Nutritional Tool Research Articles

Hybrid Human Resource Development in the Combination of Clinical and Graduate Research

Changing workplace attitudes toward clinical research is fostered by trial and error providing optimal therapeutic backgrounds and diverse ideas. On the other hand, students have many opportunities to learn while in university, and we hope that they will have hopes to contribute to team medicine and community health care, and still develop a research mindset. As one of the ways to achieve these objectives, students can be exposed to clinical research from an early point by sharing information with pharmacists and other professionals in the clinical field and working on their research projects. Our laboratory has been engaged in community health care challenges through collaborations with municipal hospitals and pharmacies in the region. In this context, we will introduce the connection between students and post-graduate education based on examples of graduation research worked on with pharmacists and professors of various professions. 1) Retrospective Study of Nutrition Risk Assessment Using Nutrition Tools: A research case study of a multidisciplinary collaboration on nutrition screening using three different nutrition assessment tools to clarify how nutritional endpoints affect nutrition risk assessment. 2) Validation of Causes and Countermeasures for Falls Using a Falls Assessment Score Sheet: Falls of the elderly in community health care. A case study of verifying fall prevention measures from the perspective of two factors: geriatric syndrome and multiple drug administration.

Malnutrition screening tool and malnutrition universal screening tool as a predictors of prolonged hospital stay and hospital mortality: A cohort study

Different nutrition screening tools have been proposed to screen inpatients, although, there is still no consensus regarding the reference method for identifying patients at nutritional risk. This retrospective cohort study aimed to evaluate the concurrent and predictive validity of the Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) to identify inpatients at nutritional risk. Data from electronic medical records were collected from adult and elderly inpatients in wards of a public tertiary hospital (Hospital de Clínicas de Porto Alegre, Brazil) over one year. Only the first nutritional evaluation was considered for each patient. GLIM criteria was used for malnutrition status (concurrent validity) and hospital stay length and mortality were outcomes to predictive validity. A total of 5270 patients were included in this study. The mean patient age was 59±16 years old, and 50.7% were males. More than 60% of the patients (65.8%) were admitted to a surgical unit, 63.8% had mild disease-related metabolic stress, 50.7% experienced prolonged hospital stays (more than ten days), and 1.9% of the patients died. Considering the availability of nutritional data, it was possible to perform nutritional screening of 98.1% of patients by MST and 96.7% of patients by MUST. A higher proportion of patients at risk were identified by MUST (53.6%) as compared to MST (21.3%; P<0.001). MST had 89.9% of Specificity, 60.4% of PPV, 94.6% of NPV, and a moderate agreement with malnutrition by GLIM criteria (κ=0.591; P<0.001). A prolonged hospital stay was positively associated with the classification of nutritional risk based on both screening tools. Death was positively associated with nutritional risk by MST (hazard ratio [HR] 2.09; 95% confidence interval [CI] 1.37-3.16) and by MUST (HR 1.79; 95% CI 1.00-3.18) after adjustment based on sex, age, admission type (surgical or clinical), and disease-related metabolic stress. MST may be good concurrent validity to malnutrition by GLIM criteria as compared to MUST. However, both risk nutritional tools were positively associated with predicting a prolonged hospital stay and mortality.

Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study

BackgroundThe global leadership initiative on malnutrition (GLIM) proposed the first international standards (GLIM criteria) for malnutrition diagnosis. Early screening using nutritional tools is recommended to improve the prognosis of older patients. The association between Mini Nutritional Assessment-Short Form (MNAⓇ-SF) and Geriatric Nutritional Risk Index (GNRI) and prognosis has been reported, but there is insufficient evidence to develop the GLIM criteria for older inpatients. We aimed to evaluate the MNAⓇ-SF, GNRI, and GLIM criteria to determine their contribution to the prognosis prediction of hospitalized older patients at 1 year after discharge.MethodsThis study included 386 patients hospitalized between September 2014 and October 2015, and May and December 2019. After excluding 17 patients who died at the time of initial hospitalization, 23 who were lost to follow-up after 1 year, and 28 who had missing data on admission, only 318 were included in the final analysis.The primary outcome was death within 1 year after discharge, assessed using the MNA®-SF, GNRI, and GLIM criteria, and survival analysis was conducted. Multivariate Cox proportional hazards analysis was performed to identify the nutritional assessment tools that contributed to the prognosis prediction.ResultsA total of 43 patients died within 1 year. Of them, 58.1% had malnutrition and 37.2% were at risk of malnutrition, assessed using the MNAⓇ-SF; 27.9% had severely malnourished assessed using the GNRI; and 58.1% had severely malnourished assessed using the GLIM criteria. The proportions of malnourished and severely malnourished patients were significantly higher in the mortality group than in the survival group.Multivariate Cox proportional hazards analysis showed hazard ratios of 1.06 (95% confidence interval [CI]: 0.24–4.71) for at risk and 2.17 (95% CI: 0.48–9.84) for malnutrition (MNAⓇ-SF); 5.68 (95% CI: 2.74–11.80) for moderately malnourished and 7.69 (95% CI: 3.13–18.91) for severely malnourished (GNRI); and 1.47 (95% CI: 0.48–4.50) for moderately malnourished and 2.45 (95% CI: 1.22–4.93) for severely malnourished (GLIM criteria); GNRI had the most significant contribution to prognosis prediction.ConclusionsGNRI significantly contributed to the prognosis prediction 1 year after hospital discharge of older patients.

New nutritional screening tool for hospitalized patients with chronic kidney disease: translation, cross-cultural adaptation of Renal iNUT into Spanish and comparison with classic questionnaires

Chronic kidney disease (CKD) is characterized by its high prevalence of malnutrition, difficult to detect as it is underestimated by the usual tools. There is no valid or hospital-level nutritional screening tool in Spanish to identify patients with CKD at risk of malnutrition. to translate and accomplish the transcultural adaptation of Jackson's questionnaire (Renal Inpatient Nutrition Screening Tool [Renal iNUT]) to Spanish, which detects the risk of malnutrition in CKD inpatients and compares it with other nutritional tools. phase 1: translation, back-translation and transcultural adaptation of the questionnaire from the English to the Spanish version. A pilot test was carried out by nursing staff together with a satisfaction questionnaire. Phase 2: comparison of Renal iNUT with Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA). phase 1: the nursing staff's perception was highly favorable. They found it easy or very easy to use and 90 % of them did it in a maximum of ten minutes. Phase 2: from 48 patients included, Renal iNUT detected 44 % at low risk of malnutrition, 28 % at intermediate risk and 28 % at high risk. Increased sensitivity of Renal iNUT (p < 0.007) vs MUST (62.5 vs 33.3 %) and similar specificity (87.1 vs 90.6 %) were found, together with an acceptable correlation compared to SGA (r = 0.75, 95 % CI: 0.67 to 0.83). the Spanish version of Renal iNUT is a useful and easy-to-understand tool for health professionals. We also confirm its good correlation with SGA, with greater sensitivity than MUST for the risk of malnutrition detection in CKD inpatients.

Complexo enzimático comercial (AllzymeR) melhora a digestibilidade da ração para tilápias do Nilo em crescimento

ABSTRACT Recent studies have evidenced exogenous enzymes as nutritional tool to elaborate low-polluting aquafeeds. This study aimed to evaluate effects of enzyme complex (EC) on apparent digestibility coefficients (ADC) of energy and nutrients, including amino acids, as well nitrogen (N) and phosphorus (P) loss in pre-growout Nile tilapia (Oreochromis niloticus). Diets without EC (Control) or with EC supplemented at 225 (EC225) or 450 mg/kg diet (EC450) and fed to Nile tilapia (n = 135, 150 ± 20 g) distributed in an entirely randomized design of three treatments and three replicates of 15 fish each. Fish fed diet EC450 showed higher digestibility of energy, protein, amino acids and mineral, and increased digestible energy (DE; +221.25 kcal/kg diet), digestible protein (DP; +10.54 g/kg diet) contents of diets, whereas reduced N (−23.82%) and P (−18.46%) loss relative to fish fed diet control. This study evidenced that EC at 450 mg/kg diet optimizes the ADC of multiple nutrients, including amino acids, and identified its potential to enhance the nutritive value of feeds and elaborate sustainable feeds for Nile tilapia.

Middle-aged and older adults' acceptance of mobile nutrition and fitness tools: A qualitative typology.

The utilization of mobile health (mHealth) devices such as nutrition and fitness tools seems to be promising in facilitating healthy lifestyle behaviors in middle-aged and older adults. As user acceptance plays a decisive role in the successful implementation of mHealth tools, it is vital to examine the target groups' acceptance, particularly their usage behavior and attitudes toward these tools. This qualitative study aimed to explore how far middle-aged as well as older adults accept mobile nutrition and fitness tools and to identify facilitators and barriers shaping their acceptance. Twenty-one qualitative semi-structured interviews were conducted with German adults aged 50 years and older. Data material was analyzed using Qualitative Content Analysis (Kuckartz). A comprehensive acceptance typology with three acceptance types could be reconstructed: The Rejection Type, The Selective Acceptance Type, and The Comprehensive Acceptance Type. The target group's acceptance of mobile nutrition and fitness tools appeared to differ considerably across the three acceptance types and between the two different types of mHealth tools - with mobile nutrition tools having been less accepted. Among others, high levels of usability were identified as a key facilitator, while a desire for autonomy and privacy concerns showed to be prominent barriers. The resulting typology indicates a pronounced heterogeneity among middle-aged and older adults regarding their acceptance of mobile nutrition and fitness tools. The findings highlight a need for more individualized mHealth tools along with respective promotion strategies that are specifically tailored to the needs and expectations of middle-aged and older adults.

Low- and Medium-Socioeconomic-Status Group Members' Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study.

Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users' needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. This study aimed to gather insights into people's thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. This study shows that people from low- and medium-socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this.

Effects of a Specific Pre- and Probiotic Combination and Parent Stock Vaccination on Performance and Bacterial Communities in Broilers Challenged with a Multidrug-Resistant Escherichia coli.

Antibiotic resistance poses a risk for human and animal health, leading to a growing demand for effective alternatives. Combining nutritional tools and parent stock vaccination could be an approach to achieve sufficient protection against bacterial infections in poultry. In an Escherichia coli O1/O18 challenge trial, we investigated the protective effects of feeding diets containing Enterococcus faecium DSM 7134 and fructooligosaccharides (FOS) combined with specific parent stock vaccination in 225 ROSS 308 broilers. Data on performance parameters, intestinal microbial composition and metabolites, and antibiotic resistance genes (sul1-3, dhfr1a, SHV-12) were obtained. E. faecium and FOS combined with parent stock vaccination led to the highest body weights, which were significantly higher than those of controls throughout the experiment and decreased the relative abundance of Proteobacteria in the crop digesta compared to that in the positive control. However, cumulative feed conversation remained unaffected by the strategies. Birds receiving the pre-/probiotic combination showed lower cecal pH levels and higher crop L-lactate concentrations than the controls, whereas copy numbers of dhfr1a (trimethoprim resistance) and SHV-12 (extended-spectrum beta-lactamase) genes were only decreased in broilers from vaccinated hens compared to those in the challenged control. In conclusion, prophylactic administration of E. faecium and FOS in combination with parent stock vaccination can have complementary effects by improving broiler weight gain and stimulating intestinal bacterial metabolism, which may be beneficial for maintaining gut health in terms of Escherichia coli infection.

The geriatric nutritional risk index is an effective tool to detect GLIM-defined malnutrition in rectal cancer patients

This study aimed to investigate the value of the Geriatric Nutritional Risk Index (GNRI), prognostic nutritional index (PNI), and advanced lung cancer inflammation index (ALI) scores in detecting malnutrition in patients with rectal cancer; the Global Leadership Initiative on Malnutrition (GLIM) was used as the reference criterion. This study included patients with rectal cancer who underwent proctectomy. GNRI, PNI, and ALI were calculated to detect the GLIM-defined malnutrition using the Receiver operating characteristic (ROC) curves. Univariate and multivariate logistic regression analyses were used to evaluate the association between the nutritional tools and postoperative complications. Kaplan-Meier survival curves, log-rank tests, and univariate and multivariate Cox regression analyses were used to clarify the relationship between nutritional tools and overall survival (OS). This study enrolled 636 patients with rectal cancer. The GNRI demonstrated the highest sensitivity (77.8%), pretty specificity (69.0%), and the largest AUC (0.734). The GNRI showed good property in predicting major postoperative complications. All three nutritional tools were independent predictors of OS. The GNRI can be used as a promising alternative to the GLIM and is optimal in perioperative management of patients with rectal cancer.

Efficacy of a Digital Personalized Elimination Diet for the Self-Management of Irritable Bowel Syndrome and Comorbid Irritable Bowel Syndrome and Inflammatory Bowel Disease.

Most patients with irritable bowel syndrome (IBS) and dual-diagnosis IBS and inflammatory bowel disease (IBD) report that symptoms originate from or are exacerbated by trigger foods. Despite patient interest and need, there is no consensus on what diet is optimal. Popular diets have notable limitations including cost, length, implementation complexity, and lack of personalization. This pilot study evaluated the feasibility, desirability, and effect on gastrointestinal symptoms of a digitally delivered personalized elimination diet for patients with IBS and comorbid IBS/IBD, powered by machine learning. Participants were recruited online and were provided access to a digital personalized nutrition tool for 9 weeks (N = 37; IBS only = 16, Crohn's disease and IBS = 9, and ulcerative colitis and IBS = 12). Significant symptom improvement was seen for 81% of participants at study midpoint and persisted for 70% at end point, measured by the relevant symptom severity score (IBS symptom severity score, Patient Simple Clinical Colitis Activity Index, or Mobile Health Index for Crohn's disease). Clinically significant symptom improvement was observed in 78% of participants at midpoint and 62% at end point. Twenty-five participants (67.6%) achieved total symptomatic resolution by the end of study. Patient-reported quality of life improved for 89% of participants. Ninety-five percentage daily engagement, 95% retention, 89% adherence and 92% satisfaction with the program were reported. Dietary elimination can improve symptoms and quality of life in patients with IBS and comorbid IBS/IBD. Digital technology can personalize dietary interventions and improve adherence. Randomized controlled trials are warranted.

Magnesium is a nutritional tool for the yield and quality of oolong tea (Camellia sinensis L.) and reduces reactive nitrogen loss

Magnesium (Mg) plays an important role in controlling the biological utilization and dispersion of nitrogen (N) in crops and the environment; however, the application of Mg fertilizer is often neglected in crop nutrient management globally. Can intensified Mg management optimize the agronomic and environmental benefits of tea production? To answer this question, four trials of Mg fertilizer levels in oolong tea (Camellia sinensis L.) garden were designed, i.e., 0 (Mg0), 35 (Mg1), 70 (Mg2) and 140 (Mg3) kg MgO ha−1 yr−1, and the tea yield and quality, N use efficiency (NUE) and reactive N losses were assessed. Compared with Mg0, Mg applications significantly increased tea yield by an average of 14.1% (spring tea), 18.4% (autumn tea) and 15.8% (annual total tea), improved tea quality, and increased the partial factor productivity of applied N (PFPN) and NUE by 13.9–17.2% and 17.8–25.5% after the four-year trial, respectively. The N uptake of young shoots (i.e., harvest part) in Mg1, Mg2 and Mg3 was higher than that in Mg0 by 19.5%, 25.8% and 21.5%, respectively. Simultaneously, Mg fertilization significantly decreased the N surplus and reduced the risk of reactive N loss. There was no significant difference in the indicators mentioned above or in the economic benefits among the Mg fertilizer treatments. In conclusion, if the risk of soil nitrate leaching is not considered, the recommended Mg application rate is 35 kg MgO ha-1 yr-1; otherwise, it is 70 kg MgO ha-1 yr-1. These results indicated that Mg could be a key limiting factor and have positive effects on tea production, and reasonable Mg fertilization is beneficial to the sustainability of tea production.

240 Nutritional Intervention to Improve Carbohydrate Utilization and gut Health 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, resistant starch, oligosaccharides, and exopolysaccharides are carbohydrate structures and are nutritional tools that may enhance gut health in pigs. Dietary carbohydrates may have a role to alleviate diarrheal diseases including in pigs post-weaning but also reduce constipation in sows. 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 2 key properties: fermentability and solubility. 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 insoluble fiber may prevent constipation in sows. Starch is mostly digested and absorbed as glucose. However, resistant starch is not digested and acts as insoluble but fermentable fiber and 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 utilization as energy source and its prebiotic activity. Finally, 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 carbohydrates are important energy sources but may also provide important solutions to maintain gut health in pigs.

Adherence to Mediterranean diet among Lithuanian and Croatian students during COVID-19 pandemic and its health behavior correlates.

Maintaining healthy behavior, especially in times of crisis like the COVID-19 pandemic, is particularly important for staying healthy. Nutrition is an everyday behavior and along with other health-related behaviors is associated with many health outcomes. The aim of this study was to assess and compare adherence to the Mediterranean diet (MedDiet) and particular food choices among the Mediterranean and non-Mediterranean populations of university students and identify its lifestyle correlates at the outburst of the COVID-19 pandemic. In total, self-reported data on health-related behavior and sociodemographic characteristics were collected from 1,388 study participants, 66.4% were Lithuanians, and 33.6% were Croatians. Results revealed that vegetables, olive oil, fruits, nuts, legumes, and fish were remarkably underconsumed among university students in the Mediterranean and non-Mediterranean countries during the COVID-19 pandemic, and the composite diet is similar between countries. The higher adherence to MedDiet is associated with physical activity (β = 0.15) and non-smoking (β = 0.08). In times of crisis, public health entities should provide knowledge, skills, and tools for healthy nutrition specifying them by age and subpopulation. Interventions at the university should be implemented to build infrastructure and provide an access to health behavior-friendly environments.

Association between the Dietary Inflammatory Index with gallstone disease: finding from Dena PERSIAN cohort

ObjectiveThe Dietary Inflammatory Index (DII) is a documented nutritional tool for assessing diet-induced inflammation that has been linked to various diseases/outcomes. The association between DII and gallstone disease (GSD) is...

Wheat germ oil vitamin E cytoprotective effect and its nutrigenomics signature in human hepatocyte lipotoxicity

Wheat germ oil (WGO) is rich in α-tocopherol (vitamin E, VE), a vitamin that has long been suggested to exert hepatoprotective effects. In this study, this function of WGO-VE and its transcriptomics fingerprint were investigated in comparison with RRR−α-tocopherol and all-rac-α-tocopherol (nVE and sVE, respectively), in human liver cells treated with oleic acid (OA) to develop steatosis and lipotoxicity. Used in chemoprevention mode, all the VE formulations afforded significant reduction of the OA-induced steatosis and its consequent impact on lipotoxicity indicators, including ROS production and efflux (as H2O2), and apoptotic and necrotic cell death. A trend toward a better control of lipotoxicity was observed for WGO-VE and nVE compared to sVE.Gene microarray data demonstrated that these effects of VE formulations were associated with significantly different responses of the cellular transcriptome to compensate for the modifications of OA treatment, including the downregulation of cellular homeostasis genes and the induction of genes associated with defects of liver cell metabolism, fibrosis and inflammation, liver disease and cancer. Ingenuity Pathway Analysis data showed that WGO-VE modulated genes associated with liver carcinogenesis and steatosis, whereas nVE modulated genes involved in liver cell metabolism and viability biofunctions; sVE did not significantly modulate any gene dataset relevant to such biofunctions.In conclusion, WGO-VE prevents lipotoxicity in human liver cells modulating genes that differ from those affected by the natural or synthetic forms of pure VE. These differences can be captured by precision nutrition tools, reflecting the molecular complexity of this VE-rich extract and its potential in preventing specific cues of hepatocellular lipotoxicity.

The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users' Experiences.

BackgroundTo address the epidemic burden of diet-related diseases, adequate dietary intake assessments are needed to determine the actual nutrition intake of a population. In this context, the eNutri web app has been developed, providing online automated personalized dietary advice, based on nutritional information recorded via an integrated and validated food frequency questionnaire (FFQ). Originally developed for a British population and their dietary habits, the eNutri tool has specifically been adapted to the German population, taking into account national eating habits and dietary recommendations.ObjectiveThe primary aim of this study is to evaluate the system usability and users’ experience and feedback on the eNutri app in a small-scale preliminary study. The secondary aim is to investigate the efficacy of personalized nutrition (PN) recommendations versus general dietary advice in altering eating habits.MethodsThe app was piloted for 4 weeks by 106 participants from across Germany divided into a PN group and a control group. The groups differed according to the degree of personalization of dietary recommendations obtained.ResultsAn overall System Usability Scale (SUS) score of 78.4 (SD 12.2) was yielded, indicating an above average user experience. Mean completion time of the FFQ was 26.7 minutes (SD 10.6 minutes). Across subgroups (age, sex, device screen sizes) no differences in SUS or completion time were found, indicating an equal performance for all users independent of the assigned experimental group. Participants’ feedback highlighted the need for more personalized dietary advice for controls, while personalized nutritional recommendations improved the awareness of healthy eating behavior. Further improvements to the eNutri app were suggested by the app users.ConclusionsIn total, the eNutri app has proven to be a suitable instrument to capture the dietary habits of a German population sample. Regarding functionality, system usability, and handling, direct user feedback was quite positive. Nutritional advice given was rated ambivalent, pointing to several weaknesses in the eNutri app, minimizing the system’s full potential. A higher level of personalization within nutritional advice subjectively improved the app’s usability. The insights gained will be used as a basis to further develop and improve this digital diet assessment tool.

Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers’ public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers’ public commitments.MethodsProminent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann–Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05).ResultsAverage total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1).ConclusionsResults of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.

Evaluation of different tools for body composition assessment in colorectal cancer - a systematic review.

The nutritional status of patients with colorectal cancer (CRC) impacts on treatment response and morbidity. An effective evaluation of the body composition includes the measurements of fat and visceral fat-free mass and is currently being used in the diagnosis of the nutritional status. The better understanding regarding nutritional tools for body composition evaluation in CRC patients may impact on the outcome. Systematic review conducted according to Preferred Items of Reports for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed using the BVS (LILACS), PubMed, Embase, Cochrane, Scopus, and Web of Science databases. For the initial search, 97 studies were selected and 51 duplicate manuscripts were excluded. Thus, 46 were reviewed and seven studies included with a total of 4,549 patients. Among them were one clinical trial, one prospective study (cohort), two retrospective cohort and two cross-sectional studies. All studies included body composition evaluated by computed tomography, one with bioelectrical impedance, one with handgrip strength, and two employed mid-arm muscle circumference and body mass index. Current evidence suggests that computed tomography has better accuracy in the diagnosis of sarcopenia, visceral fat, and myopenia among individuals with CRC. Further studies are needed to identify cutoff points for these changes aggravated by CRC.

The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients

BackgroundThe simple nutritional assessment tools by Mini Nutritional Assessment (MNA) and Patient Generated Subjective Global Assessment (PG – SGA) was proposed to affect the Quality of Life (QOL) in hemodialysis patients. However, currently, no evidence assessed the potency of MNA and PG - SGA for predicting the QOL in hemodialysis patients. ObjectiveTo assess the potential implication of MNA and PG-SGA nutritional tools and the QOL among hemodialysis patients. MethodsA cross - sectional study was performed in Universitas Muhammadiyah Malang Hospital, Malang, Indonesia. A validated Kidney Disease Quality of Life – 36™ (KDQOL – 36™) instrument was used to assess the QOL. The nutritional status was assessed using MNA and PG - SGA checklist. The association between nutritional status and QOL was determined by using multiple logistic regression. ResultsA total of 96 hemodialysis patients was enrolled in our study. Of them, good QOL was observed in 75 patients (78.12%). We found that hemodialysis patients with higher MNA score and lower PG - SGA score was associated with good QOL. We also found that normal MNA nutritional status was associated with good QOL. Moreover, we also found that the score of MNA ≥23.75 and PG - SGA score ≤3,5 were associated with good QOL. ConclusionMNA and PG-SGA nutritional assessment tools are the important indicator in predicting the QOL in hemodialysis patients.

Effect of Brief Produce Exposure and Unconstrained Grocery Gift Cards on Caregiver Influence on Diet of Elementary Age Children

Children's diets affect health trajectories but are difficult to influence, especially for resource-constrained families. To assess the effectiveness of providing 4 weeks of grocery gift cards and small produce boxes to caregivers on their ability to support healthy shifts in children's diets. This 2-group randomized clinical trial was conducted from May to July 2021, with 4 weeks of intervention and follow-up at 8 weeks. Resources were provided curbside at 3 schools, 3 housing sites, and 1 after-school site for use at home. Participants consisted of 1 index child ages 5 to 11 years with 1 index caregiver from 68 low-income families. Data were analyzed from July 2021 through March 2022. During each week for 4 weeks, caregivers were offered 10-lb (4.5 kg) boxes of fruits and vegetables, $10.00 grocery gift cards, an additional $10.00 gift card over the last 3 weeks triggered by a task completion, and a 1-time choice of a $25.00 food preparation tool. Index child and caregiver diets were measured together over the phone at baseline, 4 weeks, and 8 weeks using the 2019 to 2020 Texas School Physical Activity and Nutrition (SPAN) tool, which measures the number of times food items were eaten over the prior day to report a SPAN Healthy Eating Index (SHEI) score and subscores for specific categories of foods (range, 0-57, with higher scores indicating a more healthful diet). Among 68 children (mean [SD] age, 8.2 [1.7] years; 35 [51.5%] girls) and caregivers (mean [SD] age, 37.9 [7.9] years; 63 mothers [92.6%]) from primarily low-income families, 26 caregivers were Hispanic or Latino (38.2%), while 18 caregivers were Black (26.4%), 25 caregivers were White (36.7%), and 24 caregivers had more than 1 race (35.3%). Most families were below the federal poverty level (41 of 60 families that reported income [68.3%]). Per participating caregiver, a mean (SD) 2.7 [1.4] fruit and vegetable boxes and $42.35 ($25.46) worth of gift cards were picked up over 4 weeks. Mean (SE) child SPAN SHEI increased from 32.03 (0.62) times/d to 33.75 (0.69) times/d at 4 weeks (ie, postintervention) and 34.03 (0.69) times/d 4 weeks later (ie, at 8 weeks of follow-up). Mean (SE) child fruit and vegetable intake increased from 5.31 (0.47) times/d to 5.78 (0.51) times/d postintervention and 6.03 (0.51) times/d at follow-up. Children in the control group did not have improved diet (overall mean [SE] SHEI: 31.48 [0.58] times/d at baseline, 31.68 [0.54] times/d postintervention, and 31.81 [0.52] times/d at follow-up; mean [SE] fruit and vegetable intake: 5.21 [0.45] times/d at baseline, 4.77 [0.45] times/d postintervention, and 4.68 [0.41] times/d at follow-up). Compared with children in the control group, mean SHEI was increased for children in the intervention group by 2.07 times/d postintervention and 2.23 times/d at follow-up. Improvements as a function of program dose were statistically significant for child SHEI (P = .01) and fruit and vegetable intake (P = .03). No significant changes in caregiver diets were found. This study found that easily accessed fruits and vegetables and unconstrained grocery store cards provided directly to caregivers over 4 weeks resulted in improvements in child diet, which were sustained over 4 additional weeks. Future work may investigate whether diet improvement from a brief intervention optimized for caregiver flexibility reflects a natural maximum or potential for greater improvements on extension. ClinicalTrials.gov Identifier: NCT04827654.