1.Nutritional Management for Intolerance to Human Milk Fortifier in a Preterm Small-for-Gestational-Age Infant: a Case Report
Soo-Jung KWON ; Hyun-Kyung PARK ; Min-Sun KIM
Clinical Nutrition Research 2020;9(3):235-240
Adequate nutrition is extremely crucial for the growth and development of preterm, small-for-gestational-age (SGA) infants owing to an increased risk of postnatal growth failure and poor neurodevelopmental outcome. Despite the beneficial properties of human milk (HM), it should be fortified to prevent extrauterine growth restriction; however, fortification of HM with a bovine-based human milk fortifier (BHMF) may induce feeding intolerance (FI) and necrotizing enterocolitis in preterm newborns. Herein, we have described the nutritional management of a preterm SGA newborn with intolerance to BHMF. A male infant was born at a gestational age of 32 weeks and 5 days, SGA weighing 1,490 grams (< 10th percentile). During BHMF use, he presented with symptoms of FI including abdominal distention, increased gastric residuals, and delayed enteral feeding advancement. Therefore, HM was fortified with carbohydrate powder, whey protein powder, and medium-chain triglycerides oil instead of BHMF to prevent FI and promote weight gain. Caloric density of feeds was increased once every 3 or 4 days by approximately 5 kcal/kg/day until an intake of 100 kcal/kg/day was achieved. Subsequently, his caloric and protein intake increased, growth rate improved, and full enteral feeding was achieved without any further symptom of FI. In conclusion, the symptoms of FI with BHMF in a preterm SGA neonate improved with the administration of a macronutrient fortified HM without compromising his enteral feed advancements, growth rate, and energy or protein intake.
2.Protective and Therapeutic Effects of Aloe Vera Gel on Ulcerative Colitis Induced by Acetic Acid in Rats
Gholamreza BAHRAMI ; Hossein MALEKSHAHI ; Shahram MIRAGHAEE ; Hamid MADANI ; Atefeh BABAEI ; Bahareh MOHAMMADI ; Razieh HATAMI
Clinical Nutrition Research 2020;9(3):223-234
Ulcerative colitis (UC) is a chronic intestinal inflammation. Common clinical symptoms are weight loss, diarrhea, ulcers, and inflammation. Aloe vera (AV) has several medicinal properties including antioxidant, anti-inflammatory analgesic, and improvement of gastric and skin ulcers. This study aimed to investigate the protective and therapeutic effects of AV gel on acetic acid-induced UC in rats. UC was induced in 48 rats by injection of 4% acetic acid into the rectum. Protective and treatment groups received treatments 7 days before and after the induction of colitis, respectively. The negative control group, the positive control group, and AV groups received distilled water, sulfasalazine, and 50 and 300 mg/kg of gel extract, respectively. Water and food intake and body weight changes were recorded. The extent of the mucosal ulcers, colon tissue thickening, and mucosal bleeding were scored by the Gerald classification system score (microscopy observations). Slides of tissues were prepared for pathologic assay using the modified Wallace method (macroscopic observations). The results of the macroscopic and microscopic examination showed protective and therapeutic effects of 50 mg/kg dose of AV on acetic acid-induced colitis in rats which reduces the inflammation, ulcers and tissue damage compared with negative control (p < 0.05). There were no significant changes in the amount of water and food intake, body weight changes, and colon weight in protective and treatment groups. Based on the results, AV gel could be used to improve the symptoms of UC, as well as prevent people who are susceptible to the UC.
3.Maternal Nutrition and Inadequate Gestational Weight Gain in Relation to Birth Weight: Results from a Prospective Cohort Study in India
Kumar Guru MISHRA ; Vikas BHATIA ; Ranjeeta NAYAK
Clinical Nutrition Research 2020;9(3):213-222
Inadequate/excessive gestational weight gain (GWG) can cause adverse pregnancy outcomes and only few studies have described patterns of weight gain in Indian women. Also, studies pertaining to dietary intake throughout gestation are insufficient. This prospective cohort study was conducted to evaluate GWG and nutrient intake in all trimesters of pregnancy and investigate the relationship between themselves along with that of birth weight (BW). Our study was carried out in a population-based prospective birth cohort in Odisha, India. The 418 pregnant women were followed till delivery with measurements of maternal weight, weight gain throughout gestation, and BW. Macronutrients were assessed based on a 24-hour dietary recall method in each trimester. Women characterized by under-weight pre-pregnancy body mass index (BMI) were 16.20%, and a total of 6.45% did not comply with current weight gain recommendations. Particularly, overweight and obese women gained more weight than recommended. In a multivariate analysis GWG correlated significantly with BMI (p = 0.03), total calorie intake (p < 0.001) and fat intake (p < 0.001), while BW of newborns correlated significantly with adequacy of weight gain and fat intake (p < 0.001). Though measures are taken by health workers to record the weight but nutritional counseling is not being provided regularly. A high priority should be given to increase awareness among general population regarding the importance of diet in pregnancy and how to adhere to the balanced diet for optimal growth of child.
4.Independent Association of Phase Angle with Fasting Blood Glucose and Hemoglobin A1c in Korean Type 2 Diabetes Patients
Ha-Neul CHOI ; Kyung-Ah KIM ; Young-Seol KIM ; Jung-Eun YIM
Clinical Nutrition Research 2020;9(3):205-212
The relationship between phase angle (PhA) of bioelectrical impedance analysis (BIA) and glycemic parameters in diabetes mellitus (DM) patients has not been well studied. To evaluate the prognostic value of the PhA from BIA as a glycemic marker, we investigated the relationship of PhA with various variables such as age, body mass index (BMI), and glycemic parameters in Korean patients with type 2 DM (T2DM). We evaluated the anthropometric data, body composition, glycemic parameters, and PhA of 321 T2DM patients aged 30–83 years. The patients were classified by sex into men (n = 133) and women (n = 188). General linear models identified the independent effects of PhA after covarying for age, sex and BMI. The PhA, body cell mass (BCM), extracellular mass (ECM), lean body mass, intracellular water (ICW), extracellular water (ECW), total body water (TBW), fasting blood glucose, and hemoglobin A1c (HbA1c) of T2DM Korean patients were significantly higher in men than in women. However, fat mass, ECM/BCM, ECW/ICW, ECW/TBW, and serum insulin were significantly higher in women than in men. Statistically significant independent associations were observed between PhA and age, BCM, ECM, ECM/BCM, ICW, ECW, ECW/ICW, and ECW/TBW for both sexes. There was no significant association between PhA and BMI the patients. Glycemic parameters, such as HbA1c and fasting blood glucose were independently associated with PhA. These results suggest that PhA could be an indicator for assessing ability to control fasting blood glucose in T2DM patients in Korea.
5.Association between Inflammatory Biomarkers and Nutritional Status in Fatty Liver
Hee-Sook LIM ; Joungyun CHOI ; Bora LEE ; Sang Gyune KIM ; Young Seok KIM ; Jeong-Ju YOO
Clinical Nutrition Research 2020;9(3):182-194
The prevalence and progression of non-alcoholic fatty liver disease (NAFLD) is mediated via several factors correlating with hepatic necroinflammation (adipokines/cytokines). This study was performed to analyze the level of inflammatory markers according to the presence of NAFLD and to identify related nutritional factors. A total of 80 adults were classified into 2 groups (healthy and NAFLD), and their body composition, blood tests, and eating habits were evaluated. In addition, inflammatory markers (adiponectin, high-sensitivity C-reactive protein [CRP], and tumor necrosis factor-alpha [TNF-α]), nutrient intake status, and dietary quality were compared. The quality of diet was assessed according to the nutrient adequacy ratio and the mean adequacy ratio (MAR). The NAFLD group had a higher body mass index (p < 0.001) than the healthy group and also carried significantly higher CRP levels (p < 0.001) but lower adiponectin (p = 0.001). TNF-α levels increased significantly with fatty liver grade (p = 0.023). The NAFLD group showed significantly higher intake of energy, carbohydrates, iron, sodium, vitamin A and saturated fatty acids, but significantly lower intake of zinc and vitamin E than the healthy group. The MAR values were slightly higher in the NAFLD group but without any significant difference. The levels of adiponectin and vitamin E showed a significant inverse correlation (p < 0.05). Nutritional management of NAFLD patients is important, and the intake of antioxidant and anti-inflammatory nutrients such as zinc and vitamin E should be emphasized.
6.The Association between Nuts Intake and Non-Alcoholic Fatty Liver Disease (NAFLD) Risk: a Case-Control Study
Omid ASBAGHI ; Hadi EMAMAT ; Mahnaz Rezaei KELISHADI ; Azita HEKMATDOOST
Clinical Nutrition Research 2020;9(3):195-204
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. Nuts are nutrient- and calorie-dense foods with several health-promoting compounds. In this case-control study, we investigated the association between nut intake and NAFLD risk. Hundred ninety-six subjects with NAFLD and eight hundred three controls were recruited. The participants' dietary intakes were assessed by a valid and reliable semi-quantitative food frequency questionnaire (FFQ). Participants were categorized according to deciles of daily nuts intake. Multivariable logistic regression models were used with NAFLD as the dependent and deciles of daily nuts intake as an independent variables. Range of age was 18 to 75 years. Forty three percent of participants were male. Range of nuts intake was between 0 to 90.90 g/day. In model 3, after adjusting for potential confounding variables including, age, sex, BMI, alcohol consumption, smoking, diabetes and physical activity, the relation between daily nuts intake and risk of NAFLD was positive and significant in the deciles 9 and 10 compared to the lowest decile (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.04–7.49; p = 0.039 and OR, 3.03; 95% CI, 1.03–8.90; p = 0.046, respectively). However, in the final model after additional adjusting for energy intake, no significant association was found. According to the findings, there is not any significant relationship between nuts intake and NAFLD risk; while higher intake of nuts is related to the higher risk of NAFLD mediated by energy intake.
7.The Association between Dietary Vitamin A and C Intakes and Cataract: Data from Korea National Health and Nutrition Examination Survey 2012
Jeong-Hwa CHOI ; Eunkyung LEE ; Young-Ran HEO
Clinical Nutrition Research 2020;9(3):163-170
Oxidative stress in eye lens is one of the main causes of the cataract. Dietary antioxidants including vitamin A and C are therefore known to be associated with the risk of the disease. However, evidences are still lacking in Koreans. This study aimed to examine whether dietary vitamin A and C levels are associated with the cataract, using data of Korea National Health and Nutrition Examination Survey 2012. A total of 3,344 individuals (599 cases and 2,745 controls) were analyzed in the study. Dietary data was classified into 3 groups following Dietary Reference Intakes for Koreans 2015: 1) ≤ estimated average requirements (EAR), 2) EAR-recommended nutrient intake (RNI), and 3) ≥ RNI. Findings suggested normal subjects (controls) had better vitamin A and C nutritional status. Vitamin A and C intakes of normal subjects were significantly higher than those of cataract cases (p < 0.001, respectively). Ratio of subjects who consumed vitamin A and C lower than EAR was higher in cataract cases compared to normal subjects (p < 0.001, respectively). These antioxidant intake levels predicted that having lower level of vitamins lower than EAR increased the odd ratios (ORs) for cataract [for vitamin A: OR, 1.89; 95% confidence interval (CI), 1.55–2.31 and for vitamin C: OR, 2.06; 95% CI, 1.69–2.51]. However, such associations were not retained, when the subjects’ demographic and lifestyle factor were adjusted. In conclusion, vitamin A and C showed a protective effect against cataract. However, subjects' life style and demographic factors nullified the association. More studies are required to verify the true association between dietary antioxidants and risk of cataract in Koreans.
8.The Association between Dietary Antioxidant Quality Score and Cardiorespiratory Fitness in Iranian Adults: a Cross-Sectional Study
Hossein SHAHINFAR ; Mahshid SHAHAVANDI ; Aliyu Tijani JIBRIL ; Kurosh DJAFARIAN ; Cain C. T. CLARK ; Sakineh SHAB-BIDAR
Clinical Nutrition Research 2020;9(3):171-181
The association between dietary antioxidant quality score (DAQS) and cardiovascular risk factors such as low cardiovascular fitness (CRF) and elevated blood pressure (BP) has rarely been investigated. To investigate the association between DAQS, CRF, and BP. This cross-sectional study was conducted on 270 adult subjects living in Tehran, Iran. Dietary intake was evaluated using a validated food frequency questionnaire. The DAQS was calculated using antioxidant-nutrient intake. Socio-economic status, anthropometric measures, and BP were recorded by a trained interviewer, using standard methods. A significant increase was found in maximal oxygen uptake (p value = 0.01) across tertiles of DAQS. After adjusting for confounders, the association remained unchanged (p value = 0.02). Participants in the highest tertile of DAQS had higher systolic BP (SBP) (p value = 0.01) and diastolic BP (DBP) (p value = 0.03), although adjustment for confounding factors attenuated the results (p value = 0.3 for DBP and p value = 0.6 for SBP). Our results revealed that higher DAQS is associated with better CRF in Iranian adults. Further studies are needed to establish the veracity of our results.
9.Association of Nutrient Patterns with Metabolic Syndrome and Its Components in Iranian Adults
Zahra AKBARZADE ; Mohammad Reza AMINI ; Farhang DJAFARI ; Habib YARIZADEH ; Fatemeh MOHTASHAMINIA ; Maryam MAJDI ; Elham BAZSHAHI ; Kurosh DJAFARIAN ; Cain C. T. CLARK ; Sakineh SHAB-BIDAR
Clinical Nutrition Research 2020;9(4):318-331
We aimed to examine the association between nutrient patterns and metabolic syndrome (MetS) in Iranian adults. In a cross-sectional study of 850 self-certified healthy women and men aged 20–59 years old, dietary data were assessed using three 24-hour recall. Anthropometric measures were done and blood samples were collected to measure serum fasting serum glucose and lipid profile. The MetS was defined using the International Diabetes Federation. Major nutrient patterns were identified using principle competent analysis. In the first nutrient pattern, the individuals in the fifth quintile had a higher intake of vitamins B1, B
10.A Case Study on the Customized Nutrition Intervention for a Patient with Primary Gastrointestinal Non-Hodgkin Lymphoma Underlying Chronic Kidney Disease
Young-Hwa SONG ; Han-Na KWON ; Jeong-Im HONG ; Juyeon PARK ; Ji-Yeon KIM ; Hye-Jin KIM
Clinical Nutrition Research 2020;9(4):332-342
Non-Hodgkin lymphoma comprises 2.1% of the total number of cancers in South Korea. Among those, diffuse large B cell lymphoma (DLBCL) comprises the largest percentage. Nutrition interventions have been highlighted because nutritional status in non-Hodgkin's lymphoma patients has a significant impact on treatment and prognosis, but relevant studies are inadequate. Therefore, the aim of this study was to share the case of a nutrition intervention for a patient with primary gastrointestinal non-Hodgkin lymphoma underlying chronic kidney disease who was comorbid with tumor lysis syndrome, which was a complication of a specific chemotherapy. The subject is a 76-year-old patient who was diagnosed with DLBCL. He had abdominal pain, constipation, and anorexia. After chemotherapy, he experienced the tumor lysis syndrome. The patient's condition was continuously monitored, and various nutrition interventions, such as nutrition counseling and education, provision of therapeutic diet, oral nutritional supplement, change of meal plans, and parenteral nutrition support were attempted. As a result of the nutrition intervention, oral intake was increased from 27% of the energy requirement to 70% and from 23% of the protein requirement to 77%. Despite the various nutrition interventions during the hospitalization, there were no improvements in weight and nutrition-related biochemical parameters or malnutrition. However, it was meaningful in that the patient was managed to prevent worsening and the planned third chemotherapy could be performed. These results can be used as the basis for establishing guidelines for nutritional interventions customized to patients under the same conditions.

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