Total Calories Research Articles

Application of the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool’s New Carbon Footprint Dataset

ObjectivesIncreasing concern about the environmental impacts of food production has motivated the development of a new dataset of food-related greenhouse gas emissions (GHGE). The dataset integrates with the Automated Self-Administered (ASA24) Dietary Assessment Tool, a popular web-based tool used by researchers. This paper aims to demonstrate the utility of this dataset by assessing the GHGE, or carbon footprint, of a menu from a consumer education program. MethodsThree days of a sample menu (breakfast, lunch, dinner, and snack) from the University of New Hampshire’s Extension program were entered into ASA24. The menu was based on a balanced food pattern with a range of protein sources, including meat and fish. The database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies (dataFRIENDS) was linked, by food code, with the ASA24-2020 items output file. Matches were found for all items except eight spices. Total calories and CO2 equivalents were calculated by meal and day, based on the weight of each food item. Healthy Eating Index (HEI) total and component scores were estimated for each day. Documentation of the development of GHGE data for ASA24 foods and how to use them will be located on NCI’s ASA24 website. ResultsFor the three days, total kcal were 1612,2168, and 1666, and dietary GHGE were 2.2, 3.4, and 3.2 kg CO2-eq. The third day included two types of meat: ground beef, which contributed 40.7% of that day’s carbon footprint; and a turkey patty, which contributed 3.4%. HEI scores for the three days were 94.0, 83.3, and 89.0, varying inversely with dietary GHGE. The day with the largest carbon footprint had the highest total protein component score, yet the lowest seafood and plant protein score. The opposite was true for the day with the smallest carbon footprint. ConclusionsThis paper demonstrates the application of dataFRIENDS, a new resource for ASA24 users to examine dietary carbon footprints and inform the literature on the environmental impact of food choices. The database can be used to examine menus and dietary intake data, and to compare dietary GHGE with diet quality metrics, which may affect individual food choices. Further analyses can provide context for policies regarding sustainability for federal dietary guidance. Funding SourcesNone.

Urinary Erythritol Is Increased in Response to Excess Dietary Sucrose

ObjectivesSugar-sweetened beverages are the largest source of added sugar, and the largest single source of calories, in the American diet. Consumption of added sugars is a dietary factor linked to risk of chronic disease, including obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). One of the metabolic fates of glucose, particularly in individuals with metabolic syndrome, is conversion to other sugars and polyols. Recently, the polyol erythritol was identified as a product of glucose in humans and other mammals. Excitingly, elevated circulating erythritol can predict T2DM and CVD development up to 20 years before disease onset. The relationship between diet and erythritol synthesis is unknown. We hypothesized that high sugar intake may promote erythritol synthesis from glucose. The purpose of this study was to determine if sugar in drinking water increases circulating erythritol in mice. MethodsWe fed 8-week-old C57BL/6J mice a high-fat diet with 60% fat-derived calories for two weeks. Mice were randomly divided into two treatment groups: water, or water with 30% sucrose (w/v). After two weeks of treatment, we recorded body weight, food and water intake, and fasting blood glucose. Fasting plasma erythritol and non-fasted urine erythritol were measured by gas chromatography-mass spectrometry (GC-MS). All data were analyzed using an unpaired t-test. ResultsAfter two weeks, we found that urine erythritol was 50% higher in mice treated with sucrose compared to water controls (p < 0.05). As expected, mice treated with sucrose water consumed more total calories and calories from carbohydrates than controls (p < 0.01 and p < 0.0001, respectively). There was no difference in body weight or fasting blood glucose between groups. Contrary to our expectation, there was also no significant difference in plasma erythritol between groups. ConclusionsOur findings demonstrate that erythritol synthesis and excretion are elevated in response to sugar in drinking water. This suggests that erythritol synthesis may be a mechanism to dispose of glucose during caloric excess. Funding SourcesThis work is supported by the Education and Workforce Development Predoctoral Fellowship from the USDA National Institute of Food and Agriculture.

Racial Differences in the Association of Fruit and Vegetable Intake With Cognitive Decline

Abstract Objectives Diet has been shown to be related to slower cognitive decline but there is limited knowledge on whether this relationship varies across race. Given the higher risk of cognitive impairment among African Americans (AA), diet could be a modifiable risk factor in this population. In this study, we examined racial differences (AA vs others) in the association of fruit (total fruits; berries) and vegetable (total vegetables; green leafy) intake with cognitive decline. Methods Analyses included 5423 participants of the Chicago Health and Aging Project (62% African American, 63% women, age = 73.6 (±6.1) years, education = 12.5 (±3.5) years) who completed a food frequency questionnaire and had at least two cognitive assessments (for each, a composite of 4 cognitive tests) for an average follow-up of 7.8 (±4.6) years. We used mixed models adjusted for age, sex, education, race, cognitive activities, physical activity, and total calories. Subsequent models tested interactions of diet (fruits and vegetables) with race, and models were race-stratified if p for interaction ≤0.05. Results Compared to NHW, AA had a lower (p &amp;lt; 0.0001) intake of total fruits, berries, and vegetables but a similar green leafy intake (p = 0.94). At baseline those in the highest quintile of vegetable (β = 0.126, p &amp;lt; 0.0001) and green leafy (β = 0.094, p = 0.0001) intake had better cognitive scores compared to those at the lowest quintile. During follow-up, vegetable intake in the overall population was associated with slower cognitive decline (Q5(4 servings/day) vs. Q1(&amp;lt;1 serving day) = β = 0.011, p = 0.02) and the association for green leafy intake (&amp;gt;1 serving/day vs. once/week) showed a trend (p = 0.08). There were no racial differences in the associations for vegetable and green leafy intake, however, the berry*race interaction was significant (p = 0.05). In stratified models, berry (≥once a week vs. less: β = 0.016, p = 0.01) intake was related to slower cognitive decline, but only in AA. Fruit intake was not associated with cognitive decline in either group. Conclusions Vegetable and green leafy intake may slow cognitive decline in older adults. Increasing berry intake may be an important public health intervention for brain health, particularly among African Americans. Funding Sources Alzheimer's Association and NIA.

Association of Diet and Antimicrobial Resistance in Healthy US Adults

ObjectivesAntimicrobial resistance (AMR) represents a significant source of morbidity and mortality worldwide, with expectations that AMR-associated consequences will continue to worsen throughout the coming decades. Since resistance to antibiotics is encoded in the microbiome, interventions aimed at altering the taxonomic composition of the gut might allow us to prophylactically engineer microbiomes that harbor less antibiotic resistant genes (ARGs). Diet is one method of intervention, yet little is known about the association between diet and antimicrobial resistance. Our primary hypothesis was that increased intake of dietary fiber would be associated with reduced ARG abundance in human fecal metagenomes. Beyond our directed hypotheses, we utilized machine learning approaches on a variety of diet, physiological, and lifestyle features to assess whether the abundance of antibiotic genes is correlated with variables outside the scope of our directed hypotheses.MethodsWe examined diet using the food frequency questionnaire (FFQ, habitual diet) and 24-hour dietary recalls (ASA24) coupled with analysis of the microbiome using shotgun metagenome sequencing in 290 healthy adult participants of the USDA Nutritional Phenotyping Study. Additionally, we applied machine learning to examine 387 dietary, physiological, and lifestyle features for associations with antimicrobial resistance.ResultsWe found that aminoglycosides were the most abundant and prevalent mechanism of AMR in these healthy adults and that aminoglycoside-o-phosphotransferases (aph3-dprime) negatively correlated with total calories and soluble fiber intake. Individuals in the lowest quartile of ARGs (Low-ARG) consumed significantly more fiber in their diets compared to Medium- and High-ARG individuals, which was concomitant with increased abundances of obligate anaerobes in their gut microbiota.ConclusionsOur results indicate individuals with lower abundances of antibiotic resistance genes consumed more diverse diets that were richer in fiber and limited in animal protein. We suspect that increased fiber likely drives the composition of the gut towards a more obligate anaerobe state, reducing footholds for facultative anaerobes, which are known harbors of inflammation and antibiotic resistance.Funding SourcesThis research was supported by USDA-ARS grants.

1490-PUB: Nutritional Deficiencies in Persons with Diabetes in Southwest Virginia

Introduction: Nutritional factors are associated with diabetes development and control. In addition to carbohydrate excess, other dietary contributions are decreased magnesium and fiber intake. Magnesium deficiency is related to beta cell dysfunction. Decreased dietary fiber intake is implicated in poor glycemic control. The intake of both fiber and magnesium among those with diabetes is not well known. This study provides objective data on the diet content of adults with diabetes in our area of Roanoke, VA where an estimated 11.6 % of the population has diabetes. Methods: 33 adult volunteers with diabetes recorded their food intake over 24 hours via access to the Automated Self-Administered 24-hour (ASA24®) dietary assessment tool. Macro and micronutrient intakes were calculated with reference intakes provided by RDA guidelines. The lowest reference intake was used to calculate pooled comparison for all ages by gender. P-values were calculated using one-sample t tests comparing sample averages with reference values. Logistic Regressions were used to evaluate the effect of age and sex on outcome. Results: The nutritional content of our participants with diabetes did not meet RDA guidelines with no significant age or sex differences between groups. Total calories were 2314 for men and 1862 for women. Carbohydrate intake exceeded the ADA recommended amount in 83 % of men (218g/d) and 67 % of women (196g/d) (p&amp;lt;0.01) . In addition, 83% of men and 76% of women did not meet recommended magnesium intake, averaging 314 ± 166 mg/d for men (p&amp;lt;0.05) and 264 ± 83 mg/d for women (p&amp;lt;0.01) . Finally, 100% of men and 90% of women did not meet reference fiber intake, averaging ± 9 g/d for men (p&amp;lt;0.01) and 14 ± 7 g/d for women. (p&amp;lt;0.01) . Conclusion: In addition to excessive carbohydrates, magnesium and fiber intake were significantly deficient among our population of patients with diabetes. These results may help to tailor diet interventions in future investigations for more directed nutrition approaches to improve glycemic control. Disclosure K. Mustafa: None. K. Jones: None. Funding Carilion Clinic RAPDiabetes Nutrition Study IRB 21-1307

Daily Almond Consumption Reduces Insulin Resistance and Serum Cholesterol Levels in Overweight Asian Indian Adults with Cardiometabolic Risk – A Randomized Controlled Trial

ObjectivesThe present study aimed to evaluate the efficacy of almonds consumption on insulin resistance, glycemia and lipid profile in overweight Asian Indian adults with cardiometabolic risks.MethodsA parallel-arm open-labelled, randomized controlled trial was conducted on 184 adults with cardiometabolic risks (CMR) (92 in each group). Adults with CMR were identified using the harmonizing criteria which includes presence of minimum of 3 of the following conditions: raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), impaired fasting glucose, and central obesity. The intervention group received 43g (1.5 oz) almonds/day for 12 weeks. The control group was instructed to follow their habitual diet except to exclude nuts in any form. The anthropometric, clinical, biochemical and dietary data of the participants were assessed periodically and their change from baseline were analysed using generalized linear model in SAS 9.4 version.ResultsThe study was completed by 165 adults (response rate 82.5%). Their mean age was 40 years and waist circumference 97 ± 9.6 cm at baseline. Significant reductions [mean (95%CI)] in IR (−0.5(−1.0–0.0); P = 0.04), serum total cholesterol (−10.6 mg/dl (−17.8- −3.4); P = 0.004) and low-density lipoprotein cholesterol (−7.5 mg/dl (−14.2- −0.8); P = 0.03) were observed in the intervention group compared to the control group. Within the intervention group, significant reduction of 1% each for body weight, body mass index, waist circumference, 3% fasting glucose and 2% serum triglyceride were noted compared to baseline. Multiple 24hr dietary recall as a compliance marker revealed significant increase in total fat, MUFA, PUFA calories and dietary fibre with a propionate reduction in carbohydrate calories in the intervention group compared to control group.ConclusionsDaily intake of 43g almonds reduced IR, total and LDL serum cholesterol in obese Asian Indians with CMR. Almond consumption also improved the overall quality of the diet.Funding SourcesThe present study was funded by Almond Board of California, Modesto, CA, USA.

Some factors affecting on the severity of Acute Psychoses in Alcohol Withdrawal

IntroductionAlcohol withdrawal delirium is severe complication of alcohol withdrawal leading to high mortality. Early identification of severe course of psychosis and complications threatening the patient’s life is the most important problem in the treatment of these patients.ObjectivesUnder supervision were 690 men, dependent on alcohol, in the state of withdrawal with acute psychotic disorder (primary hospitalization in the framework of this study); the average age - (39,9 ± 3,4 years), the average age of alcohol abuse - (9,7 ± 1, 1 years). The patients were examined in a dynamics after a re-hospitalization after 5-7 years. This allowed us to verify the differential diagnostic approach to acute psychotic disorders in a state of abandonment, to investigate the impact of chronic acute psychotic disorders on the course of alcohol dependence, including the formation of deficits.Methodsclinical, clinical and psychopathological, methods of quantified scales and mathematical statistics.ResultsThere were estimated factors influencing the severity of alcohol withdrawal with delirium: total amount of alcohol consumed per week, drunken alcoholics, persistent alcohol abuse, social disadaptation, cognitive impairment, psychological disorders, reducing the quality of alcohol consumed, food pattern characterized total calorie mostly due to alcohol, life trajectory, severe or chronic somatic diseases, rate of progression of alcohol dependence.ConclusionsThe severity of acute psychotic disorder in the state of alcohol withdrawal mostly depended situational factors such as the number of days of severe drinking before a psychotic disorder, the pattern of nutrition, the quality and quantity of alcohol consumed, the presence of acute somatic diseases.DisclosureNo significant relationships.

15-Year Trends in the Patterns of Meal Timing and Eating Frequency Among US Adults

ObjectivesTo characterize trends in meal timing and frequency in US population age > 19 years. MethodsWe performed a serial cross-sectional analysis of 8 National Health and Nutrition Examination Survey (NHANES) cycles (2003–2018) on 34,470 adults (52.5% women and 21% black). Time of food and beverage intake was extracted from two 24-hour food recalls. The following meal timing measures were defined: 1) The time of the last and first calorie intake either from food or drink, 2) Eating window: The time elapsed between the first and last food intake, 3) Nighttime fasting duration: The time between last and first food intake, 4) Calorie midpoint time: The time when half of the calories for the day were consumed, 5) Late night eating: Consumption of ≥33% of total daily energy between 5:00 pm and midnight, and 6) Eating frequency: Frequency of food or beverage consumption >0 kcal which were >15 minutes apart. Population means for these variables were estimated for each cycle and survey-weighted linear regression was used to assess annual changes in meal timing and frequency over 15 years. ResultsFrom 2003 to 2018, survey-weighted mean (±SE) of eating window decreased from 12.21 ± 0.06 to 12.02 ± 0.05 hours/d in both men and women (Ptrend = 0.002). Time of the last calorie intake significantly decreased from 20.31 ± 0.04 to 20.09 ± 0.03 hours/d, while the time of first calorie intake and eating frequency remained unchanged. More than two-third of participants consumed ≥ 33% of total daily energy after 5:00 pm. Over the 15-year span, composition of diet also changed, including a decline in total calorie intake (from 2178.5 ± 18.4 to 2089.0 ± 21.2 kcal/d) and percentage of energy from carbohydrate intake (from 49.0 ± 0.4 to 46.4 ± 0.3%), while percentage of energy from dietary fats increased (from 34.0 ± 0.4 to 36.5 ± 0.2%), Ptrend < 0.05. ConclusionsDietary intake of US adults has shifted to a lower % of calories from carbohydrates and a higher % from fat and a shorter eating time window. Caloric intake continues to be concentrated late in the day. These patterns are hypothesized to influence cardiometabolic health. Funding SourcesSamaneh Farsijani was supported by the K01 Career Development Award from the NIA (K01 AG071855-01A1) and the Pittsburgh Older Americans Independence Center (P30AG024827). Ziling Mao was supported by R01 AG059416 as a Graduate Student Researcher (GSR).

Urban and Rural Purchase Patterns of SNAP Participants in North Carolina

ObjectivesUrban and rural environments have different economic and social factors that influence un/healthy food access. SNAP participants are at greater risk for diet related chronic disease compared to non-SNAP participants and it is unclear whether rurality amplifies or alleviates these risks. This study examines grocery sales to SNAP participants from rural vs urban stores to provide insights into geographical disparities in the prevalence of chronic disease. MethodsWe used de-identified store-week level transaction data from a large grocery chain with >490 stores across North Carolina from Oct 2019-Dec 2020 (n = 32,182 store weeks), classifying stores as urban or rural based on USDA definitions (main exposure). We identified SNAP sales from payment mode and defined SNAP participation as having used a SNAP EBT card within the last 3 months. Products are classified into nutritionally meaningful categories: fruits, vegetables, nuts, and legumes (FVNL), sugar sweetened beverages (SSB), junk food (JF) and processed meats (PM), linked to nutrition data. We used multivariate random effects models with robust standard errors to examine the association of rural/urban stores with the share of calories of food categories purchased (main outcomes). We controlled for annual county level factors (socio-demographic composition, food environment) and weekly store level factors (composition of sales among SNAP vs non-SNAP). Results127 stores were classified as rural and 369 stores were urban. Adjusting for covariates, an average of 13.12% of total calories sold from rural stores were from FVNL, compared to an average of 13.27% of total calories sold from urban stores. Rural stores’ sales to SNAP participants had small but significantly higher share of total calories sold from SSBs (10.34% vs 9.36%), JF (30.68% vs 30.36%) and PM (5.7% vs 5.64%) compared to urban stores’ sales to SNAP participants. ConclusionsRural store sales to SNAP participants appear to be marginally different from urban store sales to SNAP participants which support concerns around the need to improve healthy food access and limit unhealthy food access in rural settings. Funding SourcesNational Institutes of Health (U48DP006374, NIH P2C HD050924).

Imbalance of Long-Chain Omega 3 Polyunsaturated Fatty Acids and Sterols in the Diet of Healthy Young People

ObjectivesThe present research was aimed at studying the content of lipid components with high biological activity in the diet of healthy young people, which regulate the risk of developing cardiovascular pathology. The purpose of this series of studies was the prevention of actual metabolic disorders as a result of changing the stereotypes choice food sources of the essential lipid components. MethodsThis study analyzed the diets of a representative group of students of the I.M.Sechenov First Moscow State Medical University: 77 men and 237 women aged 17–27. The 24 hour recall method was used three times and nutrient content was further assessed using a standard database. ResultsThe average energy value was 1788 ± 428.6 kcal for men and 1618 ± 605 kcal for women. The percentage of energy from total fat was higher than the recommended one (more than 30% of fat calories from the total energy value of the diet): by 75% (84.2 ± 23.3 g) and 95.3% (70.5 ± 23.2 g) in men and women respectively. Of greatest interest was the analysis of the amount and ratio of essential polyunsaturated fatty acids (PUFAs) of the omega 6 and omega 3 groups, as well as sterols. While the ratio of linoleic acid/α-linolenic acid was the same (9/1) in both men and women, a significant difference was shown in their amount: linoleic acid/α-linolenic acid in men was estimated at 12 g/1.4 g and 9.7 g/1.2 g in women. The amount of essential fatty acids was 6.1% and 0.7% of the total calorie content of the diet. Consumption of long-chain omega 3 PUFAs was extremely low: 80.5 ± 53.5 mg and 209.4 ± 139.5 mg of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), respectively, in the men group; 79.2 ± 68.05 mg and 229.7 ± 180.2 mg in the women group. The intake of cholesterol and plant sterols, as well as their ratio, turned out to be suboptimal both in men 1.40/1 (455 ± 204.8 mg/357 ± 163.9 mg) and in women 1.38/1 (372.3 ± 168.3 mg/295.8 ± 150.8 mg). ConclusionsThe results showed a significant imbalance of PUFAs and sterols in the students’ diet. To optimize the fatty acid composition of the diet, on the one hand, it is necessary to reduce the proportion of total fat, and also include sources of long-chain omega 3 PUFAs (EPA and DHA) in the diet 2–3 times a week, primarily through oily (but not salty) marine fish, on the other hand, consume low-fat foods containing plant sterols such as cereals products and vegetables daily. Funding SourcesNo funding.

Nutrient Composition of Plant-Based Substitutes for Animal-Sourced Foods: Evidence From Packaged and Processed Meats in 30 Countries

ObjectivesTo compare the nutrient composition of plant-based (PB) to animal-sourced (AS) items sold in 30 countries, and identify associated changes in national nutrient supply. MethodsUsing Euromonitor data from 30 countries for 2015–2021 we identified the main items contributing to PB and AS processed meat sales, and used their nutrient composition (calories, total fat, saturated fat, carbohydrate, fiber, sugar, protein, and sodium) to quantify the impacts of change in sales on the nutrient density of sales in each country and in total. ResultsSince 2014 total calories from PB meat rose a total of 3.1%/yr to 9.9 million kcal in 2021, in contrast to sales of AS processed meat which rose by about 1%/yr to 30.6 million kcal. In 2021, the energy in AS processed meat was 59% fat (22% kcal from saturated fats), 28% protein and 10% carbohydrates (3% kcal from sugar), with 0.21 g fiber, and 1.07 g sodium per 100 kcal. In comparison, energy in PB meats sold in 2021 was 41% fat (8% kcal from saturated fat), 31% protein and 13% carbohydrate (2% kcal from sugar), 2.17 g fiber and 0.56 g sodium per 100 kcal. The average annual changes in sugar were + 11% in AS and –4.1% in PB; sodium + 4% in PB and –1% in AS; and saturated fat + 12.6% in PB and –0.2% in AS. ConclusionsIsocaloric substitution of PB meat for AS processed meats would lower density by 14% for saturated fats and 18% for total fats, while raising density by 3% for both protein and carbohydrates, raising fiber intake by 1.99 g/100 kcal, and lowering sodium intake by 0.51 g/100 kcal. Differences between items, and reformulation over time of both AS and PB products would affect these results and may explain observed changes in this period. On average since 2015, the rise of PB meats has led to healthier food composition of the processed meats category regarding these nutrients of concern. Overall, PB alternatives have a preferential nutritional profile to AS processed meat. Funding SourcesNIFA National Needs Fellowship.

A Healthy Asian Ketogenic Diet, Regardless of Dietary Cholesterol Intake Improves Metabolic Parameters in Individuals With Metabolic Syndrome

Abstract Objectives We aimed to study the effect of an Asian ketogenic diet with increased egg consumption on anthropometries, glucose, and cholesterol homeostasis in people with metabolic syndrome. Methods We compared changes in metabolic parameters between a ketogenic diet (carbohydrate &amp;lt; 10% of total calories) with increased whole egg intakes (Yolk KD) or yolk-free ketogenic diet with egg white supplementation (White KD) and a balanced diet with controlled energy (C). This study included a 4-week run in phase, a 12-week intervention phase, and a follow up phase at week-36. Subjects were monitored for changes in anthropometries, biochemistries including oral glucose tolerance testing, and physical activities. Results When compared week-0 (baseline) with week-12, average body weight (Wt), waist circumference (WC), triglyceride (TG), and blood pressure in Yolk-KD and White-KD groups significantly reduced from week-0 (P &amp;lt; 0.05). No difference of these parameters in C group between week-0 and week-12 was observed (ns). When comparing Yolk-KD vs. White-KD groups, there was no difference of anthropometric and metabolic changes between week-0 vs. week-12 (ns). Wt, WC, TG, and diastolic blood pressure (DBP) in Yolk-KD group decreased 4 kg, 3.8 cm, 14.9 mg/dl, and 7.4 mmHg, respectively (P &amp;lt; 0.05). Wt, WC, TG, systolic blood pressure (SBP), and DBP in White-KD group decreased 3.9 kg, 3.3 cm, 18.1 mg/dl, 3.7 mmHg, and 4.7 mmHg, respectively (P &amp;lt; 0.05). Fasting blood sugar and high-density lipoprotein cholesterol at week-12 were not significantly different from baseline (ns). At week-36 weight reduction in Yolk-KD and White-KD groups still maintained better than that in C group (P &amp;lt; 0.05). The physical activity of all subjects was not change throughout study (ns). Conclusions Behavior modification through dietary changes plays a vital role in controlling metabolic syndrome. Implementation on ketogenic diet was easier than balanced diet with controlled energy. Therefore, an Asian ketogenic diet regardless of amounts of dietary cholesterol helps lose weight without negative impacts on physical and biochemical indices. Funding Sources Mahidol University.

Total Knee Arthroplasty With Robotic Surgical Assistance Results in Less Physician Stress and Strain Than Conventional Methods.

Poor surgical ergonomics and physiological stress have been shown to impair surgical performance and cause injuries. The prevalence of musculoskeletal pain among arthroplasty surgeons is inordinately high. This study compared surgeon stress and strain during robotic-assisted total knee arthroplasty (rTKA) and conventional TKA (cTKA). Continuous cardiorespiratory and ergonomic data of a single surgeon were measured during 40 consecutive unilateral TKAs (20 rTKAs, 20 cTKAs) using a smart garment and wearable sensors. Heart rate (HR), HR variability, respiratory rate, minute ventilation, and calorie expenditure were used as surrogate measures for physiological stress. Intraoperative ergonomics were assessed by measuring cervical and lumbar flexion, extension and rotation, and shoulder abduction/adduction. Mean operative time was longer for rTKA (48.2 ± 9 vs 31.8 ± 7min, P < .001). Calories expended per minute was lower for rTKA (2.53 vs 3.50, P < .001). Total calorie expenditure in rTKA cases 11-20 was significantly lower than the first 10 (107.1 ± 27 vs 137.6 ± 24, P = .015), and lower than cTKA (112.3 ± 37). Mean HR was lower for rTKA (81.5 ± 4 vs 90.1 ± 5, P < .001). Minute ventilation was also lower for rTKA (14.9 ± 1 vs 17.0 ± 1.0 L/min, P < .001). Mean lumbar flexion as well as the percentage of time spent in a demanding flexion position >20° were significantly lower during rTKA (P < .001). rTKA resulted in less surgeon physiologic stress, energy expenditure per minute, and postural strain compared to cTKA. Robotic assistance may help to increase surgical efficiency and reduce physician workload, but further studies are needed to determine whether these benefits will reduce musculoskeletal pain and injury among surgeons.

1129-P: Rising Prevalence of Type 2 Diabetes in the Young in Southern India

This ancillary analysis (STRIDE-I study) compares the prevalence ratio (PR) of type 2 diabetes (T2DM) in persons aged ≤40 and &amp;gt;40 years in 20 and 2016 in Southern India. In 2016, prevalence of T2DM, generalized and abdominal obesity increased in both groups (Table 1) . Hypertension and dyslipidaemia were higher among the older and younger population respectively. Higher intake of fat and protein increased the total calorie consumption in both groups. Sedentary time increased in the younger group in 2016. Poisson regression analysis (Table 2) showed an increase in the PR in 2016 in both groups. However, the increase was significantly higher in the younger group (30%) when compared to the older group (10%) . Disclosure A.Nanditha: None. P.Susairaj: None. A.Raghavan: None. K.Satheesh: None. R.Vinitha: None. D.Nair: None. C.Snehalatha: None. A.Ramachandran: None.

Examining Nutrient Intakes of Canadian Adults With Diabetes Using the Diabetes Canada Clinical Practice Guidelines Nutrient Profile Model

ObjectivesThe Diabetes Canada Clinical Practice (DCCP) Guidelines provide dietary recommendations for Canadians at risk and with diabetes to help lower risk and for self-management of diabetes. The DCCP nutrient profile model was developed to classify foods based on their adherence to the DCCP Guidelines. The objective of the study was to examine the nutrient intakes of Canadian adults with diabetes using the DCCP nutrient profile model. MethodsUsing one-day 24-hour dietary recall from the 2015 Canadian Community Health Survey-Nutrition, nutrient intakes of Canadian adults with self-reported status of diabetes were examined. Foods were categorized by the DCCP nutrient profile model as “least”, “partially”, or “most” aligned with the DCCP Guidelines. Mean nutrient intakes were estimated and standard errors were calculated using balanced repeated replication with 500 bootstrap weighted replicates. Mean estimates were adjusted for age, sex, energy intake, and misreporting status using least squares regression. ResultsCanadian adults with diabetes (n = 1,249) consumed 14% (341 kcal/d [95% CI: 254,428]), 54% (1,291 kcal/d [1112,1470]), and 31% (682 kcal/d [613,751]) of total calories from foods that are “least”, “partially”, and “most” aligned with the DCCP Guidelines, respectively. The proportion of total fat, carbohydrate, and protein intakes from foods that are “least”, “partially”, and “most” aligned with the DCCP Guidelines were similar to their caloric contribution. However, 49% of added sugar intakes (24.1 g/d [20.8, 27.4]) were consumed from foods “least” aligned with the DCCP Guidelines. Over 60% sodium (1,746 mg/d [1,578, 1,915]) and saturated fat (18.7 g/d [16.1, 21.4]) intakes were consumed from foods “partially” aligned with the DCCP Guidelines. More than half of the fiber intakes (11.2 g/d [10.2, 12.2]) were consumed from foods “most” aligned with the DCCP Guidelines. ConclusionsDespite the low caloric contribution of foods “least” aligned with the DCCP Guidelines, these foods contributed to disproportionate intakes of added sugar and saturated fat among Canadian adults with diabetes. The use of the DCCP nutrient profile model can help Canadians with diabetes improve their nutrient intakes. Funding SourcesCIHR Project Grant; Sanofi-Pasteur International Collaboration; CIHR-Doctoral Award (JJL).

Cross-Sectional Associations of Fruit and Vegetable Intake with Coronary Artery Calcification and Pericardial Adiposity

ObjectivesTo examine the associations between fruit and vegetable (F&V) scores derived from the Mediterranean Diet (MedDiet) and Healthy Eating Index (HEI, 2015) with coronary artery calcification (CAC) and pericardial adiposity (PAT) in adults with and without type 1 diabetes (T1D).MethodsWe conducted a cross-sectional analysis of baseline data from the Coronary Artery Calcification in Type 1 Diabetes study [n = 1255; T1D: n = 563; non-DM: n = 692]. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12 h overnight fast) biochemical analyses. CAC and PAT were measured using electron beam computed tomography. Logistic regression models examined associations of F&V scores with CAC (presence or absence) and linear regression models were applied to PAT analyses. Model 1 was adjusted for age, sex and diabetes status, model 2 added total calories, and model 3 added BMI and lipids (LDL and HDL-cholesterol).ResultsF&V scores had no associations with CAC in any of these models. In models 1 and 2, a one-point increase in the MedDiet-derived total fruit score was associated with a significant −1.79% (95% CI: (−0.03, −0.01); p-value = 0.0001) decrease in PAT. In model 3, a one-point increase in the MedDiet-derived total fruit score was associated with a borderline significant decrease of −0.74% (95% CI: (−0.01, 0.00); p-value = 0.054) in PAT. In models 1 and 2 for the HEI-derived total fruit score, a one-point increase in the total fruit score was associated with a significant −3.22% (95% CI: (−0.05, −0.01); p-value = 0.0012) decrease in PAT. In model 3 for the HEI-derived total fruit score, there was no significant association between the HEI-derived total fruit score and PAT (p-value = 0.140).ConclusionsBaseline analyses show MedDiet and HEI-derived total fruit scores maintained a significant to borderline significant inverse relationship with PAT, but F&V scores were not associated with presence of CAC.Funding SourcesNIH and ADA.

Time-Related Eating Patterns Are Associated with the Total Daily Intake of Calories and Macronutrients in Day and Night Shift Workers.

The aim of the study was to investigate whether time-related eating patterns are associated with the daily intake of calories and macronutrients in Brazilian male military police officers (n = 81; 29-day and 52-night workers; mean age: 36.4 ± 0.9 and 38.5 ± 0.7 years, respectively). Energy and macronutrient intake were determined by a non-consecutive 3-day food recall. Time-related eating patterns, such as the time of the first and the last meals, eating duration, and caloric midpoint, were evaluated. Individuals were classified as “early” or “late” eaters according to the median caloric midpoint. Night shift workers showed a later eating time for the last meal (p < 0.001), longer eating duration (p < 0.001), and later caloric midpoint (p = 0.037) than day workers. Late eaters from both workgroups consumed more 24 h energy (p = 0.028), fat in calories (p = 0.006) and protein (calories: p < 0.001; percentage of total calories: p = 0.042), and less carbohydrates in calories (p = 0.010) intake than early eaters. The time of the first meal was negatively correlated with 24 h energy (p = 0.024) and carbohydrate (p = 0.031) intake only in day workers. The time of the last meal was positively correlated with 24 h energy (day workers: β = 0.352; p = 0.044; night workers: β = 0.424; p = 0.002) and protein (day workers: β = 0.451; p = 0.013; night workers: β = 0.536; p < 0.001) intake for both shift workers, and with carbohydrate (β = 0.346; p = 0.016) and fat (β = 0.286; p = 0.042) intake only in night workers. Eating duration was positively correlated with energy (day workers: β = 0.473; p = 0.004; night workers: β = 0.320; p = 0.023) and carbohydrate (day workers: β = 0.418; p = 0.011; night workers: β = 0.364; p = 0.010) intake in both groups. Thus, time-related eating patterns indicative of intake later at night are associated with increased daily energy and macronutrient intake.

Independent and Joint Associations of Pessimism, Total Calorie Intake and Acid-Producing Diets with Insomnia Symptoms among Breast Cancer Survivors.

Insomnia is prevalent in up to 40% of breast cancer survivors. Few studies have examined pessimism and dietary factors as risk factors for insomnia among breast cancer survivors. We leveraged a cohort of 2944 breast cancer survivors who enrolled in the Women’s Healthy Eating and Living study; these survivors provided dietary, insomnia, mental health, demographic, and lifestyle information at baseline and at 1- and 4-year follow-up assessments. Insomnia symptoms were assessed using the Women’s Health Initiative (WHI)-Insomnia Rating Scale, and pessimism was assessed using the Life Orientation Test Revised (LOT-R). Total calorie intake and acid-producing diets were assessed using 24 h dietary recalls. Multivariable-adjusted generalized estimating equation (GEE) models were used to test the independent and joint effects of psychological and dietary factors on insomnia. In the multivariable model, women in the third tertile of pessimism had greater odds (OR = 1.57 95% CI [1.37–1.79]) of insomnia when compared to women in the lowest tertile. Total calorie intake and acid-producing diets were each independently and significantly associated with insomnia symptoms. Further, pessimism and calorie intake/acid-producing diets were jointly associated with insomnia. For instance, women with pessimism scores in tertile 3 and total calorie intakes < median reported 2 times the odds (OR = 2.09; 95% CI [1.51–3.47]) of insomnia compared to women with pessimism score in tertile 1 and calorie intakes < median. Our results highlight the need for patient care regarding mental health, and recommendations of healthy dietary intakes for breast cancer survivors.

The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study.

Hypophosphatemia might cause respiratory and heart failure and even death. We aimed to evaluate risk factors for hypophosphatemia and refeeding-related hypophosphatemia in patients requiring parental nutrition (PN). This was a single-center, retrospective study. Clinical parameters were obtained from medical records. Serum phosphate (inorganic phosphorus) was measured by photometric analysis. Hypophosphatemia was confirmed when serum phosphate level was less than 0.8mmol/L (≈2.5mg/dl). Refeeding related hypophosphatemia was confirmed if serum phosphate level had a decrease of 0.16mmol/L or more from baseline and if the final assessment was below 0.65mmol/L. A total number of 655 (426 men and 229 women, aged 62.8 ± 14.8years) hospitalized patients requiring PN were included in the study, and 60.6% of them were patients with cancer. The average body mass index (BMI) was 21.1 ± 4.1kg/m2 and the median of serum phosphate was 0.9mmol/L (quartile range: 0.68mmol/L, 1.11mmol/L). The prevalence of hypophosphatemia was 37.6% (246/655). Older age (≥ 65years vs. < 65years), lower serum level of pre-albumin (< 160mg/L vs. ≥ 160mg/L), calcium (< 2.11mmol/L vs. ≥ 2.11mmol/L), and magnesium (< 0.75mmol/L vs. ≥ 0.75mmol/L) were associated with high risk of hypophosphatemia by multivariate logistic regression (OR ranged from 1.43 to 3.06, all p < 0.05). Refeeding related hypophosphatemia was 9.5% (16/168). Serum level of calcium at baseline was significantly lower in participants with refeeding related hypophosphatemia than those without it. Total calorie and nitrogen delivered during first week of PN period showed no obvious difference between patients with and without refeeding related hypophosphatemia. Hypophosphatemia is common (37.6%) in hospitalized patients requiring PN. Monitoring of serum level of phosphorus is necessary to facilitate early treatment of hypophosphatemia.

The protective effect of peanuts, pine nuts and almonds on gastric intestinal metaplasia in Korean men.

There are reports that nut consumption provides potential benefit for gastric pathologies including stomach cancer and Helicobacter pylori infection. However, there are no studies investigating the effect of nut consumption on gastric intestinal metaplasia (GIM). In a Korean cohort of 53 424 men (average age 38.7± 7.0 years) and 33 024 women (average age 38.0± 7.0 years), we analysed the risk of GIM according to the frequency of nut consumption (peanuts, pine nuts and almonds only) as the following: rare (<1 serving/month), ≤1 serving/month and <1 serving/week, ≤1 serving/week and <3 serving/week, ≤3 serving/week and <5 serving/week and ≥5 serving/week where one serving is 15 g. Cox proportional hazards model was used to calculate the multivariable-adjusted hazard ratio (HR) for GIM and their 95% confidence intervals (CI) in each group (adjusted HR [95% CI]). Subgroup analysis was conducted by body mass index (BMI, non-obesity <25 and obesity ≥25). The models were adjusted for age, regular exercise, BMI, smoking, alcohol intake (g/day), diabetes mellitus, hypertension, dietary fibre intake, sodium intake and total calorie intake. After 5.3 years (median 5.9 years) of follow-up, GIM was observed in 5073 subjects. In men, compared with rare nuts consumption, greater nuts consumption was associated with a lower risk of GIM (rare consumption: reference, 1/month-1/week: 0.85 [0.79-0.91], 1-3/week: 0.81 [0.72-0.91], 3-5/week: 0.70 [0.57-0.86] and ≥5/week: 0.59 [0.48-0.73]). Subgroup analysis indicated that the inverse relationship between nuts consumption and the risk of GIM is more distinct in men without obesity (rare consumption: reference, 1/month-1/week: 0.83 [0.76-0.91], 1-3/week: 0.78 [0.67-0.91], 3-5/week: 0.68 [0.51-0.89] and ≥5/week: 0.51 [0.37-0.69]). However, this association was not observed in women. In conclusion, increased nuts consumption was associated with a decreased risk of GIM in working aged Korean men.