses, especially in non-tertiary hospitals, in order to prevent nurse-induced enteral nutrition interruption in all ICUs and improve medical quality.Trial registrationNot applicable.

Inflammatory markers as diagnostic and precision nutrition tools for metabolic dysfunction-associated steatotic liver disease: Results from the Fatty Liver in Obesity trial

Background & AimsMetabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern. The disease is silent, and its diagnosis is often delayed. Inflammatory markers constitute an interesting tool to act as subrogate, non-invasive markers. This study aimed to evaluate the changes of inflammatory markers throughout a two-year dietary intervention in subjects presenting MASLD, to determine which of the markers are suitable to predict the disease, and act as a customizing tool for MASLD´s dietary treatment. MethodsNinety-eight subjects with MASLD and forty-five controls from the Fatty Liver in Obesity (FLiO) Study were analyzed. MASLD was diagnosed and graded by ultrasound. The MASLD subjects were randomly assigned to two different dietary strategies, the American Heart Association (AHA diet) or a dietary strategy based on the Mediterranean pattern, which was specially designed for the study (FLiO diet), and then followed for two years. Hepatic status was additionally assessed through Magnetic Resonance Imaging (MRI), elastography, and determination of transaminases. Results & DiscussionInflammatory markers improved throughout the intervention in the MASLD subjects and managed to reach similar levels to controls, especially at 6 and 12 months. Additionally, leptin, adiponectin, M30, and LECT2 managed to significantly diagnose the disease at all time marks of the intervention, making them candidates for subrogate non-invasive markers of the disease. Moreover, baseline chemerin, leptin, LECT2, and M65 were used to build a predictive score to achieve greater weight loss, and therefore, which strategy could be more useful for MASLD ´s treatment. The predictive score was significantly able assign a specific diet to 55% of the study participants, meaning that the remaining 45% could achieve the same amount of weight loss following either diet equally. ConclusionInflammatory markers constitute a potential non-invasive tool to be used in MASLD screening and could also constitute an interesting tool for MASLD’s treatment customization, being able to predict the effectiveness of a dietary strategy based on the initial inflammatory state of each subject. Trial registrationwww.clinicaltrials.gov (NCT03183193).

Association between Dietary Inflammatory Index (DII) and the Risk of Polycystic Ovary Syndrome: A Case-Control Study

Background: Polycystic ovary syndrome (PCOS) is an inflammation-related condition and a common metabolic disorder in women at fertility ages. The Dietary Inflammatory Index (DII) is a validated nutritional tool for estimating the inflammatory potential of the diet. It is assumed that a high DII score (indicating a predominantly inflammatory diet) has an association with higher odds of PCOS. The current study aimed to investigate the association between DII and PCOS risk in women. Methods: This case-control study was conducted in 2019-2020 on 120 newly-diagnosed PCOS cases and 120 healthy controls aged 18-45 years in Khorramabad, Iran. DII was estimated based on a validated 168-item Food Frequency Questionnaire (FFQ). Results: The mean±SD of DII in PCOS patients was 0.40±2.09, while it was 0.45±1.92 in the control group (P&lt;0.001). There was a positive association between increasing DII score and the risk of PCOS (odds ratio= 2.41; 95%CI: 1.15-5.02, P for trend =0.006) in the crude model as the fourth quartile was compared with the lowest one. This association was still significant in several models after adjusting for age and energy intake (P for trend &lt;0.001), in the model adjusted for the physical activity level, education status, and family history of PCOS (P for trend=0.003), and also after additional adjustment for BMI (P for trend= 0.003). Conclusions: The present study revealed that consuming more pro-inflammatory diets with higher DII scores is related to an increased risk of PCOS.

Multidisciplinary evidence-based tools for improving consistency of care and neonatal nutrition.

Extrauterine growth restriction from inadequate nutrition remains a significant morbidity in very low birth weight infants. Participants in the California Perinatal Quality Care Collaborative Quality Improvement Collaborative, Grow, Babies, Grow! developed or refined tools to improve nutrition and reduce practice variation. Five Neonatal Intensive Care Units describe the development and implementation of nutrition tools. Tools include Parenteral Nutrition Guidelines, Automated Feeding Protocol, electronic medical record Order Set, Nutrition Time-Out Rounding Tool, and a Discharge Nutrition Recommendations. 15 of 22 participant sites completed a survey regarding tool value and implementation. Reduced growth failure at discharge was observed in four of five NICUs, 11-32% improvement. Tools assisted with earlier TPN initiation (8 h) and reaching full feeds (2-5 days). TPN support decreased by 5 days. 80% of survey respondents rated the tools as valuable. Evidence and consensus-based nutrition tools help promote standardization, leading to improved and sustainable outcomes.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 − 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62–0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Validation of Glycemic Index Values Represented as Bar Graphs in Scholarly Articles for Clinical Nutrition Application

Glycemic index (GI) has been a proven clinical nutrition tool. It has been utilized in chronic diseases such as PCOS, diabetes, obesity and metabolic syndrome. The GI value of a test food is the ratio of the glucose response over 2 hours against the reference food. The references food is usually either glucose or bread. GI values may often be directly available as values in texts, tables, or figures. The indirect values may be represented as values, images or both values and, concentration of glucose over time or GI values. Less ideally, some GI data are only presented in graphs. Data from these graphs without direct values could be extracted but this potentially contributes to less accurate results. Here, we investigate the extracted outcome from the original data and if their differences could affect the GI values. There are a few software’s and methods that may be used for data extraction; however, they are costly and complex. Also, different types of graphs require different extraction methods. Herein, we describe a simple reproducible method for extracting data from bar graphs using the freeware ImageJ. Seven extractors extracted 102 outcome values from 19 different scholarly articles. Differences between extractors were compared using the Overall Concordance Correlation Coefficients (OCCC), whereas differences between the original and extracted data were compared using the Lin’s Concordance Correlation Coefficients (CCC) and Bland-Altman. Both the OCCCs and CCCs were high for both outcome values and errors, while the CCCs were good and acceptable for the outcome. The Bland Altman showed good agreement between the extracted outcome and the true reported GI values. Therefore, the current method supports the extraction GI values from bar graphs in published scholarly articles even in their absence in text.

Dietary β-mannanase supplementation decreases digesta viscosity, improves growth and modulates gut microbiota in juvenile Nile tilapia, Oreochromis niloticus fed a soybean meal-based diet

β-mannan is an abundant non-starch polysaccharide (NSP) in soybean meal (SBM) that elevates digesta viscosity and decreases nutrient utilization in fish. This research aimed to evaluate the impacts of graded levels of dietary β-mannanase (BM) supplementation on growth performance, digesta viscosity, digestive enzyme activity, short-chain fatty acids (SCFAs) production, gut histomorphometry, and microbiome composition in juvenile Nile tilapia, Oreochromis niloticus, fed SBM-based diets (440 g kg−1). From a control diet containing 19 MJ kg−1 gross energy, 311.2 g kg−1 crude protein and 71.3 g kg−1 crude lipids, five BM-supplemented diets were made adding liquid BM (Natupulse® TS, Basf, Ludwigshafen am Rhein, Germany Germany) at either 1600, 3200, 4800, 6400, and 8000 TMU (thermostable endo-1,4-BM units) kg−1 to the control diet. Fish were hand-fed six times a day to apparent satiety for 8 weeks. Each experimental diet was fed to quadruplicate groups of 21 fingerling Nile tilapia (initial weight of 7.0 ± 0.43 g) stocked in 70-L aquaria connected as a closed recirculating system. Based on quadratic regression analysis of body weight gain (BWG) the optimal dietary BM was estimated at 4821 TMU kg−1. Fish fed the diet with BM at 4800 TMU kg−1 showed higher feed efficiency ratio (P < 0.001), activity of amylase (P < 0.001; +12.7 μm g−1) and lipase (P < 0.001; +1.6 μm g−1) enzymes, and reduced digesta viscosity (P < 0.001; −0.88 cP (cP)) compared to fish fed the control diet. Additionally, dietary BM at 4800 TMU kg−1 also increased butyric acid content (P < 0.001; +0.31 nmol L−1), reduced gut pH (P < 0.001; −0.65), and increased villus height (VH; P < 0.001; +13.8 μm) relative to fish fed the control diet. Analysis of the “core microbiota” revealed that dietary BM modulated gut microbiota of juvenile Nile tilapia with fish fed the diet containing 4800 TMU kg−1 showing higher abundance of the beneficial bacteria, Proteobacteria, Actinobacteria, and Firmicutes, and a reduced population of potentially harmful bacteria (Escherichia sp.) than fish fed control diet. In summary, including BM at a level of ≥4800TMU kg−1 in SBM-based diets showed multiple beneficial effects on juvenile Nile tilapia growth performance, energy and nutrient utilization, and gut health, promoting improved gut histomorphometry and abundance of beneficial bacteria and reducing potentially harmful bacteria. These findings highlight the potential of BM supplementation as an advanced nutritional tool to enhance growth performance and gut health of juvenile Nile tilapia fed SBM-based diets.

Effect of forage quality and narasin inclusion on ruminal fermentation, nutrient intake, and total tract digestibility of Nellore steers.

The study aimed to evaluate the effects of forage quality and narasin inclusion on intake, digestibility, and ruminal fermentation of Nellore steers. Twenty-eight rumen-cannulated Nellore steers (initial body weight [BW] = 350 ± 32.4kg) were allocated to individual pens in a randomized complete block design, with 7 blocks, defined according to the fasting BW at the beginning of the experiment. The steers were randomly assigned within blocks to 1 of 4 experimental diets in 2 × 2 factorial arrangements, being the first-factor forage quality (MEDIUM = 81g of CP/kg of dry matter [DM], and HIGH = 153g of CP/kg of DM), and the second factor was the inclusion (N13 = diet plus 13mg/kg of DM of narasin) or not (N0) of narasin (Zimprova; Elanco Animal Health, São Paulo, Brazil). The experiment consisted of a 28-d period with 22 d for adaptation and the last 6d for data collection. No haylage quality × narasin interaction (P ≥ 0.68) was observed on DM and nutrient intake. Haylage quality affected (P ≤ 0.01) DM intake, with greater values observed for steers fed HIGH compared with MEDIUM haylage. There was an increase (P < 0.001) in OM, NDF, hemicellulose, and CP intake for steers consuming HIGH vs. MEDIUM haylage. Including N13 did not affect (P > 0.39) DM and nutrient intake of steers. No haylage quality × narasin interactions were detected (P ≥ 0.60) for total tract nutrient digestibility. However, steers fed with HIGH haylage showed an increase (P > 0.001) in DM and digestibility of all nutrients compared with MEDIUM. Steers fed a MEDIUM haylage had a greater (P < 0.01) proportion of acetate compared with steers fed HIGH during all evaluated hours. Steers fed HIGH haylage had a greater (P < 0.01) proportion of propionate at 0h compared with steers consuming MEDIUM, whereas at 12h, steers consuming MEDIUM hay had a greater (P < 0.01) proportion of propionate vs. HIGH haylage. A haylage quality × narasin and haylage quality × time of collection interactions were detected (P ≤ 0.03) for rumen ammonia concentration, which was reduced (P < 0.03) in N13 vs. N0 steers consuming HIGH haylage. Collectively, high-quality haylage allows increased consumption and digestibility, with more energy-efficient ruminal fermentation. In addition, narasin might be an important nutritional tool in forage-based diets to enhance the ruminal fermentation parameters of Bos indicus Nellore steers.

Comprehensive Review of Assessment Tools for Nutrition and Feeding Practices in Early Childhood: Applications, Strengths, and Limitations

Comprehensive Review of Assessment Tools for Nutrition and Feeding Practices in Early Childhood: Applications, Strengths, and Limitations

Bayesian diagnostic test evaluation and true prevalence estimation of malnutrition in gastric cancer patients

Malnutrition is prevalent among gastric cancer (GC) patients, necessitating early assessment of nutritional status to guide monitoring and interventions for improved outcomes. We aim to evaluate the accuracy and prognostic capability of three nutritional tools in GC patients, providing insights for clinical implementation. The present study is an analysis of data from 1308 adult GC patients recruited in a multicenter from July 2013 to July 2018. Nutritional status was assessed using Nutritional Risk Screening 2002 (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Bayesian latent class model (LCM) estimated the malnutrition prevalence of GC patients, sensitivity and specificity of nutritional tools. Cox regression model analyzed the relationship between nutritional status and overall survival (OS) in GC patients. Among 1308 GC patients, NRS-2002, PG-SGA, and GLIM identified 50.46%, 76.76%, and 68.81% as positive, respectively. Bayesian LCM analysis revealed that PG-SGA had the highest sensitivity (0.96) for malnutrition assessment, followed by GLIM criteria (0.78) and NRS-2002 (0.65). Malnutrition or being at risk of malnutrition were identified as independent prognostic factors for OS. Use any of these tools improved survival prediction in TNM staging system. PG-SGA is the most reliable tool for diagnosing malnutrition in GC patients, whereas NRS-2002 is suitable for nutritional screening in busy clinical practice. Given the lower sensitivity of NRS-2002, direct utilization of GLIM for nutritional assessment may be necessary. Each nutritional tool should be associated with a specific course of action, although further research is needed.

Association between the Composite Dietary Antioxidant Index and Stroke: A cross-sectional Study.

The composite dietary antioxidant index (CDAI) is indeed a valuable nutritional tool used to evaluate the overall antioxidant capacity of an individual's daily food consumption. The CDAI was calculated from the intake of six antioxidant components in the diet, including vitamin A, vitamin C and vitamin E, carotenoids, selenium, and zinc. This study aimed to determine the association between CDAI and stroke. Utilizing data from the 2003-2018 NHANES dataset, CDAI was computed by summarizing the intake of six dietary antioxidants based on 24-hour dietary recall interviews. The relationship between CDAI and stroke was examined using multivariate logistic regression and restricted cubic spline analysis. This study ultimately included 39,432 participants, of whom 1,527 (3.87%) had a stroke. The multivariate logistic regression model 3 that fully adjusted all confounding variables showed a negative association between CDAI and stroke (OR = 0.97; 95% CI:0.95, 0.99). The highest tertile of CDAI saw a 23% drop in the prevalence of stroke compared to the lowest tertile (OR = 0.77; 95%CI: 0.64,0.92). Restricted cubic spline suggested that this negative correlation was nonlinear with an inflection point of -2.99. Subgroup analyses and interaction tests showed that this negative correlation was more applicable in patients with prediabetes (P < 0.05). There was a non-linear negative correlation between CDAI level and stroke prevalence, and this correlation was more significant in people with pre-diabetes. Appropriate CDAI levels may contribute to the management of stroke risk.

Prognostic Nutritional Index Correlates with Liver Function and Prognosis in Chronic Liver Disease Patients.

The Prognostic Nutritional Index (PNI) is widely recognized as a screening tool for nutrition. We retrospectively examined the impact of PNI in patients with chronic liver disease (CLD, n = 319, median age = 71 years, 153 hepatocellular carcinoma (HCC) patients) as an observational study. Factors associated with PNI < 40 were also examined. The PNI correlated well with the albumin-bilirubin (ALBI) score and ALBI grade. The 1-year cumulative overall survival rates in patients with PNI ≥ 40 (n = 225) and PNI < 40 (n = 94) were 93.2% and 65.5%, respectively (p < 0.0001). In patients with (p < 0.0001) and without (p < 0.0001) HCC, similar tendencies were found. In the multivariate analysis, hemoglobin (p = 0.00178), the presence of HCC (p = 0.0426), and ALBI score (p < 0.0001) were independent factors linked to PNI < 40. Receiver operating characteristic (ROC) curve analysis based on survival for the PNI yielded an area under the ROC curve of 0.79, with sensitivity of 0.80, specificity of 0.70, and an optimal cutoff point of 42.35. In conclusion, PNI can be a predictor of nutritional status in CLD patients. A PNI of <40 can be useful in predicting the prognosis of patients with CLD.

PROTOCOL OF A RANDOMIZED, PARALLEL, DOUBLE-BLIND, PLACEBO-CONTROLLED PILOT TRIAL OF A KETONE ESTER IN AGING

Abstract Background Ketone bodies function as an energy and signaling metabolite and are hypothesized to interact with several geroscience pathways. Ketone esters (KE) are a nutritional tool that induce ketosis without other dietary changes; no studies have addressed KE in an aging population. Objectives The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot study is to determine the tolerability of 12-weeks of KE ingestion in older adults (&amp;gt;65y). Secondary outcomes include safety and acute ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, general and inflammatory aging biomarkers and gut microbiome. Methods Community dwelling older adults who are independent in activities of daily living, and with no unstable acute medical conditions (n=30) will be recruited. The study intervention is a KE (n=15) or a placebo (PLA). Firstly, ketone kinetics after 12.5 or 25g of KE consumption will be assessed over four hours. Secondly, after collection of baseline safety, functional and biological measurements, participants will be randomly allocated to consume KE or PLA daily for 12-weeks. A questionnaire will assess tolerance daily for 2-weeks, and then via recall at 2-week intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12. Conclusion This study will provide data demonstrating the feasibility, tolerance, and safety of 12-weeks of KE consumption in older adults as well as exploratory data across a range of geroscience-related endpoints. This will facilitate our long-term goal: use of KE to study geroscience mechanisms and clinical outcomes relevant to frailty.