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Parenteral and enteral nutrition support are key components of care for various medical and physiological conditions in infants, children, and adults. Nutrition support practices have advanced over time, driven by the goals of safe and sufficient delivery of needed nutrients and improved patient outcomes. These advances have been, and continue to be, dependent on research and development studies. Such studies address aspects of enteral and parenteral nutrition support: formulations, delivery devices, health outcomes, cost-effectiveness, and related metabolism. The studies are supported by public funding from the government and by private funding from foundations and from the nutrition support industry. To build public trust in nutrition support research findings, it is important to underscore ethical research conduct and reporting of results for all studies, including those with industry sponsors. In 2019, American Society for Parenteral and Enteral Nutrition's (ASPEN's) Board of Directors established a task force to ensure integrity in nutrition support research that is done as collaborative partnerships between the public (government and individuals) and private groups (foundations, academia, and industry). In this ASPEN Position Paper, the Task Force presents principles of ethical research to guide administrators, researchers, and funders. The Task Force identifies ways to curtail bias and to minimize actual or perceived conflict of interests, as related to funding sources and research conduct. Notably, this paper includes a Position Statement to describe the Task Force's guidance on Public-Private Partnerships for research and funding. This paper has been approved by the ASPEN Board of Directors.

OBJECTIVES: Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men. DESIGN: Prospective cohort study. SETTING: 5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study. MEASUREMENTS: Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables. RESULTS: The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18). CONCLUSIONS: Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.

Poor nutrition is linked to frailty and both poor nutrition and frailty are recognized risk factors for falls. This study examined the association between dietary protein intake and subsequent reported falls in community-dwelling older Americans with a history of falls. Other nutritional, functional, and sociodemographic-related variables were also considered in our model. This was a retrospective analysis using data from the U.S. Health and Retirement Study (HRS) and Health Care and Nutrition Study (HCNS), both funded by the U.S. National Institute on Aging. The study population (n=3,859) was community-dwelling older adults, aged >65 years, who reported ever experiencing a fall on the 2012 HRS and had also completed the 2013 HCNS and 2014 HRS. Univariable logistic models were created for all variables of interest; variables approaching statistical significance (p < 0.1) were included in the initial multivariable logistic model. Backwards selection (cut-off of p

The aims of the present study were to compare the adherence to dietary guidelines and evaluate potential differences in nutrient profiles among adults by diabetes status. We used the Mexican Alternate Healthy Eating Index (MxAHEI) to evaluate adherence to dietary guidelines. We calculated the MxAHEI scores (total and by dietary component) with scales from 0 (non-adherence) to 100 (perfect adherence) based on a food frequency questionnaire. Mean daily intakes of macronutrients and micronutrients (g, mg, mcg/1000 kcal per day) were also estimated by diabetes status. Sex-specific, multivariable linear regression models were estimated to test whether MxAHEI scores as well as nutrient intakes were different by diabetes status. Mexican adults had low adherence to the dietary guidelines irrespective of their diabetes status (score &lt, 50 points). Among men, the MxAHEI score was 2.6 points higher among those with diabetes than those without diabetes (46.9, 95% confidence intervals (CI): 44.6, 49.2 vs. 44.3, 95% CI: 44.2, 45.6, respectively). Among women, the total MxAHEI score was similar in individuals with diabetes compared to those without diabetes. Lower intakes of carbohydrates and added sugars and higher intakes of protein, calcium, and zinc were observed in individuals with diabetes. Our findings support the development of strategies focused on promoting dietary patterns that can help to prevent and control the disease.

OBJECTIVES: Diabetes and prediabetes are a major public health concern in the United States. It is unknown how food-related behaviors are influenced by diabetes status. Therefore this study assessed the association between diabetes status and food behaviors (meal preparation, food procurement, and food spending) among U.S. adults. METHODS: Data from 8799 adults from the 2005–2016 National Health and Nutrition Examination Survey were categorized by glycated hemoglobin levels (A1c%): nondiabetes (6.5%; n = 1071). A1c levels were compared with meal preparation, food procurement, and spending data. Age-adjusted analyses for total and by sex (n = 4481 females and n = 4318 males) were performed. RESULTS: All adults (P = 0.002) and males (P = 0.001) with diabetes and prediabetes spent less money dining out than those without diabetes. Those with diabetes had a significantly further distance to grocery stores among the adult (P = 0.018) and male samples (P = 0.032). Females with diabetes spent more on carryout/delivered foods (P = 0.025) and ate fewer meals per week with family (P = 0.039) than those without diabetes. Females with diabetes were less likely to serve as the main food shoppers (P = 0.012) and males with diabetes were less likely to share meal planning/preparation responsibilities (P = 0.034). CONCLUSIONS: Diabetes status associates with meal preparation, food procurement, and spending behaviors, and differs for males and females. These findings support the importance of addressing the behavioral context of food choices to help support a healthier diet and lifestyle for all adults. FUNDING SOURCES: Abbott Nutrition.

OBJECTIVES: Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. METHODS: Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c

OBJECTIVES: To compare the intake of macronutrients, micronutrients, and dietary patterns between Mexican adults with and without diabetes. METHODS: Design: We calculated the mean intakes and adequacies of energy, macronutrients and micronutrients, and factor analysis was used to identify dietary patterns. We computed sex-specific, age- and energy-adjusted and fully-adjusted linear regression models to test whether nutrient intakes and dietary patterns scores were different by diabetes status. Setting: Mexico Participants: Mexican men (n 1142) and women (n 1620) participating in the Mexican National Health and Nutrition Survey 2012. RESULTS: The energy intake from carbohydrates and added sugars was lower in men and women with diabetes than in men and women without diabetes, but slightly above the recommended among adults with diabetes. Men with diabetes consumed more protein, total, monounsaturated and saturated fatty acids, vitamin D, calcium, and potassium than men without diabetes. The score for the prudent pattern and basic dietary pattern was 0.49 higher and 0.35 lower, respectively, among men with diabetes versus men without diabetes (P

Background: The prevalence of vascular dysfunction increases with advancing age, as does the loss of muscle mass, strength and function. This systematic review explores the association between vascular dysfunction and skeletal muscle health in healthy adults. Methods: EMBASE and MEDLINE were searched for cross-sectional and randomized controlled studies between January 2009 and April 2019, with 33 out of 1246 studies included based on predefined criteria. Assessments of muscular health included muscle mass, strength and function. Macrovascular function assessment included arterial stiffness (pulse wave velocity or augmentation index), carotid intima-media thickness, and flow-mediated dilation. Microvascular health assessment included capillary density or microvascular flow (contrast enhanced ultrasound). Results: All 33 studies demonstrated a significant association between vascular function and skeletal muscle health. Significant negative associations were reported between vascular dysfunction and -muscle strength (10 studies); -mass (9 studies); and -function (5 studies). Nine studies reported positive correlations between muscle mass and microvascular health. Conclusions: Multiple studies have revealed an association between vascular status and skeletal muscle health in healthy adults. This review points to the importance of screening for muscle health in adults with vascular dysfunction with a view to initiating early nutrition and exercise interventions to ameliorate functional decline over time.

BACKGROUND: Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount. OBJECTIVE: We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1. METHODS: In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA). RESULTS: Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P

The present study investigated the meal patterns across demographic characteristics in middle-aged and older US adults. Study participants were noninstitutionalized participants from the 2005&ndash, 2016 National Health and Nutrition Examination Survey, an observational cross-sectional study. Data from 17,361 adults were categorized into 45&ndash, 59 years (n = 7366), 60&ndash, 70 years (n = 5348), and 71+ years (n = 4647) to compare demographics, nutrient intakes, and meal patterns. Dietary recalls were collected using the multiple-pass method. Data analyses were weighted to create a nationally representative sample. Two-thirds of adults reported consuming three meals on the day of intake. Lunch was the most often skipped meal across all age groups. A greater proportion of adults over 70 years reported consuming breakfast, while a smaller proportion reported consuming snacks. Significant differences were observed in total energy and nutrient intakes and proportion of the day&rsquo, s intakes by meal. Grain, milk, and dairy food group intakes were highest at breakfast, while the protein food group intakes were highest at lunch and dinner. Age-related differences in meal consumption and composition provide valuable formative data to support targeted nutritional education and intervention opportunities to promote and encourage healthy food choices.

OBJECTIVES: Adiposity is often approximated by body mass index (BMI), weight, and % fat from dual energy x-ray absorptiometry (DXA). We aimed to describe how different measures of adiposity and body composition are similarly or differentially related to mobility limitation and mortality. METHODS: Older community-dwelling men aged ≥65 yrs were followed for 10 years for mortality (N = 5849) and at six study contacts over 14 year for self-reported mobility limitations (any difficulty walking 2–3 blocks or with climbing 10 steps, N = 5841). Baseline measures of adiposity included weight, BMI, % fat by DXA. Appendicular lean mass (ALM, by DXA) was analyzed as ALM/ht(2). Proportional hazards models estimated the risk of mortality and repeated measures generalized estimating equations estimated the likelihood of mobility limitation. Adiposity and ALM/ht(2) measures were analyzed as quintiles and with splines. RESULTS: Over 10 years, 27.9% of men died; over 14 years, 48.0% of men reported at least one mobility limitation. We observed U-shaped relationships between weight, BMI, % fat and ALM/ht2 with mortality. There was a log-linear relationship between weight, BMI and % fat with incident mobility limitation, with higher values associated with greater likelihood of mobility limitation: for those with the lowest values of each of these metrics (quintile 1), the likelihood of mobility limitation was 1.6 to 3.5 times greater than those with the highest values for these metrics (quintile 5, P

Background Obesity and chronic disease risk are significantly related to healthy lifestyle behavior, including dietary intakes. Further, the interrelated etiology of many chronic conditions supports the comorbidity in US adults to manage multiple diagnoses. The purpose of this study was to assess diet quality across varying numbers of existing conditions, including obesity, hypercholesterolemia, hyperglycemia, and hypertension. Methods Cross-sectional analysis of data from 17 356 adults aged 45 years and older from the 2005-2016 National Health and Nutrition Examination Survey were assessed for the presence of overweight or obesity (body mass index >25 kg/m2), hyperglycemia (glycated hemoglobin >5.7%), hypercholesterolemia (>200 mg/dL), and high blood pressure (>120/80 mm Hg). Overall diet quality was assessed using Healthy Eating Index 2015 scores computed from the intakes reported during the 24-hour dietary recall collected in the mobile examination center. The total score (range 0-100) is based on the sum of 13 subscales that represent concordance with the Dietary Guidelines for Americans. Results Few adults presented with no markers of chronic disease (n = 407), with other presenting 1 indicator (n = 1978), 2 indicators (n = 4614), 3 indicators (n = 6319), and all 4 indicators (4038). While there was no significant difference in mean energy intakes on the day of intake, those with all 4 markers of chronic disease had a significantly poorer diet quality ( P < .001) and consumed significantly more saturated fat ( P = .026), but significantly less total carbohydrates, dietary fiber, and added sugars ( P < .005). While mean consumption of protein was lowest in those with more chronic conditions, the differences were not significant. Conclusion Overall dietary intakes from the day of intake indicated that those with a greater number of chronic conditions presented with poorer overall dietary intakes. The foundational intervention strategy across all evidence-based treatment strategies is the promotion of healthy lifestyle behaviors.