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Background: Replacing some animal sources of protein with plant foods is encouraged. Nutrient intake may reflect changes in the protein source. The adequacy of habitual nutrient intake among US adults has not been evaluated by the level of animal protein (AP) intake. Objectives: The objective of this study was to compare food consumption and nutrient intake and adequacy among quintiles of percent AP intake. Methods: Dietary intake data of adults 19+ y (N = 9706) from What We Eat in America, National Health and Nutrition Examination Survey 2015-2018 were used. Proportions of protein from animal and plant sources were estimated from ingredients in the Food and Nutrient Database for Dietary Studies 2015-2018, and then applied to dietary intakes. Intakes were classified by Q of percent AP. Food intake was described using the United States Department of Agriculture Food Patterns components. Usual nutrient intakes were estimated using the National Cancer Institute Method and compared with age and gender-specific Dietary Reference Intakes (DRIs). Comparisons between quintiles were made using t-tests. Results were considered significant at P < 0.01. Results: Total protein intake was higher as the Q of AP intake increased. Among the higher quintiles of percent AP, <1% did not meet their DRIs for protein than 17% in Q1 and 5% in Q2 (P < 0.01). In quintiles with lower compared with higher percent AP, there were significantly higher percentages not meeting DRIs for vitamins A, B12, choline, zinc, and calcium but meeting recommendations for folate, vitamin C, saturated fat, cholesterol, and fiber (P < 0.01). Among all quintiles, over one-third did not meet DRIs for fiber, vitamins A, C, D, E, K, choline, calcium, and potassium. Conclusions: Replacing protein from animal sources with plant foods may result in lower intakes of protein and some nutrients but a better intake of dietary components associated with reducing chronic disease risk. The current intake of US adults indicates dietary improvements are needed, regardless of protein source. [ABSTRACT FROM AUTHOR]

Frequent fast food (FF) consumers may make more healthful food choices at eating occasions without FF. However, it is not clear if poor diet quality of frequent FF consumers is a function of FF consumption or less healthful food choices overall. The objective of this study was to compare diet quality, energy, and nutrient intakes of infrequent FF consumers (INFREQ) with that of frequent FF consumers on an intake day with FF (FREQ-FF) or without FF (FREQ_NO FF). This study is a cross-sectional analysis of 1 day dietary intake data from What We Eat in America, National Health and Nutrition Examination Survey 2013-2016, the dietary intake component of National Health and Nutrition Examination Survey. Participants included adults aged 20 years and older (N = 4,012), who, during the previous 7 days, reported no consumption of FF or pizza (n = 2,142 INFREQ) or reported FF or pizza three or more times and either had FF/pizza (n = 1,455 FREQ_FF) or did not have FF/pizza (n = 415 FREQ_NO FF) on the intake day. Main outcomes were energy, nutrient density (nutrient intake per 1,000 kcal), and diet quality evaluated using Healthy Eating Index (HEI) 2015. Group comparisons were made using t tests. Differences were considered significant at P < 0.001. Compared with INFREQ consumers, FREQ_FF consumers had higher intakes of energy and fat per 1,000 kcal, lower scores for total HEI and most components, and lower nutrient densities of most micronutrients (P < 0.001). HEI component scores of INFREQ consumers for vegetables, fruit, whole grains, and added sugars were higher than FREQ_FF consumers (P < 0.001). Energy intake, most nutrient densities, and total HEI and component scores of FREQ_NO FF consumers were not significantly different from FREQ_FF consumers with the exception of fruit but were different from INFREQ consumers for some nutrients and HEI components. Results suggest diet quality and nutrient intake of frequent FF consumers on a non-FF intake day is not markedly different from a day with FF. [ABSTRACT FROM AUTHOR]

Consuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not. The objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters. This study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall. Adults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters. This study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015. Nutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P <0.001. On the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P <0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P <0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P <0.001). Incorporating vegetable-based salad into one's diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement. [ABSTRACT FROM AUTHOR]

Abstract: The Women''s Intervention Nutrition Study is a randomized clinical trial designed to evaluate if a lifestyle intervention targeting fat intake reduction influences breast cancer recurrence in women with early stage, resected disease receiving conventional cancer management. This report details the concept, content, and implementation of the low-fat eating plan used in the dietary intervention group of this trial. Intervention group participants were given a daily fat gram goal. The intervention was delivered by centrally trained, registered dietitians who applied behavioral, cognitive, and motivational counseling techniques. The low-fat eating plan was implemented in an intensive phase with eight biweekly (up to Month 4), individual counseling sessions followed by a maintenance phase (Month 5 up to and including Year 5) with registered dietitian visits every 3 months and optional monthly group sessions. Self-monitoring (daily fat gram counting and recording), goal setting, and motivational interviewing strategies were key components. Dietary fat intake was equivalent at baseline and consistently lower in the intervention compared with the control group at all time points (percent eneregy from fat at 60 months 23.2%±8.4% vs 31.2%±8.9%, respectively, P<0.0001) and was associated with mean 6.1 lb mean weight difference between groups (P=0.005) at 5 years (baseline and 5 years, respectively: control 160.0±35.0 and 161.7±32.8 lb; intervention 160.2±35.1 and 155.6±32.1 lb). Together with previously reported efficacy results, this information suggests that a lifestyle intervention that reduces dietary fat intake and is associated with modest weight loss may favorably influence breast cancer recurrence. The Women''s Intervention Nutrition Study low-fat eating plan can serve as a model for implementing such a long-term dietary intervention in clinical practice. [Copyright &y& Elsevier]

Weight loss in obese subjects ingesting very-low-energy (VLE; < 2510 kJ/d), low-fat (≤ 1 g/d) formula diets is associated with liver-function-test abnormalities and gallstone formation. It is unknown whether these abnormalities develop during treatment with diets higher in energy and fat. We prospectively studied liver-function tests and gallstone formation in 73 obese patients ingesting ≈3500 kJ and 15-25 g fat daily for 10 wk. Two of 53 patients completing the protocol developed ultrasonographic gallstones during weight loss, a rate substantially lower than that observed with VLE diets. Trend analysis demonstrated significant increases in AST and ALT activities, but changes were less than those observed with VLE diets. Patients who developed gallstones had a significantly greater weight loss rate and larger increases in AST and ALT than did nonstone-forming patients. These results suggest that the risk of developing hepatobiliary abnormalities with dieting is lowered when subjects ingest greater amounts of energy and fat than that administered in earlier VLE-diet studies. Our results also highlight potential risk factors and markers of new gallstone formation. [ABSTRACT FROM AUTHOR]

Phaechromocytoma is a neuroendocrine tumour of the chromaffin cells of the adrenal medulla. Tumours secrete catecholamines and typically present with hypertensive crisis or, in rare circumstances, cardiogenic shock. A 33 year old male presented with hypertensive crisis and fulminant cardiogenic shock. He required mechanical ventilation for hypoxaemia secondary to acute pulmonary oedema. A CT aortogram was performed for presumed aortic dissection which revealed a necrotic, enhancing adrenal mass. Due to severe left ventricular dysfunction, he was referred to our hospital for mechanical circulatory support (MCS). Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was established in the referral hospital and he was transferred to our intensive care unit. An Impella-CP was then inserted to offload an increasingly dilated left ventricle. Hypertensive crises continued to occur despite maximum medical therapy, and it was determined the only viable option to control these paroxysms of hypertension was to perform adrenalectomy. Surgery was successfully performed whilst on dual MCS devices (VA-ECMO and Impella). Preoperatively the patient had intravenous alpha and beta adrenoceptor blockade and fluid status was optimised to address the chronic circulating volume depletion. Glucose and electrolyte imbalances were corrected. Intra-operative management focused on blood pressure control, heart rate and arrhythmia control. Agents that induce catecholamine release were avoided and tumour manipulation was minimised. Hypotension after tumour removal was anticipated and developed relatively quickly requiring infusions of noradrenaline, adrenaline and vasopressin to support an adequate arterial pressure. His post-operative recovery was initially favourable and myocardial function had improved to the point of planning ECMO explanation. Despite cardiovascular stability the patient suffered a catastrophic intracranial haemorrhage and treatment was withdrawn. Cardiogenic shock secondary to phaeochromoctyoma can be difficult to manage and has high mortality. The evolution of short to medium term MCS devices has provided clinicians with additional therapeutic options to manage refractory cases of this uncommon cause of cardiogenic shock. The authors hope this case will add to an expanding library of practice of using MCS in phaeochromocytoma. [ABSTRACT FROM AUTHOR]

Background Dietary guidance encourages consuming a variety of fruit and vegetables (FVs), which has been associated with higher FV intake and nutrient adequacy. Dietary intake of adults in the United States has not been described in the context of variety. Objectives The objective of this study was to describe FV consumption of adults in the United States by level of FV variety. Methods One day of dietary intake data of adults aged ≥20 y (n  = 10,064) in What We Eat in America, NHANES 2013–2016 were used. FV variety was the count of foods consumed that contributed to total FV intake. Each FV was counted only once; a mixed dish counted as 1. Variety levels were high (≥5 items, n  = 2316); moderate (3–4 items, n  = 3423); or low (1–2 items, n  = 3746). Differences between each level of variety were compared by t test. Results Among the low, moderate, and high levels, total FV intakes were 1.4, 2.6, and 4.4 cup equivalents (CE), respectively. CE amounts of FVs consumed were 0.3, 0.6, and 1.4 of vegetables excluding potatoes; 0.2, 0.3, and 0.3 of potatoes; 0.3, 0.6, and 1.2 of fruit; and 0.4, 0.4, and 0.5 from mixed dishes, respectively; percentages of each level reporting intake were 34%, 64%, and 89% for vegetables excluding potatoes; 23%, 34%, and 32% for potatoes; 22%, 49%, and 75% for fruit; and 72%, 71%, and 72% for mixed dishes, respectively. Conclusions Those with more variety of FV intake include whole FVs more frequently and in higher amounts. These results support suggestions for encouraging more FVs at snacks and as side dishes and salads at meals to increase total intake. [ABSTRACT FROM AUTHOR]

Objective: To investigate patient reports of physician communication about the 2006 Institute of Medicine (IOM) Guidelines for Survivorship Care, and patient follow-up care behaviors in a sample of African American and Caucasian breast cancer survivors. Methods: Fifteen-minute telephone interviews were conducted in a cross-sectional study with a sample of African American (n =30) and Caucasian (n =69) breast cancer patients, who were within 5 years of their diagnosis and primary treatment for breast cancer at two Baltimore, Maryland medical centers, during the summer of 2006. Multiple items assessed patient reports of physician discussions about IOM Guidelines, their recurrence concerns, and their follow-up treatment, screening, diet and exercise practices. Results: Patients with higher incomes, more education, female physicians, and of younger ages reported more complete physician discussions of the IOM Guidelines. No significant differences were noted between African American and Caucasian patients. Conclusion: Patients at greatest risk for breast cancer recurrence – those with less education, income, and resources – report limited guidance from their physicians about evidence-based, follow-up care guidelines, designed to minimize their risk. Practice implications: Physicians need strategies for effectively delivering the IOM Guidelines for Survivorship Care to disadvantaged breast cancer patients, to promote enhanced quality of life and reduced risk of recurrence. [Copyright &y& Elsevier]

Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity. [ABSTRACT FROM AUTHOR]

The performance of two electric submersible pumps (ESP), when pumping non-Newtonian polymer fluids, was tested at a pump test facility of the university. The results are compared with existing models, and the de-rating coefficients are evaluated for the operating range of the pumps that allow a proper design of ESP field installations. Two different electric submersible pump types (82 stages and 7 stages) were tested at the newly-built pump testing facility. The initial tests were performed with water at several frequencies to check the pump's performances, and the results were compared with the manufacturer's catalog curves. The performance measurements included pressure, flow rate, torque, rotational speed, and temperature. Besides, an intake pressure sensitivity analysis was performed. The actual polymer tests were conducted for three HPAM polymer concentrations (400-ppm, 800-ppm, 1600-ppm), three rotational speeds, and several discharge pressures. Additionally, fluid samples were taken during all tests and were subsequently analyzed. The polymer test results showed that the performance reduction factors for both pump types and all frequencies are much higher than expected. However, the provided polymer concentrations have low viscosity. Most likely, non-newtonian fluid behavior, specifically its viscoelasticity, is responsible for this substantial performance loss. Head and rate reduction close to 50 percent was measured at the best efficiency point of the pumps. A comparison to existing models indicates a significant underestimation of the performance loss when pumping a polymer solution. Moreover, the mechanical shearing of the molecular polymer chains was minor. Known models for pump performance do not apply in this instance. Because of the complexity of the polymer-laden fluid, we cannot offer one that works, and so we recommend that anyone in this situation must perform an experimental performance test. The novelty of those experiments was the testing of two powerful electric submersible pumps, using a non-newtonian polymer fluid, to investigate the pump performance, performance correction coefficients, and compares appropriate correction models to apply the gained knowledge more quickly in the field. • Although a low viscous shear-thinning fluid was tested, the observed ESP performance decrease was substantial • The flow rate and pump head drop, resulting in an efficiency decrease of up to 50%, compared to pumping freshwater. • Curve Correction Pairs approach and Hydraulic Institute Model. • Fake Viscosity approach seem to be realistic models. • No extraordinary high shear degradation of the fluid was observed in the first stages of the ESP. [ABSTRACT FROM AUTHOR]

Nutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement. Our aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools. A literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process. Twenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently. Nutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition. [ABSTRACT FROM AUTHOR]

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals. [ABSTRACT FROM AUTHOR]