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Targeting effective strategies to prevent cognitive decline is key in the aging population. Some diets have been linked to a slower cognitive decline, potentially through reducing inflammation. We aimed at determining the effect of inflammatory dietary patterns (IDPs) on cognitive function in three population-based cohorts. In this longitudinal study, we analyzed data from the Canadian Longitudinal Study of Aging, CoLaus|PsyCoLaus and Rotterdam Study. Our analytical sample included participants over 55 years old with baseline data on cognition, dietary intake, and inflammatory markers. IDPs were derived for each cohort using reduced rank regression to reflect maximal variation in three inflammatory markers. We calculated scores of consumption of the IDPs, higher scores indicating more IDP consumption. We used inverse probability of treatment and censoring weights in the marginal structural models to estimate associations of higher versus lower quarters of consumption of an IDP on general cognition (Mini-Mental State Evaluation) and four cognitive domains (memory, verbal fluency, verbal learning and processing speed and executive function) during at least 3 years of follow-up. We included 10,366 participants (mean age 68) followed-up for a mean of 5 years. Diet explained between 1 and 2% of the variation of the inflammatory markers. There were no differences in general cognition when comparing the highest to the lowest quarter of consumption of IDPs among the three cohorts. Mean differences for the four cognitive domains were of small magnitude across cohorts and not clinically relevant. Diet explained low variation in inflammatory markers. Consuming IDPs was not associated with mean differences in general or domain-specific cognitive function. [ABSTRACT FROM AUTHOR]

Biological hormonal changes are frequently cited as an explanatory factor of sex and menopause differences in cardiometabolic diseases (CMD) and its associated risk factors. However, iron metabolism which varies between sexes and among women of different reproductive stages could also play a role. Recent evidence suggest that iron may contribute to CMD risk by modulating oxidative stress pathways and inflammatory responses, offering insights into the mechanistic interplay between iron and CMD development. In the current review, we provide a critical appraisal of the existing evidence on sex and menopausal differences in CMD, discuss the pitfall of current estrogen hypothesis as sole explanation, and the emerging role of iron in CMD as complementary pathway. Prior to menopause, body iron stores are lower in females as compared to males, but the increase during and after menopause, is tandem with an increased CMD risk. Importantly, basic science experiments show that an increased iron status is related to the development of type 2 diabetes (T2D), and different cardiovascular diseases (CVD). While epidemiological studies have consistently reported associations between heme iron intake and some iron biomarkers such as ferritin and transferrin saturation with the risk of T2D, the evidence regarding their connection to CVD remains controversial. We delve into the factors contributing to this inconsistency, and the limitation of relying on observational evidence, as it does not necessarily imply causation. In conclusion, we provide recommendations for future studies on evaluating the potential role of iron in elucidating the sex and menopausal differences observed in CMD. • Cardiometabolic diseases (CMD) differ in prevalence and risk factors between sexes. • Sex and menopause status significantly predict CMD outcomes. • Attributing CMD's sex differences solely to the estrogen hypothesis is not persuasive. • Levels of iron biomarkers differ between sexes in different reproductive stages. • Changes in iron levels may mediate associations between sex, menopause, and CMD. [ABSTRACT FROM AUTHOR]

Diet may play an essential role in the aetiology of bladder cancer (BC). Vitamin D is involved in various biological functions which have the potential to prevent BC development. Besides, vitamin D also influences the uptake of calcium and phosphorus, thereby possibly indirectly influencing the risk of BC. The aim of the present study was to investigate the relation between vitamin D intake and BC risk. Individual dietary data were pooled from ten cohort studies. Food item intake was converted to daily intakes of vitamin D, calcium and phosphorus. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs) were obtained using Cox-regression models. Analyses were adjusted for gender, age and smoking status (Model 1), and additionally for the food groups fruit, vegetables and meat (Model 2). Dose–response relationships (Model 1) were examined using a nonparametric test for trend. In total, 1994 cases and 518,002 non-cases were included in the analyses. The present study showed no significant associations between individual nutrient intake and BC risk. A significant decreased BC risk was observed for high vitamin D intake with moderate calcium and low phosphorus intake (Model 2: HR high vitD, mod Ca, low P : 0.77, 95% CI: 0.59–1.00). No significant dose–response analyses were observed. The present study showed a decreased BC risk for high dietary vitamin D intake in combination with low calcium intake and moderate phosphorus intake. The study highlights the importance of examining the effect of a nutrient in combination with complementary nutrients for risk assessment. Future research should focus on nutrients in a wider context and in nutritional patterns. [ABSTRACT FROM AUTHOR]

Although intermittent energy restriction (IER) seems to be as effective as continuous energy restriction (CER) for weight loss, there is still a need to determine the putative effect of this strategy upon the metabolic-inflammatory status. This study aimed to compare the effects of IER versus CER on cardiometabolic and inflammatory markers, over a 12-week period, in adults with obesity. Twenty-eight Norwegian adults (20–55 years) with obesity [body mass index: 35.4 (3.7) kg/m2] from a clinical trial (NCT02169778) who completed a 12-weeks diet-induced weight loss as IER (n = 14) or CER (n = 14) were included in this study. Cardiometabolic, adipokines and inflammatory markers were evaluated at baseline and after the intervention. Plasma levels of 13 inflammatory cytokines and chemokines (IL-1β, IFN-α 2 , IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12, IL-17A, IL-18, IL-23, and IL-33) and 4 adipokines (adiponectin, adipsin, leptin and resistin) were measured through multiplex bead-based flow cytometric immunoassays. Both interventions resulted in comparable reductions in fasting glucose and insulin concentrations, lipid profile biomarkers, and adipokines. There were significant differences in HOMA-IR between interventions, with a more pronounced reduction in the IER group (−3.7 vs −1.6, P = 0.040). Inflammatory cytokines and chemokines decreased significantly in the IER group only. Differences in the relative changes of IL-1β (−48.5 vs 58.2%, P = 0.011), IFN-γ (−53.2 vs 45.1%, P = 0.023), MCP-1 (−22.0 vs 17.4%, P = 0.023), IL-18 (−40.8 vs 10.1%, P = 0.019), IL-23 (−64.8 vs 44.0%, P = 0.011) and IL-33 (−53.4 vs 35.7%, P = 0.028) were statistically significant between groups, with improvements in the inflammatory profile in the IER group. Our results suggest that a 12-weeks intermittent energy restriction, in comparison to a continuous energy strategy, could be advantageous to reduce inflammation associated with obesity, and consequently improve insulin resistance, regardless of the amount of weight loss. Registered under ClinicalTrials.gov Identifier no. NCT02169778. [ABSTRACT FROM AUTHOR]

Evidence suggests that gut microbiota is a potential factor in the pathophysiology of both obesity and related metabolic disorders. While individual randomized controlled trials (RCTs) have evaluated the effects of probiotics on adiposity and cardiovascular disease (CVD) risk factors in subjects with overweight and obesity, the results are inconsistent. Thus, this systematic review and meta-analysis aimed to evaluate the effects of probiotic supplementation on body weight, body adiposity and CVD risk markers in overweight and obese subjects. A systematic search for RCTs published up to December 2020 was conducted in MEDLINE (via PubMed), EMBASE, Scopus and LILACS. Meta-analysis using a random-effects model was chosen to analyze the impact of combined trials. Twenty-six RCTs (n = 1720) were included. Data pooling showed a significant effect of probiotics in reducing body weight (MD:-0.70 kg; 95%CI:-1.04,-0.35 kg; P < 0.0001), body mass index (BMI) (MD:-0.24 kg/m2; 95%CI:-0.35,-0.12 kg/m2; P = 0.0001), waist circumference (WC) (MD:-1.13 cm; 95%CI:-1.54,-0.73 cm; P < 0.0001), fat mass (MD:-0.71 kg; 95%CI:-1.10,-0.32 kg; P = 0.0004), tumor necrosis factor-α (MD:-0.16 pg/ml; 95%CI:-0.24,-0.08 pg/ml; P = 0.0001), insulin (MD:-0.85mcU/ml; 95%CI:-1.50,-0.21mcU/ml; P = 0.010), total cholesterol (MD:-0.16 mmol/l; 95%CI:-0.26,-0.05 mmol/l; P = 0.003) and LDL (MD:-0.09 mmol/l; 95%CI:-0.16,-0.03 mmol/l; P = 0.006) compared with control groups. There was a significant decrease in body weight, BMI and WC in studies using both single and multi-bacterial species. Decreases in body adiposity parameters were only observed in studies using a probiotic dose of ≥ 1010 CFU and for ≥8 weeks duration. The present meta-analysis suggests that probiotics consumption may be helpful for improving body weight, body adiposity and some CVD risk markers in individuals with overweight and obesity. The review was registered on PROSPERO (International prospective register of systematic reviews): CRD42020183136. [ABSTRACT FROM AUTHOR]

Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: "Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?". A possible cause–effect relationship between masticatory improvements and nutritional gain was also evaluated. Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument" (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744). We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p < 0.05). However, bioavailability of several nutrients remained within the same range, except for serum folate that was lower in IOD patients after 6 (mean difference 3.51 nmol/L; p = 0.01) and 12 months of rehabilitation (mean difference 3.69 nmol/L; p = 0.003). When comparing the effects of CD and IOD rehabilitations along time (for the same patient), serum albumin and vitamin B12 levels also decreased for both groups after 12 months-follow-up, but still within the reference range. The additional retention of the implants did not interfere in body weight, but reduced the risk of malnutrition (using the Mini Nutritional Assessment). Implant-supported partial prostheses also improved mastication in comparison to the conventional ones, increasing short-term daily intake of carbohydrates, protein, calcium, fiber, and iron, whereas decreasing the consumption of cholesterol. However, no long-term changes on bioavailability of most nutrients were observed, expect for a slight increase in ferritin and cholinesterase, and a small reduction in folate and Vitamin A. Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients. [ABSTRACT FROM AUTHOR]

Evidence suggests that chemotherapy (CT) leads to unfavorable outcomes on nutritional and metabolic profile; however, this is poorly understood. To evaluate the impact of CT on body composition, bone mineral density (BMD), insulin resistance, lipid markers related to atherosclerotic cardiovascular diseases in women recently diagnosed with breast cancer according to menopausal status. This is a prospective study that enrolled women newly diagnosed with stage II–III breast cancer (2014–18). Body composition were measured by dual-energy x-ray absorptiometry. Blood samples were collected to assess lipid profile, insulin resistance and sensitivity, visceral adiposity index and lipid accumulation product were calculated. Dietary intake, physical activity and function were also evaluated at the time of breast cancer diagnosis and after CT completion. Ninety-nine women (40.4% in the premenopausal stage) aged 51 ± 1 years took part in this study. CT duration was 197 ± 27 days and main regimen was anthracyclines with taxanes (88.9%). CT was associated with an increase in total and central adiposity, insulin resistance, and all lipid-related markers, and a decrease in appendicular lean mass index, BMD and HDL-c concentration. Premenopausal women experienced greater unfavorable outcomes on adiposity markers and BMD compared to postmenopausal women (p < 0.01). No changes were observed in dietary intake and physical activity after CT. Breast cancer CT negatively impacted body composition and metabolic profile. Premenopausal women experienced greater unfavorable impact on adiposity markers and BMD. [ABSTRACT FROM AUTHOR]

Consuming 0.10–0.14 g essential amino acids (EAA)/kg/dose (0.25–0.30 g protein/kg/dose) maximally stimulates muscle protein synthesis (MPS) during energy balance. Whether consuming EAA beyond that amount enhances MPS and whole-body anabolism following energy deficit is unknown. The aims of this study were to determine the effects of standard and high EAA ingestion on mixed MPS and whole-body protein turnover following energy deficit. Nineteen males (mean ± SD; 23 ± 5 y; 25.4 ± 2.7 kg/m2) completed a randomized, double-blind crossover study consisting of two, 5-d energy deficits (−30 ± 4% of total energy requirements), separated by 14-d. Following each energy deficit, mixed MPS and whole-body protein synthesis (PS), breakdown (PB), and net balance (NET) were determined at rest and post-resistance exercise (RE) using primed, constant L-[2H 5 ]-phenylalanine and L-[2H 2 ]-tyrosine infusions. Beverages providing standard (0.1 g/kg, 7.87 ± 0.87 g) or high (0.3 g/kg, 23.5 ± 2.54 g) EAA were consumed post-RE. Circulating EAA were measured. Postabsorptive mixed MPS (%/h) at rest was not different (P = 0.67) between treatments. Independent of EAA, postprandial mixed MPS at rest (standard EAA, 0.055 ± 0.01; high EAA, 0.061 ± 0.02) and post-RE (standard EAA, 0.055 ± 0.01; high EAA, 0.065 ± 0.02) were greater than postabsorptive mixed MPS at rest (P = 0.02 and P = 0.01, respectively). Change in (Δ postabsorptive) whole-body (g/180 min) PS and PB was greater for high than standard EAA [mean treatment difference (95% CI), 3.4 (2.3, 4.4); P = 0.001 and −15.6 (−17.8, −13.5); P = 0.001, respectively]. NET was more positive for high than standard EAA [19.0 (17.3, 20.7); P = 0.001]. EAA concentrations were greater in high than standard EAA (P = 0.001). These data demonstrate that high compared to standard EAA ingestion enhances whole-body protein status during underfeeding. However, the effects of consuming high and standard EAA on mixed MPS are the same during energy deficit. NCT03372928 , https://clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Ursolic acid (UA) is thought to have an anabolic effect on muscle mass in humans. This study sought to compare the effects of UA and a placebo on muscle strength and mass in young men undergoing resistance training (RT) and consuming a high-protein diet. A clinical, double-blind, placebo-controlled trial was conducted for 8 weeks. The Control + RT group (CON n = 12) received 400 mg/d of placebo, and the UA + RT group (UA n = 10) received 400 mg/d of UA. Both groups ingested ~1.6 g/kg of protein and performed the same RT program. Pre- and post-intervention, both groups were evaluated for anthropometric measures, body composition, food intake and muscle strength. Food intake remained unchanged throughout the study. Both groups showed significant increases in body weight (CON Δ: 2.12 ± 0.47 kg, p = 0.001 vs. UA Δ: 2.24 ± 0.67 kg, p = 0.009), body mass index (BMI) (CON Δ: 0.69 ± 0.15 kg/m2, p = 0.001 vs. UA Δ: 0.75 ± 0.23, p = 0.011) and thigh circumference (CON Δ: 1.50 ± 0.36, p = 0.002 vs. UA Δ: 2.46 ± 0.50 cm, p = 0.003 vs. UA 1.84 ± 0.82 cm, p = 0.001), with differences between them. There was no difference in the arm, waist and hip circumferences. Both groups showed increases in muscle mass (CON Δ: 1.12 ± 0.26, p = 0.001 vs. UA Δ: 1.08 ± 0.28 kg, p = 0.004), but there was no significant difference between them. Additionally, there were significant increases in the one repetition maximum test in the bench press and in the 10-repetition maximum test in the knee extension (CON Δ: 5.00 ± 2.09, p = 0.036 vs. UA Δ: 7.8 ± 1.87, p = 0.340 and CON Δ: 3.58 ± 1.15, p = 0.010 vs. UA Δ: 1.20 ± 0.72, p = 0.133), respectively, with no difference between them. Ursolic acid had no synergic effect on muscle strength and mass in response to RT in physically active men consuming a high-protein diet. RBR-76tbqs. [ABSTRACT FROM AUTHOR]

Exclusive enteral nutrition induces remission, improves bone health and growth in paediatric Crohn's disease (CD) patients, but is highly demanding for patients. We investigated efficacy of partial enteral nutrition (PEN) on bone health, growth and course in CD patients and assessed microbial and metabolic changes induced by PEN. We performed a two centre, non-randomized controlled intervention study in quiescent CD patients aged <19 years. Patients in intervention group received a liquid formula providing ~25% of daily energy for one year. At baseline, after 3, 6, 9 and 12 months, we collected data on bone, muscle (peripheral quantitative computertomography), anthropometry, disease activity (weighted paediatric CD activity index), metabolomic profile (liquid chromatography mass spectrometry), and faecal microbiome (16S rRNA gene sequencing). Of 41 CD patients, 22 received the intervention (PEN) (mean age 15.0 ± 1.9 years, 50% male), 19 served as controls (non-PEN) (12.8 ± 3.1 years, 58% male). At baseline, mean bone quality was comparable to reference population with no improvement during the intervention. Relapse rate was low (8/41, PEN 4/22 and non-PEN 4/19, ns). PEN was not associated with microbiota community changes (beta diversity) but significantly reduced species diversity. Metabolome changes with upregulation of phosphatidylcholines in PEN patients are likely related to lipid and fatty acid composition of the formula. PEN significantly improved growth in a subgroup with Tanner stage 1–3. In our cohort of paediatric CD patients, PEN did not affect bone health but improved growth in patients with a potential to grow. [ABSTRACT FROM AUTHOR]

People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85–0.98) and taste (0.85; 0.79–0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06–1.21) and limited options in restaurants (1.33; 1.23–1.45) and in supermarkets (1.18; 1.03–1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66–0.78), while price (1.20; 1.11–1.30), gluttony (1.17; 1.04–1.31), social group opposition (1.48; 1.18–1.85) and limited options in restaurants (1.56; 1.42–1.72) and in supermarkets (1.25; 1.07–1.47) were associated with higher adherence. Daily habits (0.82; 0.75–0.90), time (0.86; 0.78–0.94), lack of willpower (0.78; 0.70–0.87), and gluttony (0.86; 0.76–0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01–1.19), and limited options in restaurants (1.26; 1.14–1.39) and supermarkets (1.40; 1.20–1.63) were associated with higher adherence. Daily habits (0.89; 0.82–0.97), taste (0.66; 0.61–0.72), lack of willpower (0.84; 0.76–0.92) and gluttony (0.66; 0.58–0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78–0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09–1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85–0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03–1.22). In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence. [ABSTRACT FROM AUTHOR]

Obese individuals present adverse changes in the diversity and composition of the gut microbiota, leading to alterations in energy balance, lipid metabolism, endocrine disturbances, and low-grade chronic systemic inflammation increases. Probiotic supplementation appears to change gut microbiota by decrease gut permeability, inflammation, and metabolic disorders, creating a promising environment to weight loss. This revision resumes the main findings of probiotic supplementation and weight loss that contributed to building the current background linking changes in gut microbiota profile and with obesity. [ABSTRACT FROM AUTHOR]

Vitamin D is known to modulate immune function and proliferation. Higher vitamin D [25(OH)D 3 ] serum levels have been reported to have protective effects on adenoma detection and colorectal cancer (CRC) development and survival. This retrospective cohort study included 315 peri and post-menopausal women submitted to opportunistic colorectal and osteoporosis screening at the gynaecology outpatient clinic of a tertiary medical centre between 2004 and 2015. Colonoscopy findings were correlated with 25(OH)D 3 and PTH serum levels, and subsequently adjusted in a multivariate logistic regression model. Confounding factors included demographic and colorectal risk factors, pharmacological therapies and bone densitometry metrics. A total of 77 lesions were identified in 66 patients. Vitamin D insufficiency (<30 ng/mL) and deficiency (<20 ng/mL) were identified in 79.4% and 35.2% of patients, respectively. In univariate analysis, lower levels of 25(OH)D 3 were associated with polyp, adenoma and advanced adenoma detection. After adjusting for confounders, an association with polyps could not be observed, but a trend towards a negative correlation with adenoma detection was found (adjusted OR: 0.96; 95% CI 0.92–1.00; p = 0.083). Regarding advanced adenoma detection, 25(OH)D 3 (adjusted OR: 0.86; 95% CI 0.77–0.97; p = 0.013) proved to be an independent predictive factor. No association was found between 25(OH)D 3 levels and lesion detection site. The association of 25(OH)D 3 serum levels with colorectal lesions seems to be restricted to adenomatous lesions and is influenced by histological grading. Vitamin D may be a valuable biomarker for optimization of risk stratification in group-specific CRC screening protocols. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) limits food ingestion and may alter the intestinal expression of genes involved in the endogenous synthesis of polyunsaturated fatty acids (PUFAs). These changes may decrease the systemic availability of bioactive PUFAs after RYGB. To study the impact of RYGB on the dietary ingestion and plasma concentration of PUFAs and on the intestinal expression of genes involved in their endogenous biosynthesis in severely obese women with type 2 diabetes. Before, and 3 and 12 months after RYGB, obese women (n = 20) self-reported a seven-day dietary record, answered a food frequency query and provided plasma samples for alpha-linolenic (ALA), eicosapentaenoic (EPA), docosahexaenoic (DHA) and arachidonic (ARA) acid assessment by gas chromatography. Intestinal biopsies (duodenum, jejunum and ileum) were collected through double-balloon endoscopy before and 3 months after RYGB for gene expression analysis by microarray (Human GeneChip 1.0 ST array) and RT-qPCR validation. Compared to the preoperative period, patients had decreased intakes of PUFAs, fish and soybean oil (p < 0.05) and lower plasma concentrations of ALA and EPA (p < 0.001) 3 and 12 months after RYGB. FADS1 gene expression was lower in duodenum (RT-qPCR fold change = −1.620, p < 0.05) and jejunum (RT-qPCR fold change = −1.549, p < 0.05) 3 months following RYGB, compared to before surgery. RYGB decreased PUFA ingestion, plasma ALA and EPA levels, and intestinal expression of FADS1 gene. The latter encodes a key enzyme involved in endogenous biosynthesis of PUFAs. These data suggest that supplementation of omega-3 PUFAs may be required for obese patients undergoing RYGB. Clinical Trial Registry number and website: www.clinicaltrials.gov – NCT01251016 ; Plataforma Brasil – 19339913.0.0000.0068. [ABSTRACT FROM AUTHOR]

Summary Background & aims How undernutrition is reported in hospital discharge data is not understood. To assess trends in reported undernutrition and its management among hospitalized patients in Switzerland, and the association between reported undernutrition and in-hospital mortality, acquired infection, intensive care unit stay (ICU), and length of hospital stay (LOS). Methods Data from the Swiss hospital discharge databases from 1998 to 2014 (n = 13,297,188 hospitalizations, 52.2% women, 48.4% aged 65+, and 85% Swiss national). Reported undernutrition was defined by the presence of any undernutrition-related International Classification of Diseases 10th revision code. Nutritional management was defined by the presence of any nutritional intervention code. Results Prevalence of reported undernutrition increased from 0.32% in 1998 to 3.97% in 2014 in Switzerland, and similar but varying trends were found for each of the seven Swiss administrative regions: ranging from 0.18% to 2.13% in Ticino and from 0.23% to 5.63% in Mittelland. Undernutrition management of hospitalizations with reported undernutrition increased from 0.6% in 1998 to 57.8% in 2014, with wide variations according to administrative region: from 0% to 32.9% in Ticino and from 0% to 68.9% in Central Switzerland. After multivariable adjustment, reported undernutrition was positively associated with in-hospital mortality: odds-ratio and (95% confidence interval): 2.30 (2.26–2.34); acquired infection: 3.57 (3.46–3.70); ICU stay: 1.65 (1.63–1.68) and longer LOS: 19.6 ± 0.2 vs. 13.0 ± 0.1 days. Conclusion Undernutrition is increasingly reported in Switzerland; still, over 40% of undernourished hospitalizations don't benefit from nutritional support. Reported undernutrition is associated with increased in-hospital mortality, acquired infection, ICU stay, and LOS. Highlights • Undernutrition reporting in hospital data increased from 0.3% in 1998 to 4% in 2014. • 40% of hospitalizations with undernutrition had no nutritional management reported. • Reporting rates varied considerably between regions. • Undernutrition was positively associated with unfavourable outcomes. [ABSTRACT FROM AUTHOR]

Summary Background & aims Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3. Methods Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system. Results 2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally ‘at-risk’. After multivariate adjustment, patients nutritionally ‘at-risk’ had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients ‘at-risk’ vs. 4431 ± 881 in patients ‘not at-risk’ (p < 0.003). Being nutritionally ‘at-risk’ also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62–0.97). Patients ‘at-risk’ had lower percentage of total costs in medical interventions, food, imaging and “other”, but the absolute differences were less than 2%. Conclusion Hospital costs of patients nutritionally ‘at-risk’ are less well reimbursed than of patients ‘not at-risk’. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed. [ABSTRACT FROM AUTHOR]

Summary Background & aims The vitamin A nutritional status is marginal for most of the newborns, and the prevention of that deficiency is promoted by breastfeeding. The Ministry of Health of Brazil established the National Vitamin A Supplementation Program, giving mega-doses of this nutrient to women right after delivery, in order to provide adequate vitamin A content in the breast milk and The International Vitamin A Consultative Group has supported the recommendation, to supplement with 400 000 IU of VA immediately after delivery. This study compares retinol concentrations in breast milk (colostrum, 2 and 4 months) from mothers supplemented during immediate postpartum with 400 000 IU versus 200 000 IU of vitamin A. Methods A randomized, controlled, triple-blind trial, conducted in two public maternities in Recife, Northeast Brazil. Two hundred and ten mothers were recruited and allocated into two treatment groups: 400 000 IU or 200 000 IU of Vitamin A and monitored for 4 months. Results There was no significant difference between retinol concentrations in breast milk between treatment groups (400 000 IU vs 200 000 IU) in the studied period: 2 months (p = 0.790) and 4 months (p = 0.279), although a progressive reduction of concentrations throughout the study was observed in both treatment groups, 400 000 IU (p < 0.0001) and 200 000 IU (p < 0.0001). Conclusions The absence of an additional effect of a higher dosage justifies the 200 000 IU supplementation, according to the World Health Organization. Registered under ClinicalTrials.gov Identifier No. NCT00742937 . [ABSTRACT FROM AUTHOR]

Summary Background & aims Hospitalized patients should be screened for nutritional risk and adequately managed. Being nutritionally ‘at-risk’ increases in-hospital mortality, length of stay (LOS) and costs, but the impact on actual costs has seldom been assessed. We aimed to determine nutritional risk screening and management in a Swiss university hospital. The impact of being nutritionally ‘at-risk’ on in-hospital mortality, LOS and costs was also assessed. Methods Retrospective analysis of administrative data for years 2013 and 2014 from the department of internal medicine of the Lausanne university hospital (8541 hospitalizations, mean age 72.8 ± 16.5 years, 50.4% women). Being nutritionally ‘at-risk’ was defined as a Nutritional risk screening-2002 score ≥ 3 and nutritional managements were collected from medical records. Results Screening increased from 16.5% in 2013 to 41.9% in 2014 (p < 0.001), while prevalence of ‘at-risk’ patients remained stable (64.6% in 2013 and 62.7% in 2014, p = 0.37). Prevalence of ‘at-risk’ patients was highest in patients with cancer (85.3% in 2013 and 70.2% in 2014) and lowest in patients with disease of skin (42% in 2013 and 44.8% in 2014). Less than half of patients ‘at-risk’ received any nutritional management, and this value decreased between 2013 and 2014 (46.9% vs. 40.3%, p < 0.05). After multivariate adjustment, ‘at-risk’ patients had a 3.7-fold (95% confidence interval: 1.91; 7.03) higher in-hospital mortality and higher costs (excess 5642.25 ± 1479.80 CHF in 2013 and 5529.52 ± 847.02 CHF in 2014, p < 0.001) than ‘not at-risk’ patients, while no difference was found for LOS. Conclusion Despite an improvement in screening, management of nutritionally ‘at-risk’ patients is not totally covered yet. Being nutritionally ‘at-risk’ affects three in every five patients and is associated with increased mortality and hospitalization costs. [ABSTRACT FROM AUTHOR]

Summary Background & aims Several barriers can hinder healthy eating in the population. We aimed to assess the prevalence of self-reported barriers to healthy eating in Switzerland and examine their socioeconomic and demographic determinants. Methods Using representative cross-sectional data from the Swiss Health Survey 2012, we assessed, separately by gender, the prevalence of ten barriers and their association with demographic and socioeconomic determinants; we used age- and multivariable-adjusted logistic regression and report the odds ratio for likelihood to identify each barrier according to each demographic and socioeconomic determinant. Results The most prevalent barriers were “price” (43.2% in women, 35.8% in men), “daily habits, constraints” (39.8%, 37.5%), “fondness of good food” (38.8%, 51.0%), “time constraint” (34.8%, 29.0%) and “lack of willpower” (22.0%, 21.2%). Prevalence of most barriers decreased with age, increased for “fondness of good food” and remained constant for “price.” After multivariable adjustment, obese participants were more likely to report “fondness of good food” [Odds ratio (95% confidence interval) for obese vs. normal weight women and men, respectively: 1.63 (1.38–1.91), 2.02 (1.72–2.38)]. Participants with lower education were more likely to report “fondness of good food” [mandatory vs. tertiary women and men, respectively: 1.93 (1.62–2.39), 1.51 (1.26–1.81)], but less likely to report “lack of willpower” [0.45 (0.38–0.55), 0.40 (0.33–0.49)] and “time constraint” [0.61 (0.51–0.73), 0.78 (0.63–0.96)]. Participants with lower income were more likely to report “price” [lowest vs. highest quartile for women and men, respectively, 1.65 (1.43–1.90), 1.47 (1.26–1.71)] but less likely to report “lack of willpower” [0.71 (0.61–0.82), 0.40 (0.33–0.49)]. Smoking, living situation, nationality and living area showed little or no association. Conclusion Several barriers to healthy eating were highly prevalent regardless of gender; the most important determinants were age, obesity, education, and income, with different effects per barrier. This requires multifaceted interventions to tackle several barriers simultaneously. [ABSTRACT FROM AUTHOR]

Background & aims: Selenium is an essential mineral for immunological function, performing crucial functions at the cellular level. This micronutrient has been determined to be frequently deficient in HIV infected patients, with correlations between reduced immunological function and greater susceptibility to opportunistic infections. Our aim was to evaluate the influence of time of exposure to antiretroviral therapy (ART) on the biochemical profile of selenium in HIV-infected patients. Methods: We performed a cross-sectional study on 50 HIV-positive men with different quantitations of viral load and CD4+ T cells, who were either receiving or not receiving ART. Dual energy X-ray absorptiometry (DXA) to determine body composition, biochemical analysis of selenium and albumin, anthropometric measurements were performed. The subjects were divided into groups according to the use of ART or not: The Control Group (CG) was 10 treatment-naïve volunteers, Group G < 2 was 20 volunteers on ART for less than 2 years, and Group G > 2 was 20 volunteers on ART for >2 years. Results: The body mass index showed that all subjects were of normal weight. The group with a longer time of exposure to ART (G > 2) had undetectable viremia and a higher CD4+ T cell count: 593.1 ± 234.6 mm3. Selenium values (μg/L) were 55.9 ± 11.9 for CG, 52.1 ± 10.5 for G < 2, and 66.9 ± 20.8 for G > 2, with a significant difference between groups G < 2 and G > 2 (p < 0.05), and only G > 2 showed normal selenium values. Conclusions: Most of th e men studied showed selenium deficiency, except for the subjects with a longer exposure to antiretroviral treatment. Thus, an adequate selenium concentration is related to better control of virology and of immunologic function. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Currently, there are no clinical or laboratory parameters that can be used efficiently to predict the prognosis of critically ill patients, but in some situations, raw bioelectrical impedance parameters have been shown to be useful. The purpose of this study was to investigate the behavior of reactance and resistance in the severity of the critically ill pediatric patient. Methods: We prospectively analyzed bioelectrical impedance in a sample of 332 critically ill pediatric patients submitted to mechanical ventilation. The values taken on admission and discharge were correlated with major outcomes to the critically ill patient. Results: We found an association of low values of Xc/H (<27.7 Ohm/m) and of R/H (<563.6 Ohm/m) on admission with multiple organs dysfunction greater or equal to 4. Both R/H and Xc/H increased significantly between admission and discharge among survivors, while among nonsurvivors there was a trend of decrease between admission and the last measurement before death. Conclusions: Bioelectrical impedance is a useful tool for monitoring of critically ill pediatric patients. A possible role of R/H and Xc/H, especially the latter, as a predictive biomarker of evolution for septic shock and organ dysfunction still remains to be elucidated. [Copyright &y& Elsevier]

Summary: Background & aims: To assess the adherence to the national dietary recommendations and to identify factors contributing to dietary compliance in Switzerland. Methods: Population-based cross-sectional study in Lausanne, Switzerland (CoLaus study), 2009–2012. Dietary intake was assessed using a validated food frequency questionnaire. Participants were dichotomized according to whether they followed the national recommendations for fruits, vegetables, meat, fish and dairy products. Results: Data from 4371 participants (54% women, mean age ± SD: 57.6 ± 10.5 years) were analyzed. Compliance with the recommendations was low: only 39.4%, 7.1%, 61.3%, 66.4%, and 8.4% complied with the Swiss recommendations for fruit (≥2/day), vegetables (≥3/day), meat (≤5/week), fish (≥1/week) and dairy products (≥3/day), respectively. In multivariate analyses, gender, age, smoking status, Swiss-born status, education, being on a diet and body mass index were associated with dietary compliance, while no difference was found between women before and after menopause. Factors specifically associated with fruits, vegetables, meat, fish or dairy products recommendations were identified. Conclusion: The low degree of compliance with dietary recommendations calls for a continued effort to increase the population awareness of the importance of a healthy and balanced diet, especially for vegetables and dairy products. This study identified determinants that should guide this effort. [Copyright &y& Elsevier]

Background & aims: In Duchenne muscular dystrophy (DMD) and in the mdx mouse model of DMD, the lack of dystrophin leads to muscle degeneration and inflammation contributes to progression of the disease. In this study, we evaluated the effects of commercially available fish oil containing EPA and docosahexaenoic acid (DHA) on mdx. Methods: Mdx mice (14 days old) were treated with fish oil (FDC Vitamins; 0.002 g EPA and 0.001 g DHA) for 16 days by gavage. Control mdx mice received mineral oil (Nujol). Grip strength measurement was used for functional evaluation. The sternomastoid, diaphragm and biceps brachii muscles were removed and processed for histopathology and Western blot analysis. Results: Fish oil decreased creatine kinase and myonecrosis. In all muscles studied, the inflammatory area was significantly reduced after treatment (18.0 ± 3.0% inflammatory area in untreated mdx mice versus 4.0 ± 1% in treated rndx mice). Fish oil protected against the loss of muscle strength. Fish oil significantly reduced the levels of TNF-α and the levels of 4-HNE-protein adducts (30-34% reduction for both) in all muscles studied. Conclusions: Commercially available fish oil may be potentially useful to ameliorate dystrophic progression of skeletal muscles, deserving further clinical trials in DMD patients. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Duchenne muscular dystrophy (DMD) is a genetic muscle disease caused by the absence of dystrophin. An established animal model of DMD is the mdx mouse, which is unable to express dystrophin. Inflammation, particularly the proinflammatory cytokine tumor necrosis factor alpha (TNF-α), strongly contributes to necrosis in the dystrophin-deficient fibers of the mdx mice and in DMD. In this study we investigated whether the antioxidant N-acetylcysteine (NAC) decreases TNF-α levels and protects the diaphragm muscle of mdx mice against necrosis. Methods: Mdx mice (14 days old) received daily intraperitoneal injections of NAC for 14 days, followed by removal of the diaphragm muscle. Control mdx mice were injected with saline. Results: NAC reduced TNF-α and 4-HNE-protein adducts levels, inflammation, creatine kinase levels, and myonecrosis in diaphragm muscle. Conclusions: NAC may be used as a complementary treatment for dystrophinopathies. However, clinical trials are needed to determine the appropriate dose for patients with Duchenne muscular dystrophy. [Copyright &y& Elsevier]

Summary: Background & aims: Ethnicity may influence bioimpedance values. The goal of this study was to measure total body impedance vector in infants and pre-school children in Brazil and compare them with those reported in other countries. Methods: We analyzed bioelectrical impedance from a sample of 255 healthy Brazilian children, aged 1–36 months, using the RXc graph method (tetrapolar analysis at 50 kHz frequency). The 95%, 75% and 50% tolerance ellipses were plotted by age group. Results: The mean impedance vector showed migration across age groups, with progressive higher reactances and lower resistances as age increased. The mean bioimpedance vectors from the present sample of Brazilian children were different from those of European children of the same age ranges. Conclusions: Our results confirm the importance of defining reference values of total body impedance vector for each country in view of the considerable ethnic diversity among different geographical areas. [Copyright &y& Elsevier]

Summary: Background & aims: There is little information regarding the prevalence of thinness in European adolescents. This was assessed in a convenience sample of children and adolescents from the Lisbon area (Portugal). Methods: Cross-sectional study including 2494 boys and 2519 girls aged 10–18years. Body mass index (BMI), waist and hip were measured using standardized methods; thinness was defined using international criteria. Body fat was assessed by bioelectrical impedance. Results: In girls, prevalence of thinness, overweight and obesity were 5.6%, 19.7% and 4.7%, respectively, whereas the corresponding numbers in boys were 3.9%, 17.4% and 5.3%. Prevalence of thinness increased whereas obesity decreased with age: from 1.5% to 7.6% for thinness and from 9.2% to 3.8% for obesity in girls aged 10 and 18, respectively. In boys, the corresponding trends were from 0% to 7.3% for thinness and from 10.6% to 3% for obesity. After adjusting for age, differences were found between BMI groups for weight, body fat percentage, fat mass, lean mass, waist and hip, while no differences regarding height were found between thin and normal weight participants. Conclusions: The prevalence of thinness is more frequent than obesity after age 14 in girls and 16years in boys. Thinness is associated with a decreased body weight and body fat, whereas no consistent effect on height was noted. [Copyright &y& Elsevier]

Summary: Background & aims: Adequate dietary intake might prevent cognitive decline among ageing subjects; hence, the relationships between dietary intake and cognitive function in a sample of non-institutionalized active elderly were assessed. Methods: Total 187 subjects aged over 65. Dietary intake was assessed using a three-day record and cognitive function using the mini-mental state examination (MMSE). After 8.5±3.5 months of follow-up, cognitive function was re-assessed in 110 subjects. Results: A considerable portion of the subjects presented a low intake of several key nutrients. At baseline, no differences were found between subjects with normal or low MMSE score regarding all dietary parameters. At follow-up, 63 subjects (57%) showed a mild improvement of their MMSE score; their consumption of calcium and of n-3 fatty acids was higher (p<0.01 and p<0.03, respectively) than subjects without improvement. Similarly, multivariate logistic regression showed subjects whose consumption of calcium was above the dietary reference intake had a significantly higher odds ratio (OR) of improving their MMSE (OR=5.41; 95% CI: 1.44–20.29), whereas no effect was found for n-3 fatty acids (OR=2.48; 95% CI: 0.46–13.36). Conclusion: Increased calcium consumption is related to improved cognitive function; the exact effect of n-3 fatty acids intake remains to be assessed. [Copyright &y& Elsevier]

Summary: Background & aims: The aim of our study was to examine, in patients with gastric cancer, the correlation between nutritional status, QoL (quality of life) and serum levels of TNF-alpha, IL-1 and IL-6. Methods: Forty-eight patients with gastric cancer were included. Nutritional status was assessed by % of weight loss in the previous 1 and 6 months, Patient-Generated Subjective Global Assessment, bioelectrical impedance analysis and by dynamometry. QoL was assessed by EORTC QLQ-C30 questionnaire. TNF-alpha, IL-1 and IL-6 serum concentrations were determined using an ELISA assay. Results: Prevalence of malnourished patients varied between 30% and 75% according to various methods used. QoL scores were significantly worse in patients with more advanced disease and in malnourished ones. Malnourished patients had higher values of IL-1 and TNF-alpha (16.7 and 28.0pg/ml), p<0.05 and p<0.001. QoL was significantly worse in patients with higher levels of IL-1 and TNF-alpha (p<0.01 and p<0.001, respectively). A TNF-alpha cut-off value of 8.72pg/ml was associated with higher risk of malnutrition (MN) according to PG-SGA (94% sensitivity, 93% specificity). No correlation was observed with perioperative complications. Conclusions: The prevalence of MN is high in patients with gastric cancer. A significant correlation was found between higher values of cytokines, especially TNF-alpha, MN and QoL. [Copyright &y& Elsevier]

BACKGROUND AND AIMS: To assess the relationships between food intake and colorectal cancer risk. METHODS: Systematic review of available prospective studies on dietary intake and colorectal cancer. RESULTS: Twelve out of 15 studies found no significant relationship between vegetable intake and colorectal cancer risk; also, 11 out of 14 studies found no relationship with fruit consumption. Conversely, the combined consumption of vegetables and fruit reduced colorectal cancer risk in three out of six studies, although the relationship was somewhat inconsistent between genders and anatomical localizations. Most studies found no relationship between cancer risk and red meat (15 in 20) or processed meat (seven out of 11) consumption; still, most of the reported relative risks were above unity, suggesting that high consumption of red or processed meat might increase colorectal cancer risk. The consumption of white meat, fish/seafood, dairy products, coffee or tea was mostly unrelated to colorectal cancer risk, although the consumption of smoked or salted fish actually increased risk. CONCLUSIONS: The relationships between dietary intake and colorectal cancer risk might be less important than previously reported. The combined consumption of vegetables and fruit might be protective, whereas excessive consumption of meat or smoked/salted/processed food appears to be deleterious. [ABSTRACT FROM AUTHOR]