Journal of Nutrition and Metabolism

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Online ISSN: 2090-0732
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Percentage of nosocomial infection by a diagnosis of malnutrition or sarcopenia in cancer inpatients.
Article
  • Bianca Tabita MuresanBianca Tabita Muresan
  • Martín Núñez‐AbadMartín Núñez‐Abad
  • Ana ArteroAna Artero
  • [...]
  • Carlos J. Sánchez JuanCarlos J. Sánchez Juan
Aim. To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods. This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results. A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; p = 0.035 ). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, p < 0.024 ). Conclusion. This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.
 
Article
Obesity induces alterations in lipid biochemistry, evolving toward dyslipidaemia atherogenesis, a critical factor in the development of cardiovascular events. Two relevant forms of lipid abnormalities are atherogenic dyslipidaemia (AD) and lipid triad (LT), which involve alterations in triglyceride levels, HDL-c, and LDL-c. The aim of this study was to assess the linkage of atherogenic AD and LT with different scales of overweight and obesity. We carried out a cross-sectional study including 418,343 Spanish adult workers, recruited from workplace health assessments. Atherogenic dyslipidaemia was defined as triglyceride levels ≥ 150 mg/dL, HDL values < 40 mg/dL in men and <45 mg/dL in women, and normal LDL. Additionally, if LDL levels were >160 mg/dL, LT was considered. Subjects affected by AD and LT in the study exhibited significantly higher mean values than those without AD and LT in all overweight, obesity, and body fat related scales studied. VAI (visceral adiposity index) was the strongest predictor of AD (AUC = 0.934, 95% CI: 0.933 to 0.936) and LT (AUC = 0.926, 95% CI: 0.923 to 0.928). Atherogenic dyslipidaemia and LT positively correlate with different scales of overweight and obesity. Further studies should aim to identify other contributory factors. Our obtained data might be useful in laying the groundwork for future works on AD and LT.
 
Article
Context and objective. The time spent by young people at the university is generally marked by a profound transition in lifestyle and eating habits, which exposes them to several risk factors for diseases that will develop later such as chronic diseases related to diet. The objective of this study was to assess malnutrition and identify the particular risk factors for malnutrition among students at the University of Maroua. Methods. Three hundred and thirty students of both sexes, aged between 17 and 35 years old, were recruited from January to February 2018. Anthropometric parameters (weight, height, waist and hip circumference, and BMI) were measured, and an eating and lifestyle questionnaire was administered to each participant, as well as a 24-hour dietary recall. Results. The mean age of participants was 23.95 ± 3.67 years and BMI was 22.19 ± 2.78 kg/m2. Approximately 6.1% were underweight, 12.1% overweight, and 0.9% obese, and all age groups were affected. Concerning eating habits, low protein, fruit, and vegetable consumption were recorded among students. Cereals were the main source of carbohydrates consumed. Besides, 6% of them had a low dietary intake, 21% had a poorly diversified diet, and 2% were highly food insecure. The students’ daily macronutrient intake was within the recommended reference values, except for carbohydrates, which exceeded and represented 62.69± 13.84% of daily energy intake. Also, only 32.2% of respondents had adequate energy intake. A poorly diversified diet was associated with a high incidence of overweight. Conclusions. Both forms of malnutrition are indeed present among the students of the University of Maroua, and nutritional education for this young segment of the population will be essential to prevent complications associated with malnutrition in the working life.
 
Article
Objective. The aim of this study was to compare the concentration of iodine in drinking water in the same or different seasons of the year in Brazilian macroregions. Method. Water samples were collected from the Basic Health Units of eight municipalities that make up the different Brazilian macroregions and the Federal District. Sample collection took place in the summer, autumn, winter, and spring seasons. The spectrophotometric method with “leuco crystal violet” was used to determine the concentration of iodine in the water. Descriptive statistics on the data were performed. To verify if there was a difference in the concentration of iodine in the water between the climatic seasons of the year in the same place and between the same seasons in different locations, the Mann–Whitney or Kruskal–Wallis test was used and a p < 0.05 value was considered significant. Results. Among the climatic seasons throughout the year in the same location, there was a difference in the concentration of iodine in the water in the municipality of Pinhais, state of Paraná/South macroregion, between autumn and summer ( p = 0.041 ) and winter and summer seasons ( p = 0.003 ). There was a difference in the concentration of iodine in the water in the summer season between the Midwest and South macroregions; Northeast and Midwest, Southeast and South; North and Midwest, Southeast and South ( p < 0.05 ). In the autumn season, there was a difference in the concentration of iodine in the water between the Midwest and South macroregions; Northeast and Midwest, Southeast and South; North and Midwest, Northeast and South ( p < 0.05 ). In the winter season, there was a difference in the concentration of iodine in the water between the Southeast and Midwest and Southeast and South macroregions ( p < 0.05 ). In the spring season, there was a difference in the concentration of iodine in the water between the Southeast and Midwest and Southeast and South macroregions ( p < 0.05 ). Conclusion. There were differences in the iodine concentrations in drinking water in different locations in Brazil, when analyzed in the same seasons, and in the municipality of Pinhais between the autumn and summer and winter and summer seasons. Thus, it is suggested to monitor the iodine concentrations in water, considering the differences in climate, characteristics of each region, and soils throughout the Brazilian territory, since the deficiency or excess of iodine can bring risks to the health of the population.
 
Schematic presentation of the enrollment of participants in the study in Arba Minch Zuria district in February 2021.
Food groups consumed by pregnant mothers in Arba Minch Zuria district in February 2020.
Demographic and socioeconomic characteristics of pregnant mothers in South West Ethiopia in February 2020 (n � 367).
Factors associated with dietary diversity practice of pregnant mothers in Arba Minch Zuria district, South West-Ethiopia, February 2020 (n � 367).
Article
Background: Dietary diversity is very critical for fetal growth and development, as well as for the health and wellbeing of the mother. In Ethiopia, 41% of pregnant mothers consume diversified diets. There has been no study assessing whether pregnant women in southwest Ethiopia consume a varied diet. Objective: To estimate the proportion of adequate diversified dietary intake and to determine whether there is an association between diversified dietary intake and mothers' social capital. Design: A community-based cross-sectional study was conducted on 367 pregnant women in South West Ethiopia. A 24-hour multiple-pass dietary recall method was used to measure dietary intake and the 10 food groups of FANTA/FAO 2016 were used to analyze dietary diversity. Social capital was assessed based on the number of social networks in which a mother participated. Result: The proportion of diversified dietary intake was 14.7% (95% CI: 11.1, 18.3). Pregnant mothers who had social capital, had their own income, had emotional support from their husbands, were from a rich family, and had a frequent dietary intake were statistically associated with a diversified dietary intake, with an AOR of 7.8 (95% CI 1.02, 2.3 (95% CI 1.12, 4.44), 4.0, (95% CI 1.16, 13.7), 59.19), 2.3 (95% CI 1.04, 5.26), and 1.5 (95% CI 1.04, 2.07), respectively. Conclusion: Diversified dietary intake was found to be lower than previously reported, and it was associated with social capital. Methodologically rigorous studies are required to verify the association between social capital and adequate diversified dietary intake.
 
Standard CONSORT flowchart.
Article
Background: A potential effect of Job's tears on metabolic diseases has been recognized. However, studies on the effect of Job's tears on lipid profile and glycated albumin (GA) are still rare. This study aimed to examine the influence of Job's tears in conjunction with probiotics on the lipid profile and GA concentration of patients with type 2 diabetes mellitus. Methods: This double-blind 12-week study involved 60 patients with type 2 diabetes assigned randomly into two groups. The first group consumed yogurt alone (containing Lactobacillus acidophilus La5 and Bifidobacterium Bb12), while the second had yogurt with Job's tears once daily (200 ml each). Lipids and GA concentrations were measured using an enzymatic colorimetric assay. Paired and unpaired Students t-test, Wilcoxon signed-rank, and Mann-Whitney test were applied. Statistical significance was set at p < 0.05. Results: The characteristics of the groups were comparable except for baseline plasma GA (p=0.012). Subjects who used Metformin were distributed equally between the groups (p=0.118). Caloric intake between the groups also did not differ (p=0.856). There was also no change in weight, BMI, or plasma GA. Yogurt and the mixture of Job's tears and yogurt reduced cholesterol and LDL and increased HDL (all p < 0.05) within the groups. However, HDL levels in patients who had Job's tears were significantly elevated than yogurt alone (0.9 vs. 25 mg/dL, p=0.029). Conclusion: The combination of Job's tears and yogurt improved HDL more than yogurt alone.
 
CRP concentration (mg/L) analysis in celiac disease patients and healthy people. CTR—healthy control group, n = 12; FOS—CD patients submitted to fish oil supplementation, n = 11; and EXE—CD patients submitted to fish oil supplementation and aerobic exercise, n = 8. ∗P<0.05; ∗∗P<0.01. CRP (ml/L)—C-reactive protein expressed in milligrams per liter.
IL-6 results—inter- and intragroup analysis. (a) Groups distribution without IL-6 values <1.5 pg/ml: CTR—healthy control group, step 1, n = 6, step 4, n = 8; FOS—CD patients submitted to fish oil supplementation, phases 1 and 4, n = 8; and EXE—CD patients submitted to fish oil supplementation and aerobic exercise, phase 1, n = 6, step 4, n = 2; ∗P<0.05. IL-6—interleukin-6 expressed in pictograms per milliliter. (b) CTR—healthy control group, n = 12; FOS—CD patients submitted to fish oil supplementation, n = 11; and EXE—CD patients submitted to fish oil supplementation and aerobic exercise, n = 8. Results are shown in percentage (%) of individuals.
IL-6 results—inter- and intragroup analysis. (a) Groups distribution without IL-6 values <1.5 pg/ml: CTR—healthy control group, step 1, n = 6, step 4, n = 8; FOS—CD patients submitted to fish oil supplementation, phases 1 and 4, n = 8; and EXE—CD patients submitted to fish oil supplementation and aerobic exercise, phase 1, n = 6, step 4, n = 2; ∗P<0.05. IL-6—interleukin-6 expressed in pictograms per milliliter. (b) CTR—healthy control group, n = 12; FOS—CD patients submitted to fish oil supplementation, n = 11; and EXE—CD patients submitted to fish oil supplementation and aerobic exercise, n = 8. Results are shown in percentage (%) of individuals.
Correlation analysis. CTR—healthy control group, n = 12. ∗P<0.05; ∗∗P<0.01. CRP—C-reactive protein expressed in milligrams per liter (ml/L); %FM—fat mass expressed as a percentage.
Correlation analysis. CTR—healthy control group, n = 12. ∗P<0.05; ∗∗P<0.01. CRP—C-reactive protein expressed in milligrams per liter (ml/L); %FM—fat mass expressed as a percentage.
Article
Background: Several studies indicate that celiac disease patients present alterations within anthropometric, metabolic, and inflammatory parameters, while physical exercise and fish oil are known to activate modulatory pathways of such parameters. Objective: To investigate the effects of a 12-week-long protocol of aerobic exercise and its association with fish oil supplementation in nineteen adult celiac disease patients. Material and Methods. The celiacs were divided into 2 groups: (A) FOS: supplementation (n = 11); and (B) EXE: supplementation and exercise (n = 8). The celiac groups were compared to the adult healthy control group (CTR) (n 12). Aerobic exercises were performed weekly, in three sessions of 60 minutes each, with a maximal heart rate intensity of 60-70%. The participants received 2 g/day of fish oil, a daily intake of 420 mg of eicosapentaenoic acid, and 230 mg of docosahexaenoic acid. The following measurements were taken in four phases: (A) anthropometry: body mass, height, body mass index, waist-to-hip ratio, fat mass, and fat-free mass; (B) metabolic profile: total cholesterol, triglycerides, HDL, and LDL; and (C) inflammatory profile: C-reactive protein and interleukin-6. Results: Supplementation associated with aerobic exercise promoted a significant reduction in C-reactive protein (P < 0.01) and increased the proportion of individuals in the undetectable range of interleukin-6. Conclusions: The associated interventions showed a corrective and preventive potential in relation to disorders associated with chronic inflammation; however, the experimental design does not allow us to discriminate between the biological effects that are dependent on the association between interventions and those exclusively dependent on aerobic exercise.
 
Flowchart of patients included in the study.
Patients’ in-hospital mortality according to BMI categories.
ROC curve for mortality.
ROC curve for MV.
Article
Background. Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of “hospital mortality” patients. The second outcome is defined as “need for mechanical ventilation.” Methods and Materials. In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients’ lab results and pulse oximetric saturation SpO2/FiO2 (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk. Results. Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89–16.05), P=0.002), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01–7.83), P=0.041), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26–14.05), P
 
Article
Background: Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. According to the Indonesia Basic National Health Survey 2013, Indonesia's stunting prevalence reached 37.2%. Various studies have shown that impaired cognitive development is found in children with stunting and undernutrition. This study aims to determine cognitive development in stunted and undernutrition with normal stature children using the Bayley Scale of Infant Development III (Bayley-III). Methods: A cross-sectional study on 51 children aged one month to 3 years who fulfilled the inclusion criteria and who visited the outpatient clinic of Dr. Cipto Mangunkusumo National General Hospital from June 2017 to January 2018 was performed. Cognitive development was assessed using the Bayley Scale of Infant Development, Third Edition (Bayley-III). Results: 26 children with stunting and 25 children with undernutrition with normal stature participated in this study. There was a statistically nonsignificant trend toward lower median score percentiles in the stunted group compared to that in the undernourished with normal stature group in the motor (median (range) 1 (0.1-75) vs. 4 (0-79); p=0.183), cognitive (12.5 (0.1-75) vs. 16 (0.1-99.9); p=0.550), and adaptive behavior (7 (0.1-75) vs. 12 (0.1-58); p=0.657) domains. Conclusions: There is a trend toward lower cognitive, motor, and adaptive behavior abilities in stunted children compared to undernourished children with normal stature which needs further study. In addition, children with undernutrition have below-average abilities across all domains even before stunting has occurred.
 
Study areas.
Common amaranth vegetables in Kenya and Tanzania.
Pictures of the common amaranth species.
Article
African leafy vegetables such as amaranth have been utilized since time immemorial both as food and as medicine. These vegetables grew naturally in most rural environments, but currently most of them are cultivated both for home consumption and for sale. The aim of this study was to identify the most preferred amaranth species and cooking and utilization practices, as well as the beliefs and attitudes that encourage or discourage use of this vegetable. The study was carried out in seven counties of Kenya and in three regions in Tanzania. Twenty Focus Group Discussions (FGDs) with members of the community and twenty Key Informant Interviews (KIIs) with agricultural and nutrition officers were conducted in the study areas to obtain information on preferred varieties, sources of amaranth vegetables, common cooking methods, alternative uses, beliefs and taboos surrounding amaranth consumption, and the challenges experienced in production and consumption. The findings of the study showed that amaranth is one of the most commonly consumed indigenous vegetables in Kenya and Tanzania. The preference for varieties and cooking habits differs depending on the community and individuals. Amaranthus dubius and Amaranthus blitum were most common in Kenya, while Amaranthus dubius and Amaranthus hypochondriacus were most common in Tanzania. Most people consumed these vegetables because they were affordable and available or because of circumstance of lacking other foods. Regarding cooking, final taste was mostly considered rather than nutritional attribute. Several alternative uses of amaranth such as uses as medicine and livestock feed were also reported, as well as some beliefs and taboos surrounding the vegetable. Training on nutritional attributes and promotion of food preparation practices that ensure maximum nutrient benefits from amaranth is needed at the community level to realize the nutritional importance of the vegetables. Hands-on training and demonstrations were the most preferred modes of passing information.
 
Article
Previous studies have shown that the liquid gastric emptying mainly depended on energy content, regardless of compositional differences. But the gastric emptying of alcoholic beverages remains unclear. Therefore, we performed the present study to compare gastric emptying times between whisky mixed with water and glucose solution with uniform energy contents and volumes. As a crossover study, 10 healthy male volunteers ingested one of 3 test solutions with a uniform volume of 150 ml, i.e., whisky with water-containing whisky 30 ml (67 kcal), sugar water containing glucose 16.8 g (67 kcal), and water (0 kcal), and the gastric emptying time of each beverage was then assessed by ultrasound measurements of the gastric antral cross-sectional area. The gastric emptying pattern of whisky with water was faster than that of isocaloric sugar water, but slower than that of water. Each antral cross-sectional area 20, 30, and 40 min after the ingestion of sugar water was significantly larger than that of whisky with water. Antral cross-sectional areas 10 and 20 min after the ingestion of water were significantly smaller than those of whisky with water. In conclusion, the gastric emptying time of whisky would be faster than that of isocaloric glucose solution and slower than that of water. Unlike the other beverages, the gastric emptying time of alcohol drinks does not purely depend on the energy content because alcohol itself has no calorie before absorption. This study is registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000034443).
 
Flow diagram of participants’ summary.
Baseline characteristics of participants among the study groups.
Comparison of dietary intake between participants among the study groups.
Serum levels of MDA, TAC, and hs-CRP among the study groups.
Article
Aims of the Study. Reducing estrogen levels due to menopause activates oxidative and inflammatory processes, which causes symptoms of menopause, anxiety, and sexual dysfunction. As a suggestion, potential anti-inflammatory and antioxidant agents such as curcumin and vitamin E could be used as an effective alternative treatment due to parsimony, suitable access, and fewer side effects. Therefore, the present study was conducted to find out whether supplementation with curcumin and vitamin E affects inflammatory-oxidative stress biomarkers and primary symptoms of menopause in healthy postmenopausal women. Methods Used to Conduct the Study. The present study is a triple-blind parallel randomized controlled trial. Eighty-four eligible postmenopausal women aged 40 to 60 years old were randomly assigned into three groups using block randomization with an allocation ratio of 1 : 1 : 1. The curcumin group received one capsule containing 500 mg curcumin twice a day, the vitamin E group received one 500 mg capsule of vitamin E twice a day, and the placebo group took two placebo capsules containing 500 mg of microcrystalline cellulose (MCC) daily for eight weeks. Demographic and anthropometric characteristics, dietary intake, and early symptoms of menopause were collected at baseline. Serum levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and high sensitivity C-reactive protein (hs-CRP) were measured at baseline and after the intervention. Intervention safety and satisfaction with the intervention were also evaluated. Results of the Study. Eighty-one participants completed the trial and were finally analyzed. There were no statistically significant differences in demographic characteristics and dietary intake of participants (except for vitamin C intake, P=0.023) between the groups at baseline. The mean ± standard deviation (SD) score of total menopause symptoms, depression, anxiety, psychological, vasomotor, and physical domains significantly decreased within all groups (P<0.05). Between-group analyses indicated that decreasing the mean score of anxiety in the vitamin E group was significantly more than in the placebo group (P=0.026). The mean (SD) serum levels of MDA and hs-CRP significantly decreased only in the curcumin group (P=0.009 and P=0.025, respectively). Serum levels of TAC significantly increased in curcumin and vitamin E groups (P<0.001 and P=0.006, respectively). Conclusions Drawn from the Study and Clinical Implications. Curcumin could improve the oxidative stress (MDA and TAC) and inflammatory (hs-CRP) biomarkers. Vitamin E may also improve the antioxidant status by increasing the TAC levels. The alleviation of anxiety in the vitamin E group was more than in the placebo group. Clinical Trial Registration. The trial was registered at the Iranian Registry of Clinical Trials (https://irct.ir/IRCT20131009014957N6).
 
Consort flow diagram showing patients included in the study.
Comparison between the primary outcomes on the percentage of mean change of muscle mass, body fat mass, and basal metabolic rate between the curcumin and placebo groups. ∗statistically significant (p<0.05).
Comparison between the secondary outcomes on the percentage of mean change in handgrip strength, body mass index, and absolute lymphocyte count between the curcumin and placebo groups, ∗statistically significant (p<0.05).
Article
Background: Cancer anorexia-cachexia syndrome (CAS) is a significant comorbidity among all patients with cancer, increasing the mortality rate. Almost all patients with head and neck cancer experience this syndrome. CAS causes increased energy expenditure by increasing systemic inflammation and decreasing energy consumption due to anorexia. It leads to skeleton muscle breakdown and reduces the quality of life. Nutritional interventions and primary cancer treatment are the mainstays to manage this situation. However, a vicious cycle causes CAS to persist, especially in head and neck cancer, where tumour location and its treatment interfere with nutritional interventions. Curcumin shows anti-inflammatory effects, including modulated CAS in animal and in vitro studies. Objective: The study aimed to determine the effect of curcumin to treat cancer anorexia-cachexia syndrome among current patients with locally advanced or advanced head and neck cancer. Methods: This constitutes a randomised, double-blind, placebo-controlled phase IIa study. Twenty patients with CAS in locally advanced or advanced head and neck cancer adequately nourished via a feeding tube were enrolled and randomised in a 1 : 1 ratio to receive oral curcumin (at a dose of 4000 mg daily) (n = 10) or placebo (n = 10) for 8 weeks. The primary endpoint was body composition (muscle mass, body fat mass, and basal metabolic rate). The secondary endpoints were handgrip muscle strength, body mass index, absolute lymphocyte count, and safety and toxicity. Result: There was a statistically significant benefit from curcumin on improving muscle mass compared with placebo (2.16% [95% confidence interval; CI, -0.75 to 5.07] vs. -3.82% [95% CI, -8.2 to 0.57]; P=0.019). The other parameters of body composition were not significant but tended to favour curcumin benefit. The body fat mass (-0.51 [95% CI, -21.89 to 20.86] vs. -8.97% [95% CI, -19.43 to 1.49]; P=0.432) and percentage of mean change in the basal metabolic rate were noted (BMR) (0.54% [95% CI, -1.6 to 2.67] vs. -1.61% [95% CI, -4.05 to 0.84]; P=0.153). Notably, patients treated with curcumin exhibited less reduction in handgrip muscle strength and absolute lymphocyte count but was not significant. Similarly, most adverse events were grade 1 in both groups. Conclusion: The curcumin add-on resulted in a significant increase in muscle mass than standard nutritional support. Furthermore, it may improve and delay a decrease in the other body composition parameters, handgrip strength, and absolute lymphocyte count. Curcumin was safe and well tolerated. This constitutes an unmet need for clinical trials. This trial is registered with NCT04208334.
 
Flowchart of search strategy.
Continued.
Critical appraisal of eligible studies.
Article
Physical activity is beneficial to modulate immune system function and has inverse relationship to ARDS linked with SARS-CoV-2. Physical activity consists of daily activity and physical training. Studies regarding effect of physical training on patients with COVID-19 are controversial. This systematic review aims to investigate physical training on muscle health and QOL in patients with COVID-19. The literature review was carried out using keywords: (Exercise) AND (COVID) AND (Muscle) AND (Observational Study) in several databases of PubMed and Cochrane Central Register of Controlled Trials (CENTRAL). All references were reviewed using critical appraisal Newcastle Ottawa Scale (NOS) and Centre for Evidence-Based Medicine (CEBM) checklist. The studies were subsequently screened for reporting exercise, muscle, and COVID-19. The descriptions of the extracted data are guided by Preferred Reporting Items for Systematic Reviews (PRISMA) statement with GRADE approach. This study is registered in PROSPERO: ID CRD42021295188. Six studies pooled and entered review synthesis. Studies were reviewed using critical appraisal by NOS and CEBM. Two clinical trial studies and four observational designs were selected. Our result showed physical training improved patients’ outcomes in the acute phase, critical phase, and post-COVID-19 phase. Multiple types of physical trainings were suggested by those studies, and most of them showed beneficial effects to patients with COVID-19 in different phases. The level of evidence by GRADE was downgraded, and further investigations are needed to establish guidelines and strong recommendation for a specific stage of COVID-19.
 
Article
Background: Dysbiosis of intestinal microbiota may be linked to pathogenesis of obesity and metabolic disorders. Objective: This study compared the gut microbiome of obese Thai children with that of healthy controls and examined their relationships with host lifestyle, adiposity, and metabolic profiles. Methods: This cross-sectional study enrolled obese children aged 7-15. Body composition was evaluated using bioelectrical impedance analysis. Stool samples were analyzed by 16S rRNA sequencing using the Illumina MiSeq platform. Relative abundance and alpha- and beta-diversity were compared with normal-weight Thai children from a previous publication using Wilcoxon rank-sum test and ANOSIM. Relationships of gut microbiota with lifestyle activity, body composition, and metabolic profiles were assessed by canonical correlation analysis (CCA) and Spearman correlation. Results: The study enrolled 164 obese children with a male percentage of 59%. Mean age was 10.4 ± 2.2 years with a BMI z-score of 3.2 ± 1. The abundance of Bacteroidetes and Actinobacteria were found to be lower in obese children compared to nonobese children. Alpha-diversity indices showed no differences between groups, while beta-diversity revealed significant differences in the family and genus levels. CCA revealed significant correlations of the relative abundance of gut microbial phyla with sedentary lifestyle and certain metabolic markers. Univariate analysis revealed that Actinobacteria and Bifidobacterium were positively correlated with HDL-C and negatively correlated with body weight and screen time. Additionally, Actinobacteria was also negatively associated with fasting insulin and HOMA-IR. Lactobacillus showed positive correlation with acanthosis nigricans and adiposity. Cooccurrence analysis revealed 90 significant bacterial copresence and mutual exclusion interactions among 43 genera in obese children, whereas only 2 significant cooccurrences were found in nonobese children. Conclusions: The composition and diversity of gut microbiota in obese Thai children were different from those of their normal-weight peers. Specific gut microbiota were associated with lifestyle, adiposity, and metabolic features in obese children. An interventional study is needed to support causality between specific gut microbiota and obesity.
 
Reasons for caffeine consumption (expressed as %).
Article
Background: Caffeine is widely consumed among students due to its cognitive and physical enhancing effects. However, little is known about the consumption pattern of different caffeinated products among university students in the United Arab Emirates (UAE). Aim: To investigate the frequency of caffeine consumption among the young population of students, assess types of caffeinated products consumed, and document adverse effects and withdrawal symptoms experienced by university students. Methods: A cross-sectional study was conducted in the UAE from December 2019 to March 2020. A random sample of 500 university students from different universities in the UAE were approached and asked to complete a self-administered online-based questionnaire. Data were analyzed using the Statistical Package for Social Science (SPSS) version 26. Results: Of (n = 500) surveyed students, (n = 467) completed the survey 93.4%. The average level of caffeine consumption was significantly higher in females compared to male students (p < 0.005). Coffee was the highest favored source of caffeine (67.7%) followed by tea (47.3%). The average daily intake of caffeine was found to be 264 mg/day. Surprisingly, almost a third of students reported a high level of daily consumption (>400 mg/day) and more than half of them consumed less than 199 mg/day. Large proportions of students 91.1% have their caffeinated beverage after or while eating meals and 42.8% considered that this habit helped in avoiding acid reflux. Interestingly, around one third of participants have poor knowledge of caffeine-containing medical products, which seemed to affect the level of consumption in the student population (p < 0.05). The highest reported reason for caffeine intake was for studying purposes (59.4%). Conclusion: Caffeine consumption is highly prevalent among university students in the UAE. Yet, there is insufficiency in the current knowledge of safe caffeine consumption patterns reflecting the importance of health awareness programs and nutritional lectures to decrease the long-term health issues and unintentional overdose of caffeine.
 
PRISMA (preferred reporting items for systematic reviews and meta-analysis) flowchart.
Quality scores of papers included for review (based on Downs and Black assessment tool).
Article
Background: Several studies have suggested that increased oxidative stress during pregnancy may be associated with adverse maternal and foetal outcomes. As selenium is an essential mineral with an antioxidant role, our aim was to perform a systematic review of the existing literature reporting the effects of selenium supplementation during pregnancy on maternal and neonatal outcomes. Materials and methods: Six electronic databases (Medline, Embase, Cochrane Library, Web of Science, Scopus, and PubMed) were searched for studies reporting the effects of selenium supplementation during pregnancy and the postpartum period on maternal and neonatal outcomes. Only randomised controlled trials on human subjects reported in English and published up to October 2021 were included. Quality assessments were conducted using the modified Downs and Black quality assessment tool. Data were extracted using a narrative synthesis. Results: Twenty-two articles were included in our systematic review (seventeen reported on maternal outcomes, two on newborn outcomes, and three on both). Maternal studies reported the effects of selenium supplementation in the prevention of thyroid dysfunction, gestational diabetes, pregnancy-induced hypertension/preeclampsia, oxidative stress, postpartum depression, premature rupture of membranes, intrauterine growth retardation, breastmilk composition, and HIV-positive women. Newborn studies reported the effects of maternal selenium supplementation on foetal oxidation stress, foetal lipid profile, neonatal hyperbilirubinemia, and newborn outcomes in HIV-positive mothers. The majority of studies were inappropriately designed to establish clinical or scientific utility. Of interest, four studies reported that selenium supplementation reduced the incidence of thyroid dysfunction and permanent hypothyroidism during the postpartum period by reducing thyroid peroxidase and thyroglobulin antibody titres. Conclusion: The evidence supporting selenium supplementation during pregnancy is poor and there is a need for appropriately designed randomised controlled trials before routine use can be recommended.
 
Comparison of the right eye of 2 participants with different MPOD values, analyzed by VISUCAM 500. (a) Participant with high MPOD, coded green-yellow (mean MPOD of the right eye = 0.155 density unit) and (b) participant with low MPOD, coded blue (mean MPOD of the right eye = 0.082 density unit).
Comparison of the right eye of 2 participants with different MPOD values, analyzed by VISUCAM 500. (a) Participant with high MPOD, coded green-yellow (mean MPOD of the right eye = 0.155 density unit) and (b) participant with low MPOD, coded blue (mean MPOD of the right eye = 0.082 density unit).
Comparison of MPOD image of 2 participants with different L/Z intakes. (a) Participant with an average of 11.98 mg L/Z per day (mean MPOD of the right eye = 0.128 density unit) and (b) participant with an average of 0.20 mg L/Z per day (mean MPOD of the right eye = 0.093 density unit).
Comparison of MPOD image of 2 participants with different L/Z intakes. (a) Participant with an average of 11.98 mg L/Z per day (mean MPOD of the right eye = 0.128 density unit) and (b) participant with an average of 0.20 mg L/Z per day (mean MPOD of the right eye = 0.093 density unit).
Article
The aim of the study is to determine dietary lutein and zeaxanthin (L/Z) consumption and to evaluate its association with macular pigment optical density (MPOD) in Thai subjects. Methods. This study was a cross-sectional study. A total of 120 ophthalmologically healthy subjects aged between 40 and 72 years were recruited from Bangkok and the vicinity area. Demographic data were collected using a questionnaire, while a semiquantitative food frequency questionnaire assessed the L/Z intake. MPOD was determined using the reflectometry method (VISUCAM 500®, Carl Zeiss Meditec AG). Pearson’s correlation coefficient analyzed the relationship between L/Z consumption and MPOD. Results. The mean age of the participants was 50.7 ± 7.5 years. The mean consumption of L/Z was 3.03 ± 2.65 mg per day. The mean MPOD was 0.102 ± 0.023 density units. Consumption of foods rich in L/Z, including ivy gourd (r = 0.217, p < 0.05 ), Chinese flowering cabbage (r = 0.194, p < 0.05 ), balsam pear (r = 0.193, p < 0.05 ), lettuce (r = 0.182, p < 0.05 ), sweet corn (r = 0.181, p < 0.05 ), and pumpkin (r = 0.181, p < 0.05 ), was positively associated with the mean optical density (mean MPOD). Consumption of green onion (r = 0.212, p < 0.05 ) was positively associated with the sum of optical densities (MPOD volume). In contrast, chilli pepper consumption showed a negative association with mean MPOD (r = −0.220, p < 0.05 ) and amaranth showed a negative association with MPOD volume (r = −0.283, p < 0.05 ). No association was found between total L/Z consumption and MPOD. Conclusion. L/Z consumption is low among Thais living in Bangkok and the vicinity area, which may not be sufficient to ensure eye health, and total L/Z consumption is not associated with MPOD.
 
Sample population inclusion. ∗Alcohol use was defined as >7 drinks/week for women and >14 drinks/week for men. †Medications = valproic acid, methotrexate, tamoxifen, and amiodarone.
Midlife NAFLD Unadjusted Prevalence Stratified by NHDL-C, ApoB, or LDL-C tertiles, Discordance/Concordance Groups, and ApoB/TG Ratio Quartiles in Young Adulthood. Median NHDL-C: 121.0 mg/dL. Tertile ranges are low (36.0 to 107.0 mg/dL), middle (108.0 to 136.0 mg/dL), and high (137.0 to 288.0 mg/dL). Median ApoB: 88.0 mg/dL. Tertile ranges are low (22.0 to 78.0 mg/dL), middle (79.0 to 98.0 mg/dL), and high (99.0 to 292.0 mg/dL). Median LDL-C: 107.0 mg/dL. Tertile ranges are low (21 to 95 mg/dL), middle (96 to 120 mg/dL), and high (121 to 260 mg/dL). Median TG: 60.0 mg/dL. Tertile ranges are low (16 to 49 mg/dL), middle (50 to 72 mg/dL), and high (73 to 374 mg/dL).
Article
Objective: We evaluated the association of apolipoprotein B (apoB) with low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG) in early adulthood with concordant/discordant associations and midlife NAFLD. Methods: Participants from the CARDIA study were included (n = 2,655; baseline mean age: 25.0, 59.1% female, and 48.6% black). NAFLD was defined as liver attenuation ≤40 Hounsfield units after excluding other causes of liver fat. Logistic regression models assessed the odds of Y25 NAFLD among tertiles of apoB, LDL-C, non-HDL-C, and TG and quartiles of the apoB/TG ratio. Discordance/concordance analyses examined the association of apoB with each lipid marker and Y25 NAFLD. Results: The Y25 NAFLD prevalence was 10%. The high-tertile TG group (OR 1.87, 95% CI, and 1.30-2.69) and the low- (OR 1.98, 95% CI, and 1.30-3.01) and middle-apoB/TG ratio groups (OR 1.78, 95% CI, and 1.17-2.72) had the greatest odds of midlife NAFLD. Using discordance/concordance analysis, the high-apoB/high-TG group had the highest odds of NAFLD (OR 1.69, 95% CI, and 1.09-2.61) followed by the low-apoB/high-TG group. The high apoB/low TG group had the lowest odds of NAFLD. Conclusions: Among the studied lipid markers in early adulthood, TG levels have the strongest and most consistent association with midlife NAFLD.
 
Pattern of consumption of energy drinks between smokers and non-smokers.
Pattern of consumption of energy drinks between energy drink consumers who drink alcohol and those who do not drink.
Analysis of side effects experienced by daily energy drink consumers versus 1–3 annually.
Article
Background: The frequent expansion of the energy drinks (EDs) market has caused an extensive increase in the consumption of EDs, especially among younger populations. However, the lack of knowledge on EDs and their perceived beneficial effects could lead to excessive EDs consumption, which is strongly associated with serious side effects. This study aimed to assess the knowledge and perceived beneficial effects of EDs consumers and determine the consumption patterns and side effects experienced by different EDs consumers among the Malaysian population. Methods: A descriptive cross-sectional study was conducted in Malaysia from February to April 2021. A structured and validated questionnaire, consisting of 5 sections with 46 items, was distributed online. Only 515 out of 591 invited participants agreed to participate in the study. Descriptive and inferential analysis were done using SPSS. Results: The median age of participants was 23 ± 7.3 years. The majority of participants (65%) were unaware of the active ingredients of EDs, and approximately 40% of them had no idea that EDs contain caffeine. The main reason for consuming EDs was to stay awake (43%), and Red Bull was the most preferred brand (57%). Lack of rest (57%), headache (53%), and nervousness (49%) were the most experienced side effects. A significant difference was observed between consumption patterns and knowledge and perceived beneficial effects (p < 0.05). Our data showed a significant association between respondents' demographic data (e.g., coffee intake, smoking, and alcohol status) and their consumption pattern. Conclusion: ED consumers in Malaysia were found to have limited knowledge on EDs. Therefore, attention should be drawn to the Ministry of Health regarding the significant side effects such as palpitation and nervousness experienced by ED consumers. Hence, awareness ought to be raised by adopting regulations or policies to regulate the sales and warning labels of EDs in Malaysia.
 
Article
Chronic, low-grade inflammation is associated with the development of numerous diseases and is mediated in part by overactivation of the NLRP3 inflammasome. The ketone body beta-hydroxybutyrate (βHB) suppresses the NLRP3 inflammasome and alters intracellular signalling pathways in vitro and in animal models; however, this effect has not yet been shown in vivo in humans. The purpose of this single-arm pilot trial was to determine if consuming 15 mL of C8 medium-chain triglyceride (trioctanoin; MCT) oil, which induces mild elevation of βHB, twice daily (30 mL total) for 14 days would suppress markers of NLRP3 inflammasome activation in young, healthy humans while following their habitual diet. Consuming a single dose of 15 mL of C8 MCT oil significantly raised blood βHB from fasting at 60 minutes and 120 minutes post ingestion (both P < 0.05 ). However, consumption of C8 MCT oil for 14 days did not impact markers of monocyte NLRP3 inflammasome activation compared to baseline. Specifically, caspase-1 activation and secretion of its downstream product interleukin (IL)-1β were unchanged following 14 days of C8 MCT oil supplementation when measured in unstimulated and LPS-stimulated whole blood cultures (all P > 0.05 ). Acetylation of histone H3 on the lysine residue 9 was unchanged ( P < 0.05 ) and acetylation of lysine residue 14 was decreased ( P < 0.05 ) following 14 days of supplementation. Thus, adding twice daily C8 MCT oil supplementation to the habitual diet of young, healthy humans does not appear to suppress NLRP3 inflammasome activation.
 
Radar graph of factor loadings for each dietary pattern. Dietetic pattern 1 is composed of foods with high caloric-protein intake and saturated fat. Dietary pattern 2 comprises foods of traditional consumption in the Syrian diet. Pattern 3 is composed of foods with a high contribution of simple carbohydrates and saturated fat. Pattern 4 is composed of foods of traditional consumption in the Syrian diet with a predominance of mono- and polyunsaturated fatty acids. Pattern 5 is formed by fast food with a high predominance of energy and sodium.
Article
Prior to the 2016 crisis in Syria, a study conducted in Aleppo found the prevalence of metabolic syndrome to be 39.6%, which is known to be favoured by age and poor lifestyle (including physical inactivity and the consumption of hypercaloric foods, rich in saturated fats, concentrated carbohydrates, and salt), so the objective of this study was to identify the association of different dietary patterns with metabolic syndrome and their components. A cross-sectional analytical study was carried out in 104 adults aged 40 to 65 years who did not suffer from previous diseases. e sample was chosen from middle-class citizens of the city of Damascus who were contacted by telephone; they were explained about the study, the information that would be collected, and the studies that should be carried out in the clinical analysis laboratory of the Private University of Syria. A nutritional and food study was carried out using previously validated forms containing 62 items in which the food intake of the participants was studied. We apply principal component analysis and factor analysis to detect nutritional components and dietary patterns. Dietary pattern 3 (foods with simple carbohydrates and saturated fat) increased glucose levels, while dietary patterns 1 (high intake of calories, protein, and saturated fat) and 5 (fast food) increased serum triglyceride levels. In addition, pattern 1 (carbonated beverages, grains, chicken, and meat) was associated with elevated LDL cholesterol levels and the presence of the metabolic syndrome. e study findings suggest that the presence of metabolic syndrome and its components are associated with dietary patterns high in calories, protein, simple carbohydrates, and saturated fat.
 
Comparison of overweight/obesity between career type and self-reported dietary regimens.
Comparison of the frequency of food consumption by type of career.
Relationship between the type of career and type of diet evaluated.
Article
Background: Choosing a healthy diet is an increasingly a challenge for university students. The objective of this study was to compare diet and overweight/obesity in human nutrition students (HNS) and students of other careers (SOC) from a university located in Lima, Peru. Methods: It was a cross-sectional study consisting of 158 students out of an initial sample of 170. Information was collected on the sociodemographic and anthropometric characteristics of the participants and a validated questionnaire was applied to evaluate the frequency of food consumption. Results: There was no significant difference in diet between HNS and SOC (p > 0.05). HNS most frequently consumed yellow/orange vegetables (p = 0.020), purple vegetables (p = 0.049), citrus fruits (p = 0.029), eggs (p = 0.002), whole milk (p = 0.013), yogurt (p = 0.017), tofu (p = 0.003), olive oil (p = 0.003), other vegetable oils (p < 0.001), and alcoholic beverages (p = 0.037) than SOC. In contrast, HNS had a lower frequency of nonfried tuber intake (p = 0.039), fried tubers (p < 0.001), milk desserts (p = 0.048), flour fritters (p = 0.027), cookies with chocolate (p = 0.050), croissants (p = 0.030), cookies with filling (p = 0.024), candies (p = 0.006), and soda (p = 0.016) than SOC. Overweight/obesity was not different between HNS and SOC (p > 0.05). Conclusions: This study found significant differences in the consumption of some foods between HNS and SOC. However, it found no significant difference in diet and overweight/obesity between HNS and SOC.
 
Article
Rather than the prophylactic vaccination, any effective synthetic, natural, or nutritional therapy or regimen that may cure or remedy, albeit partially, the complications of SARS-CoV-2 should be highly acknowledged. Here, we reviewed and discussed possible beneficial biological effects of pomegranate juice in such diseased condition of viral infection based on the current published evidence (direct and indirect) and owing to the robust evidence that fresh pomegranate juice is highly rich with unique bioactive compounds that are approved in various occasions to be effective in several chronic diseased conditions. All related references that serve our aim are accessed through available electronic databases, particularly PubMed and Scopus. In summary, there is accepted evidence that pomegranate juice may be beneficial in SARS-CoV-2 infection conditions, especially for patients with the clinical history of chronic diseases such as hypertension, cardiovascular disease, diabetes, and cancer. However, the interventional studies that directly probe and confirm the effectiveness of fresh pomegranate juice in the management of SARS-CoV-2 infection are mandatory.
 
Article
Background: Weaning is a complex process of a gradual introduction of complementary foods to the infant's diet. It is recommended that solid food is introduced between 6 and 12 months of age. Weaning is difficult and potentially dangerous time for infants' growth and mother's education is an established determinant of its success. Little is known about weaning attitudes or practice among mothers in Najran Region of Saudi Arabia. Method: The study is a cross-sectional questionnaire-based observational investigation using random sampling scheme. We utilized ordinal logistic regression modelling to evaluate the relationship between demographic variables and knowledge level among mothers. Results: The total number included was n = 385 mothers who agreed to take part in the study. Good satisfactory knowledge rate was n = 135, 35.1%. Knowledge was mostly sought from other mothers (n = 102, 26.5%), followed by reliance on their own experience (n = 82, 21.3%). Seeking doctors' advice was associated with better knowledge levels. Worse adjusted knowledge scores were associated with bottle feeding (OR = 0.5383, p=0.0137), using cerelac preparations (OR = 0.0316, p=0.0092), development of weaning symptoms (OR = 0.5869, p=0.0260), seeking other mothers' advice (OR = 0.4750, p=0.0226), and feeding babies under 4 times daily (OR = 0.2742, p=0.0008). Mother education did not have significant impact on knowledge scores. Discussion. We confirmed, in this work, that knowledge levels were alarmingly unsatisfactory about weaning among our participants. Women were likely following local customs in terms of their choice of weaning methods even among the well-educated. The association between seeking doctors' advice and better knowledge should be utilized in future educational interventions. Underfeeding babies of below 4 times daily was correlated substantially with poorer knowledge score. This could be viewed as reverse causality, as clearly more knowledgeable mothers are expected to stick to optimum feeding frequency. Recommendations. Communication channels between physicians and mothers need to be opened and widened through focused educational programmes. Poor knowledge is clearly associated with infant underfeeding and difficulties in recognizing weaning symptoms. Such points need to be emphasized in design of health education packages to nursing mothers. Research on knowledge about weaning should focus on its association with traditional weaning methods and bottle feeding.
 
Article
Background: Morbid obesity is frequently complicated by chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and fibrosis. Parathyroid hormone (PTH) is found to be elevated in morbid obesity due to the defective hepatic metabolism of vitamin D. Bariatric surgery is performed to help patients with BMI>40 kg/m2 to effectively lose weight, particularly in patients with obesity who are afflicted with complications such as NAFLD/NASH. Objective: This study aimed to evaluate the PTH level as a predictor of hepatic function in individuals with morbid obesity who have undergone bariatric surgery. Methods: Ninety subjects with morbid obesity referred for Roux en-Y gastric bypass surgery were recruited. After IRB approval, demographic profiles, anthropometric factors, liver biopsy, and laboratory tests were obtained. The two-dimensional shear wave elastography (2D-SWE) technique was applied to assess hepatic stiffness. Results: A significant reduction occurred six months after bariatric surgery in the anthropometric indices (p < 0.001), hepatic elasticity (p=0.002), alanine aminotransferase (p < 0.001), serum alkaline phosphatase (p < 0.001), gamma-glutamyl transpeptidase (GGT) (p < 0.001), and nonalcoholic fatty liver disease fibrosis score (NFS) (p < 0.001). Serum PTH concentration was not predictive of postsurgical liver fibrosis and steatosis at six months but could predict weight loss success rate. No significant alteration in serum PTH levels was observed between presurgical vs. postsurgical time points. Conclusion: A significant reduction was observed in the anthropometric parameters, liver enzymes, and hepatic elasticity after bariatric surgery. No significant effect was found on PTH levels.
 
Dyslipidemia screening algorithm and secondary dyslipidemia causes. ¹Stroke with no identifiable cause, familial hypercholesterolemia, premature cardiovascular disease in 1st or 2nd degree relatives or 1st degree relative with high levels of lipoprotein (a). HDL, High density lipoprotein; LDL, low density lipoprotein; Lp(a), Lipoproteina (a); TC, total cholesterol; TG, triglycerides; VLDL, very low density lipoprotein.
Dyslipidemia familial and individual risk factors. ∗Familial history (1st and 2nd degrees) of premature cardiovascular disease (male <55 yr; female <65 yr)-angina or acute myocardial infarction, coronary artery bypass graft, angioplasty, stroke, peripheral artery disease, or sudden cardiac death; ∗∗1st degree relative: TC >240 mg/dl and/or LDL >130 mg/dl and/or TG >170 mg/dl and/or HDL <35 mg/dl.
Dyslipidemia therapeutic approach by risk stratification. (A) Lifestyle changes; (B) CHILD-1 Diet; (C) CHILD-2 Diet.
Article
Dyslipidemias or dyslipoproteinemias are quantitative changes in total cholesterol concentration, respective fractions, or triglycerides in the plasma. Evidence supported that dyslipidemia in childhood is associated with atherosclerosis in adulthood, and early identification and treatment potentially reduce cardiovascular risk in adulthood, which is the principal cause of morbidity and mortality in developed countries. Dyslipidemias can result from primary lipoprotein metabolism changes due to different genetic causes (primary dyslipidemias) or as a consequence of exogenous factors or other pathologies (secondary dyslipidemias). Therefore, the combined dyslipidemias result from the association of important epigenetic and environmental influences with risk factors for cardiovascular disease. The criterion for lipid metabolism screening at young ages is not widely accepted and possibly follows a universal or directed screening strategy. Additionally, little is known about its long-term effects or possible risk-benefit despite the growing tendency to start pharmacological therapy. Therefore, this study aimed to review the available bibliography on dyslipidemia in pediatric age to present a practical and structured approach to dyslipidemia that focuses on screening, risk stratification for atherosclerotic disease, and therapeutic approach.
 
Article
The aims of this study were first to evaluate the nutritional knowledge, perception, and source of nutrition information among resistance-trained individuals consuming protein supplements (PS), to determine whether a correlation exists between nutrition-related knowledge and the use of PS, and finally to compare the impact of PS use among participants classified as nonprotein supplement users (NPSUs) and protein supplement users (PSUs). A cross-sectional study was conducted among a highly selected group of resistance-specialized trainees (RSTs). Among the 100 RST participants recruited, the Internet and coaches were the most common source of nutritional information. About one-third of participants believed that there were no health risks after consuming PS. Both NPSU and PSU exhibit performance improvement that was significantly lessened in PSU compared to NPSU. This study demonstrated that RST may have misconceptions regarding the benefits of PS usage to increase strength. Our data also suggest a shortage of knowledge about PS and confirm that PSUs lack proper professional guidance. These findings highlight the need for proper monitoring to ensure adequate perception, awareness, and safety in the Lebanese sports sector.
 
Factors related to sustainability of one WASH facilities in the rural settings of North Shoa, Ethiopia,2020.
Article
Background: Water, sanitation, and hygiene (WASH) is considered as one term and recognizes that the three are closely related. The Government of Ethiopia launched the programme to improve the way water, and sanitation is provided to the people improving the WASH financing effectively, decreasing school children drop-out rates and improving the health status. The main aim of this study is to assess factors related to the sustainability of one WASH facilities in the rural settings of North Shoa zone, North East Ethipia. Methods: Institutional- and community-based cross-sectional study was conducted. Taking the total number of woredas in the zone, 20 of them were rural project woredas during the first phase of the program and clustered in 6 subzones, and 6 woredas had been selected randomly by the lottery method from each subzones. A total of 768 households were randomly selected based on the proportional size of the number of households in each woreda. A structured questionnaire was used for this study. The data were collected via interview. Multivariable logistic regression analysis was used to identify independent predictors with P < 0.05 and confidence interval of 95% considering statistically significant. Result: Among a total of 768 HHs intended to be involved, 689 were involved with 90% response rate. The communities WASH facilities were assessed to be unsustainable by more than half of the respondents (372 (54 percent)) HHs replies. Distance from current water source, community participation during water construction, practice of CLTSH in the village, declaration of open defecation free (ODF) in the village, and existence of health institution near the village were found positively associated with sustainability of one WASH facilities. Conclusion: The sustainability of WASH facilities was revealed to be relatively low. Considering distance from water source, community participation, practice of CLTSH in the village, village declared ODF, and existence of health institution are mandatory to all stake holders participating in WASH activities before, during, and after the implementation of the project.
 
Article
Celiac disease or gluten-dependent enteropathy is a chronic autoimmune pathology triggered by dietary gluten in genetic predisposed individuals, mediated by transglutaminase 2 IgA autoantibodies and associated with a deteriorating immune and inflammatory response. This leads to intestinal villous atrophy, impairing the intestinal mucosa structure and function of secretion, digestion, and absorption. The result is macro- and micronutrient deficiency, including fat soluble vitamins and minerals, and a consequent nutritional status depletion. A lifelong gluten-free diet is the only available treatment for celiac patients in order to assure normal intestinal mucosa and remission of gastrointestinal symptoms. However, a gluten-free diet can itself cause other nutritional deficiencies due to its restrictive nature regarding gluten-containing cereals. A group of gluten-free cereals, known as pseudocereals, is increasingly recognized as valuable options for gluten-free diets due to their high nutritional value. Amaranth, quinoa, millet, and buckwheat are examples of gluten-free nutrient-dense grains that can be used as alternatives to the conventional gluten-containing grains and improve the variety and nutritional quality of the celiac diet. Current work reviews the nutritional pitfalls of a gluten-free diet and analyses how pseudocereals can contribute to revert those deficiencies and optimize the nutritional value of this mandatory diet for the celiac population.
 
Article
Background: Inflammation and immobility are the most relevant mechanisms that alter protein synthesis and increase protein breakdown. Protein catabolism is associated with morbidity and mortality in critically ill children. Objective: To demonstrate the effectiveness of the routinely used enteral nutrition support guideline in preventing muscle breakdown in critically ill children. Methods: A prospective cohort study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital. Critically ill children (aged 1 month to 15 years) admitted to the PICU were enrolled. All patients were assessed for nutritional status and nutritional requirement. Enteral nutrition support following the guideline was initiated within the first 24 hours if no contraindication. The calorie target was defined either by direct measurement from indirect calorimetry or estimated from Schofield equation with protein target at least 1.5 g/kg/day. Anthropometric assessments and body composition measurements by bioelectrical impedance analysis (BIA) were examined at baseline and on the seventh day of the PICU admission. Results: Sixty-three patients were enrolled in the study. The most common age group was 1-5 years old (38.1%). The length of PICU stay was 9.1 (SD = 12.7) days. Respiratory problems were the major cause of PICU admission (50.8%). Mechanical ventilation was required in 55.6% of the patients with the average duration of 6.3 (SD = 12.4) days. Undernutrition was found in 36.5% of the patients. Enteral feeding was the major route of nutrition support (95.2%). After the first week of admission, muscle mass was significantly preserved (p < 0.01). All patients received the nutrition support at their target energy and protein goal within the first week. The enteral feeding-related complication was reported in 1.6% of the patients. Conclusion: Protein catabolism during critically ill period can be minimized by optimal nutrition support. Nutrition practice using the enteral nutrition support guideline was effective in helping critically ill children reach their target caloric and protein intake.
 
Article
Sulforaphane and allyl isothiocyanate, naturally occurring isothiocyanates, have been reported to inhibit adipocyte differentiation, but little is known about how they compare in terms of their potency and mechanism of action. In the present study, we compared the effects of sulforaphane and allyl isothiocyanate on the differentiation of 3T3-L1 preadipocytes. A mixture of insulin, dexamethasone, and 3-isobutyl-1-methylxanthine was used to establish a differentiation medium. We found that, at a concentration as low as one-tenth that of allyl isothiocyanate, sulforaphane reduced triacylglycerol levels, lipid-filled adipocyte quantity, and mRNA and protein levels of CCAAT-enhancer-binding protein α (C/EBPα) and peroxisome proliferator-activated receptor γ (PPARγ). These results suggested that sulforaphane may be a more potent adipocyte differentiation inhibitor than allyl isothiocyanate. Our results may provide insight into possible strategies for the prevention of obesity and related conditions.
 
Dietary diversity scores of children.
Prevalence of stunting and wasting.
Article
Undernutrition is the most difficult and widespread public health concern in low-income nations including Ethiopia. Therefore, this study aimed to investigate the associated risk factors of stunting and wasting among children aged 6–59 months in Jima Geneti district, Western Oromia, Ethiopia. A community-based cross-sectional study was conducted on 500 children from December 1 to 28, 2020. A multiple-stage sampling method was performed to select children from each kebele. Anthropometric measurements were taken, and the nutritional status was generated using WHO Anthro v. 3.2.1. Data analysis was performed using the SPSS version 20.0. Bivariate and multivariate logistic regression analyses were carried out to identify the associated risk factors of stunting and wasting among children in the study area. Statistical significance was set at p<0.05. The study results showed that the prevalence of stunting and wasting among children was 27% and 11.8%, respectively. The findings of this study also revealed that the prevalence of household food insecurity and poor dietary diets was 19.6% and 52.2%, respectively. Low wealth status (AOR = 2.5; 95% CI: 1.1, 5.55) and poor dietary diets (AOR = 4.7; 95% CI: 2.5, 8.83) were associated risk factors for stunting. However, child meal frequency (AOR = 3.9; 95% CI: 1.23, 12.6), and children who did feed leftover food (AOR = 2.75; 95% CI: 1.02, 7.44) were associated risk factors for wasting. Poor dietary diets (AOR = 2.65; 95% CI: 1.06, 6.66) were also associated risk factors for wasting. The findings of this study concluded that the prevalence of stunting and wasting was high in the study area. Therefore, addressing family-level risk factors which are major drivers of children’s nutritional status is crucial to ensure the nutritional status of children.
 
Relative contribution (%) to total protein intake in the Colombian population. National Survey of Nutritional Situation in Colombia (ENSIN-2015). Animal protein (black); vegetal protein (white)
Article
Background: There is a lack of knowledge in Colombia about dietary intake and sources of animal protein. Design: Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 32,457 participants aged from 1 to 64 years. The sample analyzed included 21,036 boys and nonpregnant girls, 10,099 adults, and 1,322 pregnant women, 118 of whom were below 18 years of age. Results: Protein intake was 32.9 g/d (95% CI: 32.4, 33.4) per 1,000 kilocalories. The relative contribution (%) of total protein to the total energy intake/day (acceptable macronutrient distribution) was 13.2% (95% CI: 13.0, 13.3). The acceptable macronutrient distribution (AMDR) for animal protein for those aged 1 to 64 years was 7.8% (95% CI: 7.6, 8.0), with a minimum of 7.1% (95% CI: 6.7, 7.5), which was for children aged from 13 to 17 years, and a maximum of 8.3% (95% CI: 8.1, 8.5), for children aged from 1 to 4 years (P=0.018). For all groups, animal protein made up the majority of total proteins, with 62.6% (95% CI: 61.7, 63.6) for preschoolers, 55.8% (95% CI: 53.2, 58.4) for school-aged children, 54.6% (95% CI: 53.0, 56.1) for adolescents, 58.1% (95% CI: 57.5, 58.7) for adults, and 57.5% (95% CI: 55.2, 59.7) for pregnant women (P=0.027). The three main dietary sources of animal protein were red meat (17.8%), chicken (16.3%), and eggs (10.5%). The sources of vegetal protein were bread-arepa-pasta (20.0%), cereals (19.8%), and legumes (8.2%). Conclusions: Protein intake is excessive according to the Recommended Dietary Allowance (RDA), while it is not excessive from the perspective of the AMDR.
 
Description of study activities. CNAQ, Council on Nutrition Appetite Questionnaire.
Mean change in CNAQ scores at weeks 1 and 2 from baseline (ITT population)∗. ∗ITT population including all patients who are analyzed in the study. CNAQ, Council on Nutrition Appetite Questionnaire; ITT, intention to treat.
Proportion of patients by CNAQ score ranges (ITT population)∗. ∗ITT population including all patients who are analyzed in the study. CNAQ, Council on Nutrition Appetite Questionnaire; ITT, intention to treat.
Article
Loss of appetite (LOA) may have a negative impact on a patient’s well-being owing to loss of nutrition and associated conditions. The current study assessed the effects of an appetite-stimulating medication containing multivitamins, lysine, and zinc in Indian patients with a history of LOA. Using an investigator-initiated, single-center, open-label, single-arm design, we evaluated the effectiveness and safety of the appetite-stimulating medication (15 mL) in 50 male or female patients (18–55 years old) attending the outpatient department, with a confirmed diagnosis of LOA after two weeks of therapy and assessed the change in Council on Nutrition Appetite Questionnaire (CNAQ) score and safety of the medication after two weeks of treatment. CNAQ scores were presented as mean (standard deviation (SD)). The mean age of patients was 42.1 years, with the majority (66%) being males. At weeks 1 and 2, a statistically significant improvement was observed in the mean CNAQ scores of 25.48 (5.10) and 25.48 (4.29), respectively, vs. baseline (22.08 (2.76); P ≤ 0.0001 both). Majority of the patients had CNAQ appetite scores of 17–28 at baseline (94%), week 1 (66%), and week 2 (78%) of treatment. For patients with acute and chronic illness, a statistically significant improvement was observed in the mean CNAQ score at week 1 (26.75 (3.69), P = 0.0256; 25.24 (5.33), P = 0.0004) and at week 2 (26.63 (3.46), P = 0.0027; 25.26 (4.43), P ≤ 0.0001) from baseline (21.88 (3.31) and 22.12 (2.69), respectively). No serious adverse events were reported during the study. The study findings suggest that appetite-stimulating medication containing multivitamins, lysine, and zinc could be a suitable treatment option for the management of LOA with no significant safety concerns.
 
Trends of underweight among children under five years in Ethiopia, evidence from EDHS 2005–2016.
Article
Background: Underweight is one of the paramount major worldwide health problems, and it traces a big number of populations from infancy to old age. This study aimed to analyze the trends and predictors of change in underweight among children under five years in Ethiopia. Method: The data for this study were accessed from three Ethiopian Demographic and Health Survey data sets 2005, 2011, and 2016. The trend was examined separately for the periods 2005-2011, 2005-2016, and 2011-2016. Multivariate decomposition analysis of change in underweight was employed to answer the major research question of this study. The technique employed the output from the logistic regression model to parcel out the observed difference in underweight into components, and STATA 14 was utilized for data management and analysis. Result: Perceiving the overall trend, the rate of underweight was decreased from 38% in 2005 to 24% in 2016. The decomposition analysis results revealed that, about 12.60% of declines in underweight have been explained by the difference in population characteristics or endowments (E) over the study period. The size of the child at birth, husband's education, women's education, and household wealth index contributed significantly to the compositional decline in underweight. Conclusion: The magnitude of underweight among children under five years indicates a remarkable decline over the last ten years in Ethiopia. In this study, two-twelfth of the overall decrease in underweight among children under five years over the decade was due to the difference in characteristics between 2005 and 2016. Continuing to educate the population and boost the population's economy is needed on the government side in Ethiopia.
 
General structure of ARs. R-alkyl or alkenyl side chain, oxygenated R is also possible. The R position may be changed and presence of additional polyphenolic rings is possible depending on the type of organism synthesizing ARs.
A proposed biosynthetic pathway of ARs by PKSIII according to [10].
ARs absorption and metabolism. ARs enter the human body mainly with whole grain products, although gut microbiome origin of ARs is also possible. ARs are transported through the lymph and blood as a part of lipoproteins (LP) toward the liver and other tissues. ARs are metabolized in the liver and excreted through the kidneys with urine or through the intestine with feces.
ARs metabolism in mammalian cells (pentadecylresorcinol (C15 : 0) is shown as an example). Hydroxyl groups on the phenolic ring are conjugated with amino acids, glucuronide, and/or sulfate groups during metabolism.
The main regulatory functions of ARs according to in vivo and in vitro studies.
Article
The investigation of alkylresorcinols has drawn an increasing interest recently. Alkylresorcinols (ARs) are natural chemical compounds synthesized by bacteria, fungi, sponges, and higher plants, possessing a lipophilic polyphenol structures and a myriad of biological properties. Human takes ARs as a component of a whole grain diet (from whole grain rye, wheat, and barley products), and thus, alkylresorcinols are frequently used as whole grain intake markers. Besides, ARs are considered as promising bioregulators of metabolic and immune processes, as well as adjuvant therapeutic agents for antimicrobial and anticancer treatment. In this review, we attempted to systematize the accumulated information concerning ARs origin, metabolism, biological properties, and their effect on human health.
 
Article
Maternal depression affects parenting and children’s early development, but its effect on dietary intake is unknown. While husbands’ involvement in parenting and having friends to talk to may reduce childcare stress, this has not been thoroughly studied. In this study, mothers were stratified by the presence or absence of mood disorders, and the effects of support from their husbands and friends on the dietary intake of their 3-year-old children were examined. This cross-sectional analysis included 920 mother-child pairs examined at the National Center for Child Health and Development in Japan. Dietary intake was assessed using a brief dietary history questionnaire, and physical measurements were taken when the children were 3 years old. The Kessler Psychological Distress Scale was used to screen for maternal mood disorders, 3 years after delivery. The presence or absence of the husband’s assistance with housework and childcare, mental support, and friends was obtained from a self-administered questionnaire when the child was 3 years old. Differences in the children’s physical measurements, energy, and food intake with the presence or absence of support for subjects with or without mood disorders were compared. Mothers with support from husbands or friends had significantly fewer mood disorders. Support from friends and family did not affect the children’s physical development and whether or not mothers had mood disorder symptoms. However, children’s vegetable intake was higher if mothers were supported. Children of mothers with mood disorders had a significantly higher vegetable intake and fruit intake, depending on the support from friends (P=0.046, P=0.037); thus, such support may increase children’s vegetable and fruit intake. The results of this study revealed the importance of supportive friends and family regarding childcare.
 
Distribution of parturients by body mass index and morbidity profile. Note: underweight: BMI < 18.5 kg/m²; normal: 18.5 ≤ BMI < 25 kg/m²; overweight: 25 ≤ BMI < 30 kg/m²; obese: BMI ≥ 30 kg/m². ∗Fisher’s exact test. A value of p<0.05 is considered significant.
Article
Obesity is a real public health problem whose prevalence continues to increase throughout the world. It affects all age groups and does not spare pregnant women. This work aims to determine the prevalence of obesity and to study its association with maternal and neonatal characteristics and the morbidity profile of pregnancy. This is a descriptive and cross-sectional study carried out in the maternity ward of the prefectural hospital center called “Sidi Lahcen” in Témara, Morocco, over a 12-month period. Maternal and neonatal data are collected through a preestablished questionnaire, and anthropometric parameters were recorded. 390 participants, aged between 18 and 43 years, were included in this study, with a prevalence of overweight and obesity of 34.9% and 41%, respectively. Correlation results revealed that the prevalence of overweight and obesity was significantly elevated in women over 25 years p
 
Sociodemographic characteristics of university students.
BMI, % BF, WC, and anemia in female and male university students.
BMI, % FB, WC, and anemia in humanities, business, health, and engineering students.
Analysis of the association between sociodemographic characteristics and overweight/obesity in university students.
Binary logistic regression analysis of factors associated with overweight/obesity in university students.
Article
The university represents a critical space for students in terms of prevalence of malnutrition. -e objective of this study was to determine the body mass index (BMI), body fat percentage (% BF), waist circumference (WC), and anemia in university students. A cross-sectional study was carried out in 2,285 university students from Lima, Peru. The sample was selected by nonprobability convenience sampling. Anthropometric data and hemoglobin levels were measured. The Chi-square test was used. The analysis of the associated factors was done using binary logistic regression. A significance level of 5% was considered. There were no significant differences between men and women in BMI (p > 0.05). -e men presented significantly high and very high levels of % BF (p < 0.001). -e proportion of women who presented anemia and high and very high WC was significantly higher compared to men (p < 0.001). Being older than 27 years (ORB = 2.07; 95% CI = 1.19–3.6), being male (ORB = 2.68; 95% CI=2.02–3.55), studying at the engineering faculty (ORB = 1.39; 95% CI = 1.09–1.79), having excess body fat (ORB = 8.17; 95% CI = 6.13–10.87), and having an elevated WC (ORB=35.51; 95% CI = 25.06–50.33) significantly predicted overweight/obesity. -e findings of this study suggest that college students, especially males and those who are not enrolled in health sciences colleges, should be a priority in healthy lifestyle interventions, particularly nutritional education programs, to reduce the prevalence of overweight and obesity.
 
Article
Vitamin D is an important hormone that is known for the regulation of calcium and phosphate metabolism. Vitamin D deficiency leads to rickets in children and osteoporosis in adults leading to poor bone mineralisation and can also lead to serious dental complications in the same population. Recent studies have shown vitamin D to work as a hormone needed not only in bone and teeth but also in other body organs from intrauterine life up to old age. It has been demonstrated that Vitamin D has various effects on biological processes that deal with cell growth, differentiation, cell death, immune regulation, DNA stability, and neuronal growth. Despite being readily formed in the body through the intervention of the sun, patients are still found to have low vitamin D levels. We review studies done to show how vitamin D works.
 
Frequency of eating patterns during social isolation.
Changes in the frequency of low and high consumption of plant-based foods before and during social isolation. ∗Before social isolation; ∗∗during social isolation.
Changes in the frequency of low and high consumption of animal-based foods before and during social isolation. ∗Before social isolation; ∗∗during social isolation.
Changes in the frequency of low and high consumption of processed food before and during social isolation. ∗Before social isolation; ∗∗during social isolation.
Article
Background: Peru has one of the highest infection and death rates in the world for the COVID-19 pandemic. The government implemented house confinement measures with probable consequences on lifestyle, particularly affecting eating habits, physical activity, sleep quality, and mental health. Objectives: The aim of this study was to assess the lifestyles, physical activity, and sleep characteristics, as well as changes in eating habits in a Peruvian population during the first wave of the COVID-19 pandemic. Methods: A cross-sectional descriptive study was performed. We analyzed Peruvian adults based on an online self-administered questionnaire divided into sociodemographic, anthropometrics, COVID-19 diagnosis reported, lifestyle habits, and frequency of consumption of foods. Results: During confinement for COVID-19, 1176 participants were studied. Of these, most reported weight gain (1 to 3 kg) and 35.7% were overweight. The lifestyles habits showed that 54.8% reported doing physical activity and 37.2% sleep less. The Peruvian sample presented a main meal pattern of breakfast (95.7%), lunch (97.5%), and dinner (89.1%). Likewise, eating habits before and during COVID-19 pandemic showed that vegetables (OR:1.56, CI95% 1.21-200), fruit (OR: 1.42, CI95% 1.10-1.81), legumes (OR:1.67, CI95% 1.23-2.28), and eggs (OR: 2.00, CI95% 1.52-2.65) presented significant consumption increase during social isolation, while bakery products (OR: 0.74, CI95% 0.56-0.97), meat, snack, refreshment, and fast food decreased in consumption. Other foods showed no significant differences. Conclusion: This study showed an important frequency of overweight and sleep changes. There was a slight increase in physical activity despite the social isolation measures and an increase in healthy eating habits; nevertheless, the majority reported gaining weight.
 
Factors that contribute to the presence of nutritional deficiency and muscle dysfunction in COPD patients (modified from Gea J Sancho-Muñoz A Chalela R Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations. J Thorac Dis. 2018; 10 (12): S1332–S1354. DOI:10.21037/jtd.2018.02.66; ∗ figure created on the BioRender platform).
Flowchart for studies included in the scoping review.
Article
Chronic obstructive pulmonary disease (COPD) is a common, preventable, treatable lung disease characterized by persistent respiratory symptoms and airflow limitation and multiorgan impact. This affects the nutritional status of patients and requires multidimensional interventions including nutritional interventions according to individual metabolic needs. Our scoping review determined the effects of antioxidants in the treatment of COPD patients and their role in the decrease in the probability of exacerbations, hospital readmissions, and changes in lung function. The sources MEDLINE, LILACS, and Google Scholar were consulted and 19 studies were selected. The most indicated antioxidants are N-Acetylcysteine, vitamins E and D, and Zinc. Other antioxidants from plants or fruits extracts are also being investigated. The beneficial effect of antioxidants in stable or exacerbated patients is not clear, but theoretical and biological arguments of benefit justify lines of research that specify the impact on reducing oxidative stress and negative effects in COPD.
 
The main phenolic compounds in pomegranate.
The main anthocyanoside compounds in pomegranate.
The main flavonoid and alkaloid compounds in pomegranate.
A summary of pomegranate clinical trials in different diseases.
Article
Punica granatum L. belongs to the Punicaceae family which is distributed around the world. Different parts of pomegranate like seed, peel, juice, and leaves are rich in potential bioactive compounds. These plants have found application in traditional medicine such as in treatment of gastrointestinal, cardiovascular, and endocrine diseases, among others. The present review aimed to summarize the current research on the traditional and scientific applications of P. granatum with regard to the phytochemical content and clinical applications that may be useful for future drug development. Information about P. granatum was obtained from local classic herbal literature and electronic databases, such as PubMed, Scopus, and ScienceDirect. Several phytochemical constituents including polyphenolics, flavonoids, anthocyanosides, alkaloids, lignans, and triterpenes have been reported from the plant. Randomized clinical trials have provided evidence as to the pharmacological activities of pomegranate in several diseases including diabetes, cardiovascular disease, oral cavity disorders, endocrine disorders, and cancer. The present review has provided an insight into the traditional applications of the plants, and some of them have been validated by scientific evidence, particularly their applications as treatment of cardiovascular and endocrine diseases.
 
Components of metabolic syndrome frequency according to tertiles of uric acid. T1 (2.5–4.4 mg/dL), T2 (4.5–5.0 mg/dL), and T3 (5.1–6.3 mg/dL) in men; T1 (1.2–3.1 mg/dL), T2 (3.2–3.8 mg/dL), and T3 (3.9–6.8 mg/dL) in women.
Article
We explored the association between serum uric acid (SUA) and metabolic syndrome (MetS) and insulin resistance (IR) among health personnel from a public hospital in Peru in a cross-sectional study with data from the Plan for the Prevention and Surveillance of Communicable and Noncommunicable Diseases of Huaycán Hospital. MetS was defined according to Latin American Diabetes Association (ALAD) criteria and IR with surrogate IR markers, triglyceride-to-HDL-C ratio (TG/HDL-C), and triglyceride-to-glucose index (TyG). The association between SUA and MetS and IR was determined using Poisson regression models in a sample of 292 participants with an average age of 46.2 ± 10.6 years. The total prevalence of MetS was 38%, and the individuals with MetS presented mainly alterations in anthropometric parameters (obesity and body fat). Finally, the adjusted regression models showed that women with SUA in the highest tertile increased the prevalence of MetS (PR: 1.71, 95% CI: 1.07–2.74) compared to the lowest tertile of SUA in women, while SUA increased hypertriglyceridemia and IR (TG/HDL-C and TyG) in both sexes. We concluded that SUA is strongly associated with MetS in women, and SUA increases hypertriglyceridemia and IR in both sexes. On the contrary, more research is required regarding the female population.
 
Proportion of households with inadequate energy and nutrient intake not meeting 100% REI and EAR intake by the food security level.
Article
Food insecurity is often deeply rooted in poverty. Hence, accessibility and the quality of foods consumed may affect the dietary pattern. The study aims to assess the relationship between food insecurity and dietary consumption. This investigation analyzed the data from the 2015 Updating of Nutritional Nutrition Survey. The Household Food Insecurity Access Scale (HFIAS) was used to determine household food security status and the prevalence of food insecurity. Food weighing, food inventory, and food recall were the methods used to collect food consumption data of sampled households. The study revealed poor nutrient quality and a greater likelihood of inadequacy of nutrients among moderate and severe food insecure households. Mild, moderate, and severe levels of food insecurity were found to affect 12%, 32%, and 22% of the population, respectively. The test showed that both moderate and severe food insecure families have significantly lower mean consumption of meat, milk, and fats and oils in contrast to food secure households. In comparison with food secure households, moderate and severe food insecure households consume higher amounts of cereals and cereal products, rice, and vegetables. Moderate and severe food insecure households have higher consumption of total carbohydrates but have significantly lower average intake of vitamin A, riboflavin, niacin, and total fat related to food stable households. Moreover, the results of the multiple logistic regression revealed that food insecure households have a higher likelihood to be deficient in energy, protein, calcium, vitamin A, thiamin, riboflavin, niacin, and vitamin C intakes, but except for iron (p value <0.05). Indeed, household food insecurity was associated with the higher consumption of calorie-dense food among Filipino households. This explains a lower nutrient quality and a higher likelihood of inadequacy of nutrients among moderate and severe food insecure households.
 
Prevalence of under nutrition among children living in an orphanage in Addis Ababa, Ethiopia, 2020 (n = 271).
Sociodemographic characteristics of study participants living in orphanages, Addis Ababa, Ethiopia, 2020 (n � 271).
Hygienic, sanitation, support, and care characteristics of caregivers of children in the orphanages in Addis Ababa, Ethiopia, 2020 (n � 271).
Article
Background. Undernutrition contributes to the death of around 3 million children and threatens the futures of hundreds of millions, undermining healthy development and the strength of their societies by preventing children from achieving their full potential. Orphans are at greater risk of undernutrition because they are more likely to be extremely poor and receive less medical and social care. However, there is little information about the prevalence of undernutrition and associated factors among under-five orphan children. Objective. This study aimed to assess undernutrition and associated factors among under-five orphan children in orphanages in Addis Ababa, Ethiopia. Methods. An institution-based cross-sectional study was conducted in Addis Ababa from February 28 to March 28, 2020. A simple random sampling technique was employed to recruit a total of 275 orphan children. An interviewer-administered questionnaire and anthropometric measurements were used to collect data. Data were entered using EpiData version 3.1 and analysis was done by WHO Anthro version 3.2.2 and SPSS version 23. Multivariable logistic regression analysis was performed to identify determinants of undernutrition at a p value of less than 0.05 with an adjusted odds ratio of 95% confidence interval. Results. The prevalence of wasting, stunting, and underweight were 11.1%, 45.8%, and 25.5%, respectively. Presence of illness (AOR = 2.23; 95% CI: 1.41, 12.73), children who received less than three meals per day (AOR = 2.11; 95% CI: 1.58, 7.71), and children who were not vaccinated (AOR = 2.86; 95% CI: 2.07, 11.61) were significantly associated with stunting. Children who were not vaccinated (AOR = 2.04; 95% CI: 1.29, 9.71) and who had inadequate dietary diversity scores (AOR = 1.32, 95% CI: 1.16, 12.65) were significantly associated with wasting and underweight, respectively. Conclusion. The prevalence of undernutrition was very high compared to national data. Health status, meal frequency, and vaccination status were associated factors of stunting. Vaccination status and dietary diversity score were associated factors with wasting and underweight, respectively. Therefore, improving meal frequency, dietary diversity, and early treatment during childhood illness are important to reduce orphan undernutrition. 1. Introduction Undernutrition denotes the insufficient intake of energy and nutrients to meet an individual’s needs to maintain good health [1]. Malnutrition is affecting a highly vulnerable population in several regions of the world [2]. Under-five children are the most vulnerable age group for undernutrition particularly in developing countries which is among the most serious health problems facing Ethiopia [3]. Undernourished children have lower resistance to infection and are more likely to die from common childhood illnesses such as diarrheal diseases, febrile illness, and respiratory infection [4]. Undernutrition increases the frequency and severity of such infections and contributes to delayed recovery. In addition, the interaction between undernutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status [5]. Malnutrition is affecting a highly vulnerable population in several regions of the world. According to the global nutrition report estimation, undernutrition contributes to the death of around 3 million children per year and threatens the futures of hundreds of millions, undermining the healthy development of their bodies and the strength of their societies by preventing children from achieving their full potential [6]. This problem in the early stages of life can increase the risk of infections, morbidity, and mortality together with decreased mental and cognitive development [3]. An estimated 17.8 million orphan children in the world had lost both parents (double orphan) and 153 million children in the world are orphans (single orphan) with more than one in seven children orphaned in Sub-Saharan Africa [1, 7]. In Ethiopia, 5.5 million children (around 6% of the total population) are categorized as orphans or vulnerable children. Orphan comprises almost 12% of Ethiopia’s total child population, and half of the children below the age of five are stunted [1, 3]. The children in orphanages had a significantly higher rate of undernutrition than nonorphanages. Consequently, many orphan and vulnerable children are still in a difficult situation and seek immediate attention [6, 8]. Orphaned and institutionalized children may experience one or several micronutrient deficiencies. Children may contract an infection due in part to poor nutritional status and are vulnerable to infections since they are at risk for a variety of complications, putting their health and development in great trouble [1]. Due to poverty, family disintegration, domestic violence, disability, and social unrest, the number of orphans is expected to increase in the next future. These children are most vulnerable and may be at greater risk from child labor, trafficking, prostitution, abduction, stigma, discrimination and they are potentially at greater risk of malnutrition because they are more likely to be extremely poor and receive less medical and social care. This portion of the population seeks immediate support for their survival and growth, despite less number of orphanages compared to the magnitude of orphans and vulnerable children [9, 10]. Orphan children in Ethiopia are the most prevalent forms of social problems and are vulnerable to all forms of abuses and exploitations, loss of inheritance rights, loss of opportunity for education, basic health care, normal growth, and development as well as shelter. And they are also at risk of future incidents of HIV infection. They faced many problems including basic needs such as food, safe water, parental care, supervision, and protection. As a result of this, they suffer from malnutrition and poor health. Children living in orphanages tend to be neglected and become malnourished [10–12]. United Nations international children’s fund and World Bank review in New York indicated that the situation of orphans and vulnerable children receives little attention in poverty reduction strategy papers and national strategic plans, despite the large magnitude of the problem that existed in some countries [13]. Based on the National Nutritional program, millions of Ethiopians are still under chronic and acute malnutrition that ranks among the top, both in Sub-Saharan Africa and the world. Although the progress and achievements observed so far can be celebrated, the deep-rooted causes of malnutrition in the country call for high-impact, integrated, and coordinated interventions to end hunger [14]. Another assessment made by the former Children and Youth Affairs Organization in Ethiopia showed the problems faced by the orphanages as inadequate funding to support programs designed for the children, shortage of trained personnel, inadequate skills training that resulted in long care in an orphanage, lack of psychosocial service, and lack of long-term strategic planning. However, there is a limited study conducted on the nutritional status and associated factors among institutionalized under-five orphaned children in Ethiopia and there is no study conducted in the study area. Thus, information regarding the nutritional status of orphan and vulnerable children and associated factors is limited in the study setting. Therefore, this study will be helpful to fill the gap by providing information for policymakers, NGOs, and other stakeholders. 2. Methods and Materials 2.1. Study Area This study was conducted in Addis Ababa which is the capital city of Ethiopia. There are 8 under-five orphanages in Addis Ababa which are given licenses by the Addis Ababa women’s and children’s affairs office. These orphanages are devoted to the care and raring of children who lost their parents and some of these orphanages give health care services for the people outside the orphanage and give support for the vulnerable and fostered children. There are 406 under-five orphan children reared in orphanages. 2.2. Study Design and Period An institutional-based cross-sectional study was conducted from February 28 to March 28, 2020, in orphanages in Addis Ababa 2.3. Study Populations The study populations of this study were all institutionalized under-five orphan children residing in Addis Ababa orphanages. 2.4. Inclusion Criteria and Exclusion Criteria All under-five orphans who had stayed full-time at the orphanages were included in this study. 2.5. Sample Methods and Procedure The sample size for the prevalence objectives was calculated using single population proportion formula determined by using the prevalence of stunting, wasting, and underweight (35.1%, 7.5%, and 8.9%) with 4%, 2%, and 2% margin of error, respectively, from a similar study conducted in Hawassa town [15] and 95% CI using the formula n = (Z a/2)²p (1-q)/d². By adding a 10% nonresponse rate and by considering the population correction formula, the sample size for the prevalence objectives (stunting = 243), (wasting = 261), and (underweight = 275). Finally, the highest calculated sample size from the three indicators was taken as the final sample size, that is, 275. The sample size was also calculated for the associated factors objective through considering different factors [15–17] which were significantly associated with outcome variable with 95% level of confidence, a ratio of unexposed to exposed 1 : 1, power of 80%, and taking in account 10% nonresponse rate. Finally, by considering the population correction formula, the maximum sample size was found to be 222. The final sample size for the associated factors objective was lower than for the prevalence objectives. Therefore, the maximum sample size from the first specific objective (n = 275) was used for this study. A simple random sampling technique was used to recruit a total of 275 study participants. The sample size required for each orphanage was allocated proportionally to the number of orphans in each orphanage. Participants were selected from each stratum randomly from the list of the orphan children registered in the orphanage administration book. 2.6. Data Collection Tools and Measurements Data were collected by using an interviewer-administered, pretested, and structured questionnaire. The questionnaire was initially prepared in the English language by adapting from different sources. The prepared tool was translated into the Amharic language and again back to English to check its consistency. The questionnaire was composed of sociodemographic characteristics, hygiene, and environmental factors, feeding practice, health-related variables, and anthropometric measurements. Data were collected by three data collectors and one supervisor after receiving training for two days by principal investigators in the Amharic language about methods of anthropometric measurement, interviewing technique, and filling questionnaires. The anthropometric measurements, height and weight, were measured using a standard measuring scale using standard operating procedures. Weights of under two year’s children were measured by spring balance weighing without shoes and in light cloth to the nearest 0.1 kg. Beam balance was used to measure the weight of children above two years. The scale was calibrated immediately before and during each session by placing standard calibration weights of 5 kg iron on the scale to ensure accuracy. The length was measured using a wooden board in recumbent position while the child was barefooted and free of a head wearing on children <2 years to the nearest 0.1 cm and height was measured using a wooden board in standing-up position while the child was barefooted and free of any head wearing on children >2 years and recorded to the nearest 0.1 cm. The child was positioned feet together: feet flat on the ground, heels touching the backplate of the measuring instrument, legs straight, buttocks against the backboard, scapula against the backboard, and arms loosely at their side. These measurements were compared and classified of nutritional status using WHO standard growth curves for under-five children. Height for age, weight for age, and weight for height were expressed in standard deviation units (Z scores) from the median of the reference population. The use of this reference population is based on the finding that well-nourished young children in all population groups follow very similar growth patterns. The reference populations are useful for comparison facilitating the examination of differences in the anthropometric status of subgroups in a population and changes in nutritional status over time [18]. Dietary diversity score was assessed based on the number of food groups consumed from the seven food groups within the last 24 hours. Accordingly, children were classified as having adequate dietary diversity scores if they had consumed four and more from seven food groups [19]. 2.7. Data Quality Control Data quality was assured initially through the careful design of the questionnaire and data collection procedure. The data collectors and supervisor were trained for two days on data collection procedures by developing manuals relevant to achieving the objectives of this study. They were trained on how to approach the study subjects, how to record data, how to measure weight and height, and how to control missing data by the principal investigator. In addition to delivering training, the principal investigator and supervisor discussed how to supervise data collectors. A supervisor supervises the data collectors daily to assure that the data collection activities were carried out according to the training guide. The questionnaire was prepared originally in English language and then translated into Amharic language and retranslated into English by a language expert. Almost all of the questions were adopted from other previously conducted similar studies with little modifications [12,20–22]. A pretest was employed before engaging to full implementation of data collection by taking 5% of the sample size (n = 14) outside the study area. The responses of participants were checked by supervisors and the principal investigator by administering the questionnaire at the end of data collection to randomly selected 10% of orphans already visited by the data collectors. Moreover, a supervisor was checking everything recorded by data collectors in each questionnaire daily to ensure no data are missing, and as a result, the data were precise and accurate. Data collectors themselves checked for internal consistency, that is, the extent to which the responses to different questions correlate with each other during interviewing each recruited orphan so that they reconfirmed the responses of the interviewees. 2.8. Data Analysis The data were entered, cleaned, and coded using EpiData version 3.1 and then exported to Statistical Package for Social Sciences (SPSS) version 23 for analysis. Anthropometric indices stunting, underweight, and wasting were generated by using WHO Anthro version 3.2.2, and results were classified according to WHO cut-off points. Descriptive statistics, frequency, percentages, table, figure, and mean and standard deviations were used to present the data. Multiple binary logistic logistics regression analyses were used to address the effect of confounders, and a 95% confidence interval was used to estimate the precision of the odds ratio. The assumption of goodness of the model was checked by Hosmer–Lemeshow test (p value 0.12, 0.35, and 0.58 for wasting, stunting, and underweight), and multicolinearity was checked using the variance inflation factor. Finally, those variables that showed p value <0.05 in multivariable analysis were taken as an independent predictor of undernutrition. 2.9. Ethical Consideration Ethical clearance was obtained from the Ethical Review Board of Bahir Dar University. A formal letter was obtained from Bahir Dar University School of Public Health and was submitted to the management of the orphanages. The directors of the orphanages were consulted before the data collection. Information regarding the aim of the study was explained to the directors, caretakers, and participants, including the procedures, potential risks, and benefits of the study. The respondents were informed that they can refuse not to participate in the study. Confidentiality was by assuring the information was not to be used for another purpose. Written informed consent was required from the orphanage directors and the caretakers, and verbal assent from the children after being informed about the study. 3. Results 3.1. Sociodemographic Characteristics of Study Participants A total of 271 under-five orphan children were involved in this study making the response rate of 98.9%. The mean (±SD) age of the children was 27 (±16.31) months and about 163 (60%) of the participants were males. Among all, 90 (33%) of children were in the age category of 36 and above months, and two-thirds 167 (61.6%) of their caretakers were between the age categories of 19 and 35 years. About 159 (58.7%) and 196 (72%) of caregivers were married and educated, respectively. Around 157 (60%) lived for less than five months in the orphanage (Table 1). Variable Frequency Percent Sex of the child Male 163 60.10 Female 108 39.90 Age of the child in months 6–11 52 19.20 12–23 78 28.80 24–35 51 18.80 ≥36 90 33.20 Age of the caregiver in years <20 10 3.7% 21–45 207 76% >45 54 20% Educational status of the caregiver Uneducated 75 27.7 Educated 196 72.30 Marital status of the caregiver Unmarried 112 41.3 Married 159 58.70 Natural parents of the child alive Yes 71 26.20 No 200 73.80 Is the orphan transferred from another orphanage? Yes 3 1.10 No 268 98.90
 
The basic process for making Bifidobacterium longum BB536-fermented mixture of camel and cow’s milk.
Diagram showing experimental design with animal groups.
Article
The present study aimed to investigate synergistic health effects of camel milk and Bif. longum BB536 in rats with diet-induced obesity, impaired lipid profile, and hyper-cholesterolemia. Wistar rats received a high-fat (HF) diet plus 2 ml/day of either cow’s milk fermented with yogurt culture (CT), camel milk fermented with yogurt culture (CAT), camel milk fermented with Bif. longum BB536 (CAP), mixed cow’s and camel milk fermented with yogurt culture (CCAT), or cow’s milk and camel milk fermented with Bif. longum (CCAP). All fermented milk products significantly reduced HDL, albumin, and total protein. ,e percentage change in body weight gain was between − 40% (CAP) and − 24% (CT) and in serum triglycerides between − 54% (CCAP) and − 37% (CT); for the other parameters, changes caused by CCAP/CT were − 40%/− 22% (total cholesterol), +29%/+8% (HDL), − 73%/− 54% (LDL), − 54%/− 37% (VLDL), − 52%/− 14% (AST), − 53%/− 31% (ALT), +43%/+25% (albumin), +37%/+25% (total protein), − 48%/− 27% (urea), and − 34%/− 16% (creatinine). Camel or cow’s milk fermented with yogurt culture or Bif. longum significantly improved negative effects of the HF diet on body weight, blood lipid profile, serum proteins, liver and kidney markers, and severity of the metabolic syndrome. Milk and fermentation culture acted synergistically with camel milk and Bif. longum generally showed stronger positive effects.
 
The prevalence of Canadians (12–79 y of age) with at least one, two, and three components of metabolic syndrome across the three age groups of 12–19, 20–50, and 51–79 years. Canadian Health Measures Survey combined Cycles 1 and 2, 2007–2011 (n = 4,272, males = 49.6%, representative of 26,038,108 Canadians aged 12 to 79 years), was conducted. ∗Significance differences between MetS prevalence of the three age groups.
Article
Background: Metabolic syndrome (MetS) is known to increase the risk of cardiovascular diseases and diabetes. Diet is a key factor in prevention and development of MetS. This study aimed to determine the association between dietary patterns and MetS among Canadians 12-79 years old using the Canadian Health Measures Survey (CHMS) combined Cycles 1 and 2 data from 2007-11. We hypothesized that MetS varies among different sociodemographic and lifestyle factors and that Canadians who have less healthy dietary patterns are more likely to have MetS. Methods: In the CHMS, MetS was determined using objective health measures. The principal component analysis method was used to determine the dietary patterns. Using logistic regression, the association between MetS and dietary patterns, controlling for potential covariates, was investigated for age groups of 12-19, 20-49, and 50-79 years. Survey data were weighted and bootstrapped to be representative at the national level. Results: The prevalence of MetS was 16.9% for ages 12-79 y (n = 4,272, males = 49.6%), representing 26,038,108 Canadians aged 12-79 years. MetS was significantly different across sociodemographic variables; Canadians with less education, income, and activity had higher MetS prevalence than their counterparts. In older adults (50-79 years of age), the "fast-food" dietary pattern was associated with 26% (odds ratio = 1.26; 95% CI: 1.04 to 1.54; p=0.0195) higher likelihood of having MetS. Conclusions: Among older Canadians, MetS is associated with a "fast-food" dietary pattern after adjustment for socioeconomic/lifestyle factors. Findings suggest the importance of diet quality/composition in the development of MetS among older Canadians and the need for further longitudinal studies on MetS and diet across the lifespan.
 
Top-cited authors
Julien S Baker
  • Hong Kong Baptist University Sport Physical Education and Health
Rebecca Wall
  • Örebro University
Scott Graham
  • Edinburgh Napier University
Marianne Findlay Baird
  • Edinburgh Napier University
Dalia El Khoury
  • University of Guelph