Summary Background & aims For patients in the intensive care unit (ICU), nutritional risk assessment is often difficult. Traditional scoring systems cannot be used for patients who are sedated or ...unconscious since they are unable to provide information on their history of food intake and weight loss. We aim to validate the NUTRIC (NUTrition RIsk in Critically ill) score, an ICU-specific nutrition risk assessment tool in Asian patients. Methods This was an observational study in the medical ICU of a university-affiliated tertiary hospital. We included all adult patients (≥18years) admitted between October 2013 and September 2014 who stayed for more than 24 h in the ICU. Components of the modified NUTRIC (mNUTRIC) score, demographic details, body mass index (BMI), use of mechanical ventilation (MV), vasopressor drugs, and renal replacement therapy (RRT) were obtained from the ICU database. For patients on MV (maximum 12 days), we calculated the energy intake and nutritional adequacy (energy received ÷ energy recommended) from enteral or parenteral feeding data. Multivariable logistic regression analysis was used with 28-day mortality as the outcome of interest. Results 401 patients (62% male, mean age 60.0 ± 16.3 years, mean BMI 23.9 ± 6.2 kg/m2 ) were included. In the univariate analysis, BMI, mNUTRIC score, MV, vasopressor, and RRT were associated with 28-day mortality. In the multivariable logistic regression analysis, mNUTRIC score (Odds ratio, OR 1.48, CI 1.25–1.74, p < 0.001), vasopressor (OR 2.31, CI 1.28–4.15, p = 0.005), and BMI (OR 0.92, CI 0.87–0.97, p = 0.002) were associated with 28-day mortality. Nutritional adequacy was assessed in a subgroup of 273 (68%) patients who received MV for at least 48 h. Median (IQR) nutritional adequacy was 0.44 (0.15–0.70). In patients with high mNUTRIC score (5–9), higher nutritional adequacy was associated with a lower predicted 28-day mortality; this was not observed in patients with low mNUTRIC (0–4) score (effect modification, p interaction <0.001). Conclusion In a mixed Asian ICU population, mNUTRIC score is independently associated with 28-day mortality. Increased nutritional adequacy may reduce the 28-day mortality in patients with a high mNUTRIC score.
The popularity of vegetarian and vegan diets is growing due to increased awareness of the environmental and health benefits of such diets. However, despite the consumption of meatless diets being ...associated with decreased risk of chronic diseases and mortality, followers of these diets are prone to certain nutritional inadequacies, which could limit health benefits. The main nutrients of concern are vitamin B12, vitamin D, iodine, selenium, calcium, and iron. It is essential for all those following vegetarian and vegan diets to implement vitamin B12 supplementation. To prevent vitamin B12 deficiency, adults should take one oral dose of 50–100 μg cyanocobalamin daily or 2000 μg weekly divided into two oral cyanocobalamin doses. Iodine supplementation is essential for pregnant and breastfeeding women and is recommended for vegetarians and vegans who are unable to access sea vegetables or iodine-fortified foods. The recommended dose of iodine supplement for adults is 150 μg daily. Selenium supplementation should be reserved for individuals with clinical evidence of deficiency due to concerns of adverse effects on lipid profiles and type 2 diabetes risk. It is recommended that vegetarian and vegan adults should supplement 4000 International Units (IU)/d of oral vitamin D to prevent deficiency as sunlight exposure is unreliable due to a range of lifestyle and environmental factors. This recommendation also applies to omnivores. As a precaution, those wishing to transition to a more plant-based diet should consider how they will substitute the nutrition they currently obtain from animal-based foods with plant-based sources or appropriate supplementation.
Background: Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake ...of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children.Objective: We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children.Design: Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality.Results: In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality.Conclusions: Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.
Update of the Healthy Eating Index: HEI-2010 Guenther, Patricia M., PhD, RD; Casavale, Kellie O., PhD, RD; Reedy, Jill, PhD, RD ...
Journal of the Academy of Nutrition and Dietetics,
04/2013, Letnik:
113, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract The Healthy Eating Index (HEI) is a measure of diet quality in terms of conformance with federal dietary guidance. Publication of the 2010 Dietary Guidelines for Americans prompted an ...interagency working group to update the HEI. The HEI-2010 retains several features of the 2005 version: (a) it has 12 components, many unchanged, including nine adequacy and three moderation components; (b) it uses a density approach to set standards, eg, per 1,000 calories or as a percentage of calories; and (c) it employs least-restrictive standards; ie, those that are easiest to achieve among recommendations that vary by energy level, sex, and/or age. Changes to the index include: (a) the Greens and Beans component replaces Dark Green and Orange Vegetables and Legumes; (b) Seafood and Plant Proteins has been added to capture specific choices from the protein group; (c) Fatty Acids, a ratio of polyunsaturated and monounsaturated to saturated fatty acids, replaces Oils and Saturated Fat to acknowledge the recommendation to replace saturated fat with monounsaturated and polyunsaturated fatty acids; and (d) a moderation component, Refined Grains, replaces the adequacy component, Total Grains, to assess overconsumption. The HEI-2010 captures the key recommendations of the 2010 Dietary Guidelines and, like earlier versions, will be used to assess the diet quality of the US population and subpopulations, evaluate interventions, research dietary patterns, and evaluate various aspects of the food environment.
The gluten-free diet (GFD) is currently the only effective treatment in remitting the symptoms of coeliac disease (CD), a chronic systemic autoimmune disorder caused by a permanent intolerance to ...gluten proteins in genetically susceptible individuals. The diet entails the substitution of gluten-containing products with gluten-free-rendered products. However, over recent decades the nutritional profile of gluten-free (GF) food products has been increasingly questioned within the scientific community. The aim of this paper is to review the nutritional profile of gluten-free-rendered products currently available on the market, and discuss the possible relationship thereof with the nutritional status of coeliac patients on a GFD. Key inadequacies of currently available GF products are low protein content and a high fat and salt content. More adequate levels of dietary fiber and sugar than in the past have been reported. Population studies confirmed the above mentioned inadequacies. Further efforts are required to conceive adoptable interventions for product development and reformulation in order to achieve compliance with nutritional recommendations.
Background Breakfast meals provide essential nutrients and energy to children and adolescents. Based on recommendations from the International Breakfast Research Initiative (IBRI), the Breakfast ...Quality Score (BQS) was developed to assess breakfast nutritional value among the French adult population. However, its application to children remains unexplored. Objective This study aimed to evaluate the BQS in assessing the nutritional quality of breakfasts consumed by French children aged 4–17 years. Methods A total of 4,015 breakfasts, obtained from dietary recalls provided by 1,448 children participating in the French representative dietary survey (INCA3), were analyzed. As for adults, the performance of the BQS was tested through correlations with other nutritional indicators and comparison of nutrients and dietary components between tertiles of scores. The study examined the regularity of breakfast consumption and compared the BQS of children’s breakfasts across socio-demographic modalities and breakfast categories distinguished by their primary grain component. Additionally, a predictive modeling using Partial Least Squares (PLS) regression identified influential INCA3 food groups. Results The majority of children consumed solid breakfasts regularly. Socio-professional category, household income and food insecurity influenced BQS, revealing contradictory disparities. Ready-to-eat cereal (RTEC) breakfasts had the highest BQS (73.5% for children and 73.1% for adolescent), while biscuits and viennoiseries scored the lowest (52% for children and 49.1% for adolescent). PLS highlighted RTECs, milk, and hot beverages (mainly containing chocolate milk) as being positively associated with BQS, while sweet beverages and viennoiseries were negatively associated. Conclusion The study demonstrates the effectiveness of the BQS in assessing children’s breakfast quality, with RTEC breakfasts showing the highest nutritional value. The findings provide insights into factors influencing breakfast nutritional quality and underscore the importance of promoting healthier breakfast choices among all children.
Consumers, food manufacturers and health professionals are uniquely influenced by the growing popularity of the gluten-free diet. Consumer expectations have urged the food industry to continuously ...adjust and improve the formulations and processing techniques used in gluten-free product manufacturing. Health experts have been interested in the nutritional adequacy of the diet, as well as its effectiveness in managing gluten-related disorders and other conditions. In this review, we aim to provide a clear picture of the current motivations behind the use of gluten-free diets, as well as the technological and nutritional challenges of the diet as a whole. Alternative starches and flours, hydrocolloids, and fiber sources were found to play a complex role in mimicking the functional and sensory effects of gluten in gluten-free products. However, the quality of gluten-free alternatives is often still inferior to the gluten-containing products. Furthermore, the gluten-free diet has demonstrated benefits in managing some gluten-related disorders, though nutritional imbalances have been reported. As there is limited evidence supporting the use of the gluten-free diet beyond its role in managing gluten-related disorders, consumers are urged to be mindful of the sensorial limitations and nutritional inadequacies of the diet despite ongoing strategies to improve them.
Background: Stunting was still found in coastal areas, whereas people there had greater opportunities to consume fish which is contain high animal protein to prevent stunting.Objectives: To analyze ...differences in parenting and nutrient adequacy level on stunting and non-stunting toddlers in the coastal area of Probolinggo District.Methods: This study was a case-control design, which conducted in the village of Pajurangan included Puskesmas Gending. The total sample were 46 toddlers (24-59 months old) divided into cases group (stunting) and control group (non-stunting) with each of group 23 toddlers, that chosen by simple random sampling method from 194 population of toddlers. Data collection included toddler height measurements with microtoise by researchers as well as the questionnaires parenting and SQ-FFQ. Data were analyzed using the Chi-Square test by Odds Ratio (OR).Results: 60.9% stunting group have parenting feeding medium category, but parenting basic health care have good parenting category (91.3%). Most of adequacy level of energy (60.9%), protein (65.2%) and zinc (56.5%) in stunting group were less category, whereas vitamin A was enough category (65.2%).Therefore, there were differences in parenting feeding (p=0.002; OR=10.37; 95%CI=2.374-45.301) and energy adequacy level (p=0.037; OR=4.407; 95%CI=1.26-15.414), protein (p=0.001; OR=12.5; 95%CI=2.828-55.254) and zinc (p=0.015; OR=6.175; 95%CI=1.589-23.993) on stunting and non-stunting toddlers. However, there were no differences in parenting basic health care (p=0.662) and adequacy of vitamin A (p=0.314) on stunting and non-stunting toddlers.Conclusions: Improper parenting and toddler with inadequate levels of energy, protein and zinc had greater risk of stunting compared to toddlers suffered enough. ABSTRAK Latar Belakang: Stunting masih terjadi di daerah pesisir, padahal masyarakat tersebut memiliki peluang lebih besar mengkonsumsi ikan yang kaya protein sehingga dapat mencegah stunting.Tujuan: Menganalisis perbedaan pola asuh dan tingkat kecukupan zat gizi pada balita stunting dan non-stunting di wilayah pesisir Kabupaten Probolinggo.Metode: Desain studi yang digunakan adalah case-control. Penelitian dilakukan di desa pesisir yaitu Desa Pajurangan, wilayah kerja Puskesmas Gending. Total sampel adalah 46 subjek balita berusia 24-59 bulan, terbagi menjadi 23 balita kelompok stunting dan 23 balita kelompok non-stunting. Pengambilan sampel menggunakan metode simple random sampling dari total populasi 194 balita. Pengumpulan data meliputi pengukuran tinggi badan balita dengan mikrotoa oleh peneliti serta wawancara kuesioner pola asuh dan Semi Quantitative Food Frequency Questionnare (SQ-FFQ). Data dianalisis menggunakan uji Chi-Square dengan melihat Odds Ratio (OR).Hasil: 60,9% kelompok stunting memiliki pola asuh pemberian makan kategori sedang, sedangkan pola asuh perawatan kesehatan dasar kategori baik (91,3%). Tingkat Kecukupan energi (60,9%), protein (65,2%) dan seng (56,5%) pada kelompok stunting kategori kurang, sedangkan vitamin A kategori cukup (65,2%). Terdapat perbedaan pola asuh pemberian makan (p=0,002; OR=10,37; 95%CI=2,374-45,301), tingkat kecukupan energi (p=0,037; OR=4,407; 95%CI=1,26-15,414), protein (p=0,001; OR=12,5; 95%CI=2,828-55,254) dan seng (p=0,015; OR=6,175; 95%CI=1,589-23,993) pada balita stunting dan non-stunting. Tidak terdapat perbedaan pola asuh perawatan kesehatan dasar (p=0,662) dan tingkat kecukupan vitamin A (p=0,314) pada balita stunting dan non-stunting.Kesimpulan: Pola asuh pemberian makan serta tingkat kecukupan energi, protein dan seng yang kurang berisiko lebih besar balitanya mengalami stunting dibanding kelompok yang cukup
Background: In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and ...middle-income countries (LMICs) remains to be established.Objective: We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs.Design: We carried out a systematic review of cohort and cross-sectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake.Results: A total of 33 studies from 17 LMICs were included (5 low-income countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries.Conclusions: In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs.
Abstract An index that assesses the multidimensional components of the diet across the lifecycle is useful in describing diet quality. The purpose of this study was to use the Healthy Eating ...Index-2005, a measure of diet quality in terms of conformance to the 2005 Dietary Guidelines for Americans, to describe the diet quality of Americans by varying sociodemographic characteristics in order to provide insight as to where diets need to improve. The Healthy Eating Index-2005 scores were estimated using 1 day of dietary intake data provided by participants in the 2003-2004 National Health and Nutrition Examination Survey. Mean daily intakes of foods and nutrients, expressed per 1,000 kilocalories, were estimated using the population ratio method and compared with standards that reflect the 2005 Dietary Guidelines for Americans. Participants included 3,286 children (2 to 17 years), 3,690 young and middle-aged adults (18 to 64 years), and 1,296 older adults (65+ years). Results are reported as percentages of maximum scores and tested for significant differences ( P ≤0.05) by age, sex, race/ethnicity, income, and education levels. Children and older adults had better-quality diets than younger and middle-aged adults; women had better-quality diets than men; Hispanics had better-quality diets than blacks and whites; and diet quality of adults, but not children, generally improved with income level, except for sodium. The diets of Americans, regardless of socioeconomic status, are far from optimal. Problematic dietary patterns were found among all sociodemographic groups. Major improvements in the nutritional health of the American public can be made by improving eating patterns.
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