Recent Food Intake Research Articles

Real world outcomes with cabazitaxel (cab) plus carboplatin (car) in metastatic castration-resistant prostate cancer (mCRPC).

e17052 Background: Taxane chemotherapies are a mainstay of treatment in mCRPC. The addition of carboplatin (car) to cabazitaxel (cab) has shown efficacy and toxicity within clinical trials. Although car/cab were initiated concurrently in trial, clinical efficacy of car addition in those with PSA progression on cab is unknown. Furthermore, little is known about outcomes in older patients treated with car/cab. Methods: We retrospectively reviewed 72 patients with mCRPC treated with car/cab combination therapy. Demographics, disease characteristics, and treatment history were collected via electronic medical record. Overall survival (OS), progression-free survival (PFS), best overall response (BOR) per RECIST 1.1 in those with measurable disease, PSA30 and PSA50, defined as a decrease in PSA by at least 30% or 50%, respectively, were assessed. Adverse events related to treatment were assessed. In patients ≥ 65 years old, baseline frailty was assessed with the G8 screening tool, which incorporates recent food intake, weight loss, mobility, neuropsychological conditions, BMI, polypharmacy, self-assessed health status, and age. A score of ≤ 14 suggests geriatric vulnerability. Univariate association between clinical variables and the G8 score was assessed by Fisher’s exact test and Chi-square analysis. Survival outcomes were assessed via Kaplan-Meier method. Results: Median age was 66.5 years, 45.8% were Black, and 84.5 % had high volume disease. 88.1% of patients had an impaired G8 score even though 83.7% of all patients included were classified as ECOG 0-1 by their oncologist. Initially, 32 patients (44.4%) started cab monotherapy with car added later and received a median of 4 cycles of cab prior. Median OS was 10.8 months (95% CI 8.8, 13.3) and median PFS was 6.2 months (95% CI 5.8, 8.3). PSA30 and PSA50 were 38.6% and 25.7%, respectively, with BOR of partial response (PR) in 5 patients (8.6%). In those in whom car was added due to a lack of response to cab, 32.3% and 16.1% of patients were able to recapture PSA30 and PSA50 with the combination, respectively; only 1 patient (3.8%) had a PR as BOR. 56.9% of patients did not receive further treatment after car/cab. 93.1% of patients experienced toxicity (90.6% of those in whom car was added) and 34.7% stopped treatment due to toxicity alone. Fatigue (64.8%), anemia (85.9%), leukopenia (36.6%), and thrombocytopenia (40.8%) were the most common. G-CSF support was required in 70.8% and those with an impaired G8 score were significantly more likely to require this support (p=.008). Conclusions: To our knowledge, this is the first study showing that the addition of car in those not responding to cab can recapture PSA response in roughly one third of patients. Since car/cab is toxic, this may represent a strategy to expose only those not responding to cab to the added toxicity of the doublet. More frail patients may experience increased toxicity with car/cab.

Assessment of Impact of Dietary Patterns on Obstructive Sleep Apnea Patients.

Objective Obstructive sleep apnea syndrome (OSAS) is characterized by episodic cessations of breathing due to upper airway obstruction during sleep, which may cause disturbances in dietary patterns resulting from appetite-related hormonal changes. The aim of the present study was to investigate the relationship between OSAS and nutritional and dietary patterns. Materials and Methods A total of 20 female and 53 male OSAS patients aged > 30 years were enrolled. Demographic data, as well as data on smoking and alcohol habits, were noted, anthropometric measures were made, and a questionnaire regarding chronic diseases including OSAS and four questionnaires on recent food intake frequency and content of nutrition were filled out. The content of nutrition was noted under seven categories: meat, legumes, milk and dairy products, fruits and vegetables, bread and cereals, fat and carbohydrates, and beverages. Results The severity of OSAS (assessed by the apnea-hypopnea index. AHI) was positively correlated with the body mass index (BMI), the circumferences of the waist, chest, and buttocks, and, in males, with the circumference of the neck as well. There was no correlation between the AHI and nutritional habits in terms of the frequency of meals or snacks, the scores on the Snoring, Tiredness, Observed Apnea, and High Blood Pressure-Body Mass Index, Age, Neck Circumference, and Gender (STOP-BANG) Questionnaire and the corresponding macro- and micronutrients. Worsening apnea scores led to increased intake of macronutrients of carbohydrate and protein and micronutrients of niacin and pyridoxine ( p < 0.05), and decreased intake of fat ( p < 0.05). Conclusion The present study demonstrated an association between OSAS severity and recent food intake, manifested in increased intake of carbohydrates, niacin, and pyridoxine, and decreased fat intake.

Effect of Food Intake on Exhaled Volatile Organic Compounds Profile Analyzed by an Electronic Nose.

Exhaled breath analysis using an e-nose is a groundbreaking tool for exhaled volatile organic compound (VOC) analysis, which has already shown its applicability in several respiratory and systemic diseases. It is still unclear whether food intake can be considered a confounder when analyzing the VOC-profile. We aimed to assess whether an e-nose can discriminate exhaled breath before and after predefined food intake at different time periods. We enrolled 28 healthy non-smoking adults and collected their exhaled breath as follows: (a) before food intake, (b) within 5 min after food consumption, (c) within 1 h after eating, and (d) within 2 h after eating. Exhaled breath was collected by a formerly validated method and analyzed by an e-nose (Cyranose 320). By principal component analysis, significant variations in the exhaled VOC-profile were shown for principal component 1 (capturing 63.4% of total variance) when comparing baseline vs. 5 min and vs. 1 h after food intake (both p < 0.05). No significance was shown in the comparison between baseline and 2 h after food intake. Therefore, the exhaled VOC-profile seems to be influenced by very recent food intake. Interestingly, two hours might be sufficient to avoid food induced alterations of exhaled VOC-spectrum when sampling for research protocols.

Influence of recalling recent eating episodes on healthy eating: a randomised experiment

Recall of recent eating episodes is a versatile approach to test influences on amount eaten of specific food. The present experiment explored if reminding current food intake prompts awareness for eating more healthy food. In a randomised between-subjects experiment, 60 healthy young females were offered fruit at breakfast time, which they could eat ad libitum after recalling either eating (n = 31) or non-eating (n = 29) episodes of the day before. Participants in the eating recall condition on average did not eat a larger amount of fruit than participants in the non-eating recall condition (203 ± 62 g vs 209 ± 69, d = 0.11, t = −0.42, P = 0.68, BF10 = 0.28). So no evidence was found for a stimulatory effect on amount eaten of healthy food from reminding recent food intake. This null result is discussed and guidelines for future research are presented addressing further aspects of memories of eating episodes possibly influencing healthy food ingestion.

Recent and current low food intake – prevalence and associated factors in hospital patients from different medical specialities

Background/ObjectivesPoor food intake is a major etiological factor of malnutrition. This research aims to describe the prevalence of recent and current low food intake (LIRC) and to identify factors associated with LIRC in adult hospital patients from different medical specialities.Subject/Methods1865 patients participating in the nutritionDay survey 2016–2020 in Germany were included. LIRC was defined by decreased eating both on nutritionDay and in the week before hospitalisation. Multivariate binary logistic regression was used to identify factors associated with LIRC overall and in different specialities.ResultsLIRC was observed in 21.1% of all patients, with the highest prevalence in Gastroenterology (26.6%) and the lowest in Neurology (11.2%). Weight loss within three months before nutritionDay (OR 2.62 [95% CI 1.93–3.56]), (very) poor self-rated health (2.17 [1.62–2.91]), female sex (1.98 [1.50–2.61]), uncertain weight loss (1.90 [1.03–3.51]), digestive disease (1.90 [1.40–2.56]), inability to walk without assistance (1.55 [1.14–2.12]) and emergency admission (1.38 [1.02–1.86]) were associated with increased risk, cardiac insufficiency (0.55 [0.37–0.83]) and being in a neurological ward (0.51 [0.28–0.92]) with decreased risk in the total sample. In Gastroenterology and Oncology, estimates were higher than in the entire sample; no significant associations were found in Neurology and Geriatrics, presumably due to the low prevalence of LIRC in Neurology and limited data quality in Geriatrics.ConclusionLIRC is common in German hospital patients and associated with female sex, poor health and decreased functional status. Interdisciplinary differences suggest a discipline-specific approach to dealing with malnutrition.

Diet, Fecal Microbiome, and Trimethylamine N-Oxide in a Cohort of Metabolically Healthy United States Adults.

TMAO is elevated in individuals with cardiometabolic diseases, but it is unknown whether the metabolite is a biomarker of concern in healthy individuals. We conducted a cross-sectional study in metabolically healthy adults aged 18–66 years with BMI 18–44 kg/m2 and assessed the relationship between TMAO and diet, the fecal microbiome, and cardiometabolic risk factors. TMAO was measured in fasted plasma samples by liquid chromatography mass spectrometry. The fecal microbiome was assessed by 16S ribosomal RNA sequencing and recent food intake was captured by multiple ASA24 dietary recalls. Endothelial function was assessed via EndoPAT. Descriptive statistics were computed by fasting plasma TMAO tertiles and evaluated by ANOVA and Tukey’s post-hoc test. Multiple linear regression was used to assess the relationship between plasma TMAO and dietary food intake and metabolic health parameters. TMAO concentrations were not associated with average intake of animal protein foods, fruits, vegetables, dairy, or grains. TMAO was related to the fecal microbiome and the genera Butyribrio, Roseburia, Coprobaciullus, and Catenibacterium were enriched in individuals in the lowest versus the highest TMAO tertile. TMAO was positively associated with α-diversity and compositional differences were identified between groups. TMAO was not associated with classic cardiovascular risk factors in the healthy cohort. Similarly, endothelial function was not related to fasting TMAO, whereas the inflammatory marker TNF-α was significantly associated. Fasting plasma TMAO may not be a metabolite of concern in generally healthy adults unmedicated for chronic disease. Prospective studies in healthy individuals are necessary.

Development and Validation of a Nutritional Risk Screening Scale for Stroke Patients

IntroductionStroke is a global health problem, and around 62% of stroke patients suffer from malnutrition due to dysphagia, eating speed, or stress response. This study aimed to develop a Nutritional Risk Screening Scale for Stroke Patients (NRSS-SP).Material and methodsIn the current study we construct a theoretical framework by combining stroke characteristics, the risk factors of malnutrition in stroke patients, and clinical experience. Then, using the Delphi method, we formed a pool for entries and combined the opinions and suggestions discussed by experts in a research team. Next, we collected all of the data and information, categorized, merged, and split the pool of entry items' contents. Finally, we formed a pretest scale comprising 11 items after scoring their importance.ResultsThe pretest NRSS-SP comprised 10 items in three fields: physical, psychological, and independence. The score was assigned to each factor according to the evaluation results. (e.g., Disease severity, serum albumin and dysphagia: Score 3, age ≥70 years: Score 1). The cumulative effect of four factors (depression, anxiety, serum level of albumin, and body mass index (BMI)) was 65.512%. The item-level Content Validity Index (CVI) of the NRSS-SP ranged from 0.081 to 1.000, and the scale-level CVI was 0.912. The coefficient of Cronbach’s α ranged from 0.822 to 0.911.ConclusionsAn NRSS-SP (including National Institutes of Health Stroke Scale score, BMI, serum level of albumin, recent weight loss, recent food intake, dysphagia, age, depression, anxiety, and Barthel Index) score ≥6.5 was classified as a malnourishment risk; an NRSS-SP score &lt;6.5 denoted normal nutrition.

NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality

Malnutrition is a substantial issue in hospitals, leading to prolonged length of hospital stay, increased perioperative morbidity and increased mortality. There are several validated screening tools for malnutrition, one of which is the Nutritional Risk Screening 2002 (NRS). It screens patients based on recent weight loss, reduction of recent food intake, body mass index (BMI), severity of disease and age. Higher NRS scores have been shown to be negatively associated with patients&rsquo; outcomes such as increased morbidity and mortality. The aim of the study was to evaluate how the two NRS components Nutritional Score (NS) and Severity of Disease Score (SDS) are associated with patients&rsquo; length of hospital stay and mortality. All patients admitted to the medical department of a large community hospital in Switzerland were screened for malnutrition using the nutrition screening NRS during the years 2014 to 2017. Data on patients&rsquo; NRS, primary diagnosis, number of secondary diagnoses, mortality, length of stay (LOS), discharge, sex and age were collected. The association between the NRS components and LOS/mortality was estimated using a linear mixed-effects regression model and a logistic regression model, respectively, with adjustment for confounders (age, sex, comorbidity, diagnosis group, mode of discharge and year of hospitalisation). The evaluation of the outcomes of 21,855 hospitalisations demonstrated that the NS was associated with an increment in the LOS of 5.5&ndash;12.3% per score point, depending on the diagnosis group. An increase in the SDS by one point was associated with an increase in the LOS of 2.2&ndash;11.3%. The odds for all-cause in-hospital mortality were increased by 44.1% (95% confidence interval [CI] 33.7&ndash;55.2%) per point in the NS, and by 73% (95% CI 57.5&ndash;90.1%) per point in the SDS. Increases in both components of the NRS are associated with longer LOS. The NS has a slightly stronger impact on LOS compared to the SDS and its effect is dependent on the patient&rsquo;s diagnosis group. Increases in the SDS are linked to a higher mortality than increases in the NS.

Dimensions of unhealthy exercise and their associations with restrictive eating and binge eating

Unhealthy exercise is a core symptom of eating disorders that predicts greater chronicity and risk of relapse. A detailed conceptualization of unhealthy exercise in the context of eating disorders is only beginning to emerge, and associations between specific dimensions of unhealthy exercise and eating disorder symptoms have received little attention. The aim of the current study was to examine associations between three key dimensions of unhealthy exercise – compulsive exercise (i.e., rule-driven exercise to avoid negative affect), exercise to control weight/shape, and exercise to compensate for recent food intake – with restrictive eating and binge eating. Participants were 239 women drawn from two separate studies of emotions and eating behavior; 126 (52.7%) endorsed restrictive eating and/or objective binge eating episodes in the past three months. Unhealthy exercise dimensions were measured using the Compulsive Exercise Test and investigator-designed items, and eating disorder symptoms were assessed using the Eating Pathology Symptoms Inventory. Restrictive eating was only associated with avoidance and rule-driven exercise, whereas binge eating was significantly correlated with all unhealthy exercise variables. Multiple regression results revealed that only compensatory exercise was uniquely associated with binge eating. Unhealthy exercise consists of partially distinct dimensions with differential relations to core eating disorder symptoms. Future research should examine unhealthy exercise dimensions in patients with eating disorder diagnoses and consider whether treatments for specific unhealthy exercise forms might be beneficial.

Evaluating the histological-based condition of wild collected larval fish: A synthetic approach applied to common sole (Solea solea)

Abstract In the present study, the histological-based condition of common sole (Solea solea) larvae in the English Channel was evaluated to assess the relevance of experimentally-calibrated indices for wild collected specimens. Based on topographical observation of foregut, midgut, hindgut, liver and pancreas, each of the 202 larvae analysed was attributed one of the six grades of a condition index that was developed for sole in the nineties. In parallel, a synthetic table of 20 criteria historically used as condition indicators was created from an extensive review of the literature. These criteria were related to tissular integrity, cells height, nuclei, presence of prey and vacuolisation of the same five target organs. For each larva, each criterion was scored on a scale from one to three. Multiple correspondence analyses coupled to clustering and indicator values were used to explore the relationship between the condition index and criteria as well as to highlight which complementary information the latter could provide to the former. Results showed that some adjacent grades were related to the same set of scored criteria, suggesting that these grades are not as distinguishable in the field as they can be in controlled conditions. Some criteria like vacuoles in the enterocytes, size of the hepatocytes, amount of zymogen, stain of acini, presence of prey in the digestive tract and goblet cells in the foregut, were independent of the condition index and depicted more recent food intake than a true condition status. Conversely, criteria related to tissular integrity as well as presence of energetics reserves like vacuoles in the liver appeared more relevant to evaluate the condition status of fish larvae since their increasing scores were associated to different grades. It is concluded that the grading system obtained from experimental observations may not be adapted to reflect the different larval condition states that could be encountered in the field. A simplified grading system, based on three grades and a reduced set of relevant criteria is then proposed.

Hunting success of lions affected by the moon's phase in a wooded habitat

AbstractVariation in moonlight affects foraging, hunting and vigilance behaviours in many nocturnal species. Here, we explore the effect of moonlight on the movement and hunting behaviour of African lions. Previous studies found bright moonlight is associated with reduced hunting success; however, those studies were largely undertaken in open habitats where predators are easily seen by prey species on moonlit nights. In this study, we explored whether moonlight affected hunting behaviour and success in a largely wooded environment. Measures of short‐term lion movements (distance moved, displacement and path tortuosity) derived from GPS telemetry data were used as indicators of movement behaviour. Field observations of belly distension were used to assess recent food intake. Lions had greater belly distension (indicating feeding success) on dark nights. However, this change in feeding success was not reflected by lion movement patterns—there was no evidence that these changed across moon phases. There was no evidence that lions used more covered habitats on brighter nights to facilitate concealment.

Do female northern vipers (Vipera berus) really stop feeding during pregnancy?

A temporary reduction or even cessation of feeding has been documented in a wide range of vertebrate species and is usually attributed to conflicts between foraging and other activities. It is generally recognised that females of Old World vipers (Vipera spp.) reduce or even stop feeding during pregnancy, even though detailed quantitative information for most species is limited. We conducted a long-term (2000 – 2017) and intensive mark–recapture study in a large population of northern vipers (Vipera berus) and employed two indices of feeding frequency in adult females during their breeding years. The first index uses cross-sectional data and estimated that a strict minority (7 %) of captures of females in breeding years revealed detectable signs of recent food intake (swelling of the mid-body, voiding of solid faeces). A second index is based on the magnitude of increases in body mass over recapture intervals of individual females, which can be attributed to the intake of food. Depending on the criteria used to consider an increase in body mass as a consequence of prey consumption, about 12 % (range: 2 – 29 %) of recaptures revealed indications of prey consumption. Overall, we estimated that ca. 20 % of the reproductive females fed at least once before parturition. We thus confirm that most pregnant female V. berus fail to feed, but also point out that the number of females that feed occasionally during pregnancy is higher than has often been assumed. We suggest that reduced foraging by pregnant northern vipers is, presumably in part, a consequence of their behaviour of residing in habitats where feeding opportunities are rare because prey encounter rates are low.

Inter-relationship between diet, lifestyle habits, gut microflora, and the equol-producer phenotype: baseline findings from a placebo-controlled intervention trial

Equol is an active metabolite of isoflavones produced by gut microbiota. It is beneficial to health; however, equol-producing ability varies greatly among individuals. These variations depend on the host's gut microbiota and lifestyle habits including diet. We investigated the relationship between the gut microbiota, lifestyle habits including diet, and equol-producing ability in postmenopausal Japanese women. We studied 58 postmenopausal Japanese women aged 48 to 69 years who visited the Sendai Medical Center in January, 2018. Self-administered questionnaires assessed their recent and remote food intake histories and lifestyle habits. Fecal microbiome analysis was performed using a next-generation sequencer. Urinary equol was measured using an immunochromatographic strip test. Women with urinary equol concentration >1.0 μM were defined as equol producers. Equol-producing bacteria were identified in 97% (56) of women; however, only 13 (22%) were equol producers. Equol producers showed significantly higher microflora diversity (P = 0.002), and significantly different recent and remote food intake patterns compared with equol nonproducers. Higher consumption of foods such as meat, fish, soy, vegetables, and Japanese snacks positively affected microbial diversity and equol production, whereas a high intake of Ramen and smoking showed negative effects. Equol production might not depend on the quantity, but on the quality of equol-producing bacteria. High microbial diversity might enhance equol production. Increasing microbial diversity through healthy lifestyle habits and habitual consumption of a wide variety of foods might be useful to maintain a healthy gut environment for equol production.

Phosphorus Consumption Within 1 Hour Prior to Blood Work and Associated Serum Levels of Phosphate, Calcium, and PTH in Adult Patients Receiving Hemodialysis Treatment.

Background:While dietary intake is known to influence serum markers of chronic kidney disease–mineral and bone disorder (CKD-MBD), the effects of recent food and beverage intake, particularly phosphorus consumption on these serum markers (phosphate, calcium, and parathyroid hormone [PTH]), are unknown in hemodialysis patients. An understanding of these effects could have direct and important implications on the management of CKD-MBD.Objective:To determine whether serum phosphate, calcium, and PTH levels were higher in hemodialysis patients who had consumed dietary phosphorus within 1 hour prior to their routine dialysis-related blood work (non–phosphorus-fasted) compared with patients who did not (phosphorus-fasted).Design:Observational, cross-sectional study.Setting:Kingston Health Sciences Center—Kingston General Hospital Site and its affiliated satellite hemodialysis units.Patients:Two hundred fifty-four adult patients receiving outpatient hemodialysis treatment for end-stage kidney disease were recruited.Measurements:The main measurements for this study included an assessment of dietary phosphorus intake as well as serum phosphate, calcium, PTH, albumin, Kt/V, and urea reduction ratio.Methods:A direct patient interview was performed to assess dietary phosphorus intake within 1 hour prior to routine dialysis-related blood work. The Canadian Nutrient File was then used to estimate dietary phosphorus based on the specific foods and beverages (including portion sizes and brands where applicable) identified in the interview. Serum measures of phosphate, PTH, calcium, albumin, and dialysis adequacy (Kt/V and urea reduction ratio) were obtained from participants’ routine dialysis-related blood work.Results:Non–phosphorus-fasted participants had nonsignificantly higher serum PTH levels compared to phosphorus-fasted participants (61.2 ± 64.7 vs 47.9 ± 39.7, P = .05). Non–phosphorus-fasted participants with PTH levels at the Kidney Disease Improving Global Outcomes (KDIGO) “target” (between 15 and 60 pmol/L) had significantly higher serum phosphate levels relative to phosphorus-fasted participants (1.6 ± 0.3 vs 1.4 ± 0.4, P = .006). In non–phosphorus-fasted participants, there was a nonsignificant association between the number of items containing inorganic phosphate additives and higher levels of serum phosphate and lower levels of serum calcium.Limitations:Some limitations include the cross-sectional nature of this study, self-reporting biases and estimates (as opposed to direct measurements) related to the dietary assessment, and the use of single (and not serial) assessments of serum measures.Conclusions:Dietary phosphorus intake in close proximity to blood work may contribute to subtle alterations in some key serum CKD-MBD parameters in adult outpatient hemodialysis patients but may not meaningfully alter CKD-MBD management.

Accumulate or eliminate? Seasonal mercury dynamics in albatrosses, the most contaminated family of birds

Albatrosses (Diomedeidae) are iconic pelagic seabirds whose life-history traits (longevity, high trophic position) put them at risk of high levels of exposure to methylmercury (MeHg), a powerful neurotoxin that threatens humans and wildlife. Here, we report total Hg (THg) concentrations in body feathers from 516 individual albatrosses from 35 populations, including all 20 taxa breeding in the Southern Ocean. Our key finding is that albatrosses constitute the family of birds with the highest levels of contamination by Hg, with mean feather THg concentrations in different populations ranging from moderate (3.8 μg/g) to exceptionally high (34.6 μg/g). Phylogeny had a significant effect on feather THg concentrations, with the mean decreasing in the order Diomedea > Phoebetria > Thalassarche. Unexpectedly, moulting habitats (reflected in feather δ13C values) was the main driver of feather THg concentrations, indicating increasing MeHg exposure with decreasing latitude, from Antarctic to subtropical waters. The role of moulting habitat suggests that the majority of MeHg eliminated into feathers by albatrosses is from recent food intake (income strategy). They thus differ from species that depurate MeHg into feathers that has been accumulated in internal tissues between two successive moults (capital strategy). Since albatrosses are amongst the most threatened families of birds, it is noteworthy that two albatrosses listed as Critical by the World Conservation Union (IUCN) that moult and breed in temperate waters are the most Hg-contaminated species (the Amsterdam and Tristan albatrosses). These data emphasize the urgent need for robust assessment of the impact of Hg contamination on the biology of albatrosses and they document the high MeHg level exposure of wildlife living in the most remote marine areas on Earth.

Dynamics and Trends in Fecal Biomarkers of Gut Function in Children from 1-24 Months in the MAL-ED Study.

Growth and development shortfalls that are disproportionately prevalent in children living in poor environmental conditions are postulated to result, at least in part, from abnormal gut function. Using data from The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal cohort study, we examine biomarkers of gut inflammation and permeability in relation to environmental exposures and feeding practices. Trends in the concentrations of three biomarkers, myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT), are described from fecal samples collected during the first 2 years of each child's life. A total of 22,846 stool samples were processed during the longitudinal sampling of 2,076 children 0–24 months of age. Linear mixed models were constructed to examine the relationship between biomarker concentrations and recent food intake, symptoms of illness, concurrent enteropathogen infection, and socioeconomic status. Average concentrations of MPO, NEO, and AAT were considerably higher than published references for healthy adults. The concentration of each biomarker tended to decrease over the first 2 years of life and was highly variable between samples from each individual child. Both MPO and AAT were significantly elevated by recent breast milk intake. All three biomarkers were associated with pathogen presence, although the strength and direction varied by pathogen. The interpretation of biomarker concentrations is subject to the context of their collection. Herein, we identify that common factors (age, breast milk, and enteric infection) influence the concentration of these biomarkers. Within the context of low- and middle-income communities, we observe concentrations that indicate gut abnormalities, but more appropriate reference standards are needed.

Providing Oral Nutrition to Women in Labor: American College of Nurse-Midwives.

Historically, oral intake for women during labor has been limited to nothing by mouth or clear liquids only. These restrictions are based on the risk of aspiration during or after the administration of general anesthesia. While aspiration can be life threatening, older methods of anesthesia are rarely used in current intrapartum care, and evidence is inconclusive that withholding oral nutrition reduces the risk of gastric aspiration. Additionally, withholding oral nutrition may result in the development of ketosis and may potentially contribute to a woman's stress and dissatisfaction with the birth experience. The purpose of this Clinical Bulletin is to review the evidence related to this practice and provide recommendations to promote informed, shared decision making regarding oral intake during labor with women at low risk for gastric aspiration.

Recent Fast Food Consumption and Bisphenol A and Phthalates Exposures among the U.S. Population in NHANES, 2003-2010.

Background:Phthalates and bisphenol A (BPA) are widely used industrial chemicals that may adversely impact human health. Human exposure is ubiquitous and can occur through diet, including consumption of processed or packaged food.Objective:To examine associations between recent fast food intake and BPA and urinary metabolites of di(2-ethylhexyl) phthalate (ΣDEHPm) and diisononyl phthalate (DiNPm) among the U.S. population.Methods:We combined data on 8,877 participants from the National Health and Nutrition Examination Survey (NHANES 2003–2010). Using 24-hr dietary recall data, we quantified: a) fast food intake [percent of total energy intake (TEI) from fast food]; b) fast food-derived fat intake (percent of TEI from fat in fast food); and c) fast food intake by food group (dairy, eggs, grains, meat, and other). We examined associations between dietary exposures and urinary chemical concentrations using multivariate linear regression.Results:We observed evidence of a positive, dose–response relationship between fast food intake and exposure to phthalates (p-trend < 0.0001) but not BPA; participants with high consumption (≥ 34.9% TEI from fast food) had 23.8% (95% CI: 11.9%, 36.9%) and 39.0% (95% CI: 21.9%, 58.5%) higher levels of ΣDEHPm and DiNPm, respectively, than nonconsumers. Fast food-derived fat intake was also positively associated with ΣDEHPm and DiNPm (p-trend < 0.0001). After adjusting for other food groups, ΣDEHPm was associated with grain and other intake, and DiNPm was associated with meat and grain intake.Conclusion:Fast food may be a source of exposure to DEHP and DiNP. These results, if confirmed, could inform individual and regulatory exposure reduction strategies.Citation:Zota AR, Phillips CA, Mitro SD. 2016. Recent fast food consumption and bisphenol A and phthalates exposures among the U.S. population in NHANES, 2003–2010. Environ Health Perspect 124:1521–1528; http://dx.doi.org/10.1289/ehp.1510803

Compliance with preoperative oral nutritional supplements in patients at nutritional risk--only a question of will?

Preoperative nutrition has been shown to reduce morbidity after major gastrointestinal (GI) surgery in selected patients at risk. In a randomized trial performed recently (NCT00512213), almost half of the patients, however, did not consume the recommended dose of nutritional intervention. The present study aimed to identify the risk factors for noncompliance. Demographic (n = 5) and nutritional (n = 21) parameters for this retrospective analysis were obtained from a prospectively maintained database. The outcome of interest was compliance with the allocated intervention (ingestion of ⩾ 11/15 preoperative oral nutritional supplement units). Uni- and multivariate analyses of potential risk factors for noncompliance were performed. The final analysis included 141 patients with complete data sets for the purpose of the study. Fifty-nine patients (42%) were considered noncompliant. Univariate analysis identified low C-reactive protein levels (P = 0.015), decreased recent food intake (P = 0.032) and, as a trend, low hemoglobin (P = 0.065) and low pre-albumin (P = 0.056) levels as risk factors for decreased compliance. However, none of them was retained as an independent risk factor after multivariate analysis. Interestingly, 17 potential explanatory parameters, such as upper GI cancer, weight loss, reduced appetite or co-morbidities, did not show any significant correlation with reduced intake of nutritional supplements. Reduced compliance with preoperative nutritional interventions remains a major issue because the expected benefit depends on the actual intake. Seemingly, obvious reasons could not be retained as valid explanations. Compliance seems thus to be primarily a question of will and information; the importance of nutritional supplementation needs to be emphasized by specific patients' education.

Huge Adrenal Hemangioma: A Rare Cause of Deceivingly High Liver Stiffness Measurement by Transient Elastography

ransient elastography (Fibroscan; Echosens, Paris, TFrance) is a noninvasive tool with satisfactory accuracy and reproducibility to estimate liver fibrosis and steatosis. It has become an important investigation in patients with liver diseases. Because the latest model of Fibroscan can measure controlled attenuation parameter and liver stiffness simultaneously, it may be used as a screening tool for fatty liver in high-risk individuals, eg, diabetic and obese subjects. With increasing applications of transient elastography in large cohorts of asymptomatic patients, interpretation of liver stiffness measurement (LSM) may sometimes be challenging. Grossly elevated serum alanine aminotransferase, extrahepatic cholestasis, hepatic congestion, hepatic amyloidosis, and recent food intake result in falsely high LSM and incorrect diagnosis of cirrhosis. Here we report a patient with a huge adrenal hemangioma that affected LSM. An 80-year-old man had a 10-year history of diabetic mellitus, hypertension, and hyperlipidemia. Transient elastography examination was performed in March 2014 for suspected nonalcoholic fatty liver disease. The median of 10 LSMs was 34.8 kPa, a level suggestive of cirrhosis because LSM was above 10.3 kPa. The success rate of LSM was 91%, and the interquartile range was 9.7 kPa, indicating good quality examination. As part of the work-up for probable cirrhosis, abdominal ultrasonography was performed and showed a large tumor in the right upper quadrant. Subsequent positron emission tomography–computed tomography confirmed the mass to be a large hypermetabolic, partially cystic/necrotic mass arising from the right adrenal area that measured 12.3 13.9 13.8 cm, with a maximum standardized uptake value (SUV) of 2.2 (Figures A and B). Laparotomy and right adrenalectomy were subsequently performed. Pathological features were in keeping with hemangioma with extensive degenerative changes and massive hemorrhage. A liver biopsy examination was also performed in the perioperative period, which showed no evidence of liver fibrosis (Brunt stage 0). The use of transient elastography has increased exponentially since its approval by the U. S. Food and Drug Administration on April 5, 2013. LSM correlates