Nutrition and Dietetics - Dietetic Internship

 

Dietetic Internship Director:
Dawn Erickson, MPH, RD, LDN
This email address is being protected from spambots. You need JavaScript enabled to view it.
318-257-3043
CTH 149C

Abstracts on Emerging Research

Article: Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomized controlled trial

Citation: Baldwin, C., Spiro, A., McGough, C., Norman, A. R., Gillbanks, A., Thomas, K., Cunningham, D., O’Brien, M., Andreyev, H. (2013) Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomized controlled trial. J of Hum Nutr and Dietetics, 431-440.

Abstract:

Background: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or nutrition supplements on survival, nutrition endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma.

Methods: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for one year. Survival, nutritional status and quality of life were assessed.

Results: In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal and lung cancers were recruited. Median follow-up was 6 months. One-year survival, was 38.6%. No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention.

Conclusions: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.

 


Article: Effects of early prebiotic and probiotic supplementation on development of gut microbiota and fussing and crying in preterm infants: A randomized, double-blind, placebo-controlled trial

Citation: Partty, A., Luoto, Raakel., Kalliomake, M., Salminen, S., Isolauri, E. (2013) Effects of early prebiotic and probiotic supplementation on development of gut microbiota and fussing and crying in preterm infants: A randomized, double-blind, placebo-controlled trial. The Journal of Pediatrics, 1272-1277.

Abstract:

Objective: To evaluate the impact of early prebiotic and probiotic intervention on preterm infants’ well-being, crying, growth, and microbiological programming.

Study design: Ninety-four preterm infants (gestational age 32-36 weeks and birth weight >1500g) randomized to receive prebiotics (mixture of galacto-oligosaccharide and polydextrose 1:1), probiotics, (Lactobacillus rhamnosus GG), or placebo during the first 2 months of life were followed up for 1 year. Infants were catergorized based on the extent of crying and irritability during the first 2 months of life, and their gut microbiota was investigated by fluorescence in situ hybridization (n=66) and quantitative polymerase chain reaction (n=63).

Results: A total of 27 of 94 (29%) infants were classified as extensive criers, significantly less frequently in the prebiotic and probiotic groups than in the placebo group (19% vs 19% vs $&%, respectively; P=.02). The placebo group had a higher percentage of Clostridium histolyticum in their stools than did the probiotic group (13.9% vs 8.9%, respectively; P=.05). There were no adverse events related to either supplementation.

Conclusions: Early prebiotic and probiotic supplementation may alleviate symptoms associated with crying and fussing in preterm infants. This original finding may offer new therapeutic and preventative measures for this common disturbance in early life.

 


Wang, M., Chen, L., Clark, G. O., Lee, Y., Stevens, R. D. Ilkayeva, O. R., Wenner, B. R., Bain, J. R. Charron, M. J. Newgard, C. B., & Unger, R. H. (2010) Leptin therapy in insulin-deficient type I diabetes. Proceeding of the National Academy of Science, 107, 4813-4819.

This article explores the possibility of treating type I diabetics with leptin supplementation. The usual treatment of type I diabetes is monotherapy of insulin. Injected insulin cannot meet needs of the alpha cells while not exceeding the insulin requirements of the skeletal muscles. Longer term insulin use may contribute to lipotoxic cardiomyopathy through fatty acid-mediated insulin resistance. The high incidences of coronary artery disease may be attributed to the hyperinsulinemia that monotherapy produces. Leptin therapy would suppress lipogenesis where insulin therapy increases lipogenesis and cholesterologenesis. This research found that leptin treatment reduced food intake and weight loss was from fat mass not lean body mass. They found that hyperleptinemia therapy corrected rodents’ insulin deficiency. They did not find a mechanism for this action, and therefore do not know if this benefit would translate to human. Leptin therapy may help type I diabetics control their disease.


Ferrie, S. , Herkes, R. , Forrest P. (2013). Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults: a retrospective audit of 86 patients. Intensive Care Medicine, 39, 1989-1994.

Extracorporeal membrane oxygenation (ECMO) is a modified heart-lung machine used for patients with severe cardiac or respiratory failure. There are two types of ECMO, venoarterial (VA) and venovenous (VV). VA ECMO can decrease pulsatile flow to the microcirculation and reduces gut perfusion. But gut dysfunction can happen in both VV and VA ECMO. This study looked at barriers to successful nutrition delivery and to investigate whether there is a difference between patients on VA and VV ECMO with regard to feeding tolerance. They found that enteral nutrition was started on average 13.1 hours after ICU admission. There was no difference between ECMO modes in incidence of feeding intolerance. On average, 80% of nutritional goals were being met each day in the first 2 weeks on ECMO. Most ECMO patients are heavily sedated. Propofol is the most used sedation and provides 1.1 kcal per ml. This can cause a problem for nutrition support. Most of the patient’s calorie needs could be met by propofol, but not their protein needs. Also ECMO patients are often fluid restricted. Propofol and fluid restriction can cause a problem with nutrition support. The patient would need a high calorie, high protein low-volume formula. Most low-volume formulas are also low protein. This means that a patient’s caloric needs are usually being met but they need protein supplementation. New products are needed that provide higher amounts of protein and micronutrients in a low-volume formula. This study found that enteral feeding can be tolerated by ECMO patients, no matter the mode.

 


Provided by Brittany Smith:

Sugar-sweetened Carbonated Beverage Consumption Correlates with BMI, Waist Circumference, and Poor Dietary Choices in School Children

Collison, K. S., Zaidi, M. Z., Subhani, S. N., Ali-Rubeaan, K., Shoukri, M., & Al-Monhanna, F. A. (2010). Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BioMedical Central Public Health, 10, 234-247.

A study conducted in Saudi Arabia to test the correlation between sugar-sweetened beverage consumption (SSB) and BMI, waist circumference, poor dietary choices in school age children between ages 10-19. This study used 5033 boys and 4400 girls that were randomly selected from middle and high schools in different regions. To assess the children’s diet they used a 7 day food frequency questionnaire. Height, weight, and waist circumference was measured.

The results of this study showed that there was a correlation between SSB intake and BMI is males but not females. SSB intake had a direct correlation with poor dietary choices in males and females. Poor dietary choices were determined by frequency of certain foods eaten such as fast food, savory snacks, iced desserts, and total sugar consumption. SSB intake and fast food had a high correlation in both genders. Foods such as fish, eggs, fruits, and vegetables were reported eating less by the older children, and the consumption of hot SSB was higher among the older children. This article’s results show that decreasing SSB intake could have a good impact on a person’s health.


Provided by Brittany Smith:

Effects of Breastfeeding and Low Sugar-sweetened Beverage Intake on Obesity Prevalence in Hispanic Toddlers
Davis, J. N., Whaley, S. E., & Goran, M. I. (2012). Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers. American Society for Nutrition, 95, 3-8.

This study was conducted to determine the effects that breastfeeding and sugar-sweetened beverage (SSB) intake had on obesity in children. 1483 Hispanic children from the Los Angeles area in the WIC program were used in this study. The ages of the children ranged from 2-4 years. Diets were assessed through phone surveys with the parents of the children. Heights and weights were taken by trained WIC staff. The children were placed in categories depending on the length of time breastfed and the amount of SSB consumed. The study used chi-squared test to compare breastfed categories to SSB categories.

The results showed that children who were breastfed had a lower rate of obesity than the children who were not breastfed. Also children who had a low SSB intake had a lower rate of obesity than children who had consumed a high amount of SSBs. Children who were breastfed for at least a year with a low amount of SSB consumption had a lower rate of obesity compared to children who were not breastfed with a high amount of SSB consumption. In conclusion, the result shows that breastfeeding and a lower intake of SSBs could decrease risk of obesity in Hispanic toddlers.


Provided By Haley Kormos:

Effect of short-term administration of cinnamon on blood pressure in patients with prediabetes and type 2 diabetes

Akilen, R., Pimlott, Z., Tsiami, A., Robinson, N. (2013). Effect of short-term administration

of cinnamon on blood pressure in patients with prediabetes and type 2 diabetes. Nutrition Journal, 29, 1192-1196.

Objective: The aim of this study was to systematically review and evaluate the effect of short-term administration of cinnamon on blood pressure regulation in patients with prediabetes and type 2 diabetes by performing a meta-analysis of randomized, placebo-controlled clinical trials.

Methods: Medical literature for randomized controlled trials (RCTs) of the effect of cinnamon on blood pressure was systematically searched; three original articles published between January 2000 and September 2012 were identified from the MEDLINE database and a hand search of the reference lists of the articles obtained through MEDLINE. The search terms included cinnamon or blood pressure or systolic blood pressure (SBP) or diastolic blood pressure (DBP) or diabetes. A random effects model was used to calculate weighted mean difference and 95% confidence intervals (CI).

Results: The pooled estimate of the effect of cinnamon intake on SBP and DBP demonstrated that the use of cinnamon significantly decreased SBP and DBP by 5.39 mm Hg (95% CI, 6.89 to 3.89) and 2.6 mm Hg (95% CI, 4.53 to 0.66) respectively.

Conclusion: Consumption of cinnamon (short term) is associated with a notable reduction in

SBP and DBP. Although cinnamon shows hopeful effects on BP-lowering potential, it would be premature to recommend cinnamon for BP control because of the limited number of studies available. Thus, undoubtedly a long-term, adequately powered RCT involving a larger number of patients is needed to appraise the clinical potential of cinnamon on BP control among patients with type 2 diabetes mellitus.


Provided By Haley Kormos:

ESPEN endorsed recommendations: Nutritional therapy in major burns

Rousseau, A., F., Losser, M., R., Ichai, C., Berger, M., M. (2013). ESPEN endorsed

recommendations: Nutritional therapy in major burns. Clinical Nutrition, 32, 497-502.

Background & aims: Nutrition therapy is a cornerstone of burn care from the early resuscitation phase until the end of rehabilitation. While several aspects of nutrition therapy are similar in major burns and other critical care conditions, the patho-physiology of burn injury with its major endocrine, inflammatory, metabolic and immune alterations requires some specific nutritional interventions. The present text developed by the French speaking societies, is updated to provide evidenced-based recommendations for clinical practice.

Methods: A group of burn specialists used the GRADE methodology (Grade of Recommendation, Assessment, Development and Evaluation) to evaluate human burn clinical trials between 1979 and 2011. The resulting recommendations, strong suggestions or suggestions were then rated by the non-burn specialized experts according to their agreement (strong, moderate or weak).

Results: Eight major recommendations were made. Strong recommendations were made regarding, 1) early enteral feeding, 2) the elevated protein requirements (1.5e2 g/kg in adults, 3 g/kg in children), 3) the limitation of glucose delivery to a maximum of 55% of energy and 5 mg/kg/h associated with moderate blood glucose (target _ 8 mmol/l) control by means of continuous infusion, 4) to associated trace element and vitamin substitution early on, and 5) to use non-nutritional strategies to attenuate hypermetabolism by pharmacological (propranolol, oxandrolone) and physical tools (early surgery and thermo-neutral room) during the first weeks after injury. Suggestion were made in absence of indirect

calorimetry, to use of the Toronto equation (Schoffield in children) for energy requirement determination (risk of overfeeding), and to maintain fat administration _ 30% of total energy delivery.

Conclusion: The nutritional therapy in major burns has evidence-based specificities that contribute to improve clinical outcome.


 

Provided by Christie Clark

Lacroix, E., Charest, A., Cyr, A., Baril-Gravel, L., Lebeuf, Y., Paquin, P., Chouinard, P. Y., Couture, P., & Lamarche, B. (2012). Randomized controlled study of the effect of a butter naturally enriched in trans fatty acids on blood lipids in healthy women. American Journal of Clinical Nutrition, 95, 318-325.

This study was conducted to determine if consuming butter naturally enriched with ruminant sources of trans fatty acids (rTFAs) in large but attainable amounts would affect plasma lipid concentrations in healthy women.   A total of 61 Quebec women who had a mean age of 38.3 ± 17.1 years, a body mass index (BMI) of 23.6 ± 2.9 kg/m^2, and a low-density lipoprotein (LDL) concentration of 51.82 ± 13.86 mmol/L participated in this study. Participants were free of previous cardiovascular disease (CVD) type 2 diabetes, dyslipidemia, and endocrine disorders and not taking medications for hyperlipidemia or hypertension. Every meal was provided to participants over the 8-week study. Two separate diets were assigned to each participant, the rTFA diet and the control diet, and each lasted four weeks. The rTFA diet had a total of 3.7g of rTFAs/day and supplied 1.5% of total energy. The control diet had a total of 0.9g of rTFAs/day and supplied 0.3% of total energy. The diets differed only in the total amount of rTFAs; the caloric and macronutrient distributions remained constant. The enriched butter provided the difference in rTFAs as other sources were not included in the diets. Statistical analyses were preformed on plasma lipid concentrations and the level of statistical significance was 5%. Covariates included menopausal status, weight, baseline lab values, and treatment order but none were statistically significant. Researchers found no significant changes in total cholesterol, LDL, apo A-1, apo B, cholesteryl ester transfer protein (CETP), hepatic lipase, endothelial lipase, or triglyceride concentrations after the rTFA diet in comparison to the control diet. Women with a BMI ≥ 25 (n=18) had a significant reduction of HDL cholesterol while women with a BMI < 25 had no significant reduction. The rTFA diet did increase total:HDL and LDL:HDL cholesterol ratios, but not significantly. The authors concluded that LDL was not affected by integrating rTFAs into the diet, but HDL was lowered, predominately in overweight women. This shows that adiposity may affect the way the body responds to dietary changes.


Provided by Christie Clark

Djousse, L., Lee, I. M., Buring, J. E., & Gaziano, J. M. (2009). Alcohol consumption and risk of cardiovascular disease and death in women: Potential mediating mechanisms. Circulation, 120, 237-244. 

This prospective study was performed in order to investigate the association between alcohol consumption, cardiovascular disease (CVD), and death and to establish which mediating factors reduced the risk of these events. A total of 26,399 women with an average age of 54.7 ± 7.1 years and body mass index (BMI) of 26.8 ± 5.5 participated in this 12.2-year study. At the start, researchers obtained blood samples in order to assess hemoglobin A1c, C-reactive protein, fibrinogen, intercellular adhesion molecule-1, triglycerides, and total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol. Blood pressure, smoking status, physical activity level, menopausal status, and diet and medical history were also obtained at this time. Participants’ alcohol intake was determined by questionnaire and was classified into categories of 0.1-4.9, 5.0-14.9, 15-29.9, and ≥30 grams per day. Using the Cox proportional hazards model, researchers computed multivariable hazard ratios (HRs) with a 95% confidence interval, controlling for age, BMI, smoking status, physical activity level, fruit and vegetable intake, menopausal status, and family history of premature myocardial infarction. This was referred to as the basic model. After estimating the HR, researchers compared moderate drinkers (5.0-14.9 grams/day) with non-drinkers and added sets of intermediate factors, one at a time, including blood pressure, inflammatory/hemostatic factors, and lipid factors. The change in HR in moderate drinkers and abstainers was then compared. Over the 12.2-year course of the study, a total of 1039 new CVD cases, 785 total deaths, and 153 cardiovascular deaths occurred. Researchers found J-shaped associations among alcohol consumption and risk of CVD and CVD death, with the lowest risk found, in both cases, with moderate drinkers. The following intermediate factors were associated with lower risk of CVD: lipids (28.7%), diabetes/hemoglobin A1c (25.3%), inflammatory/hemostatic factors (5.0%), and blood pressure (4.6%). A total of 86.3% of moderate drinkers’ decreased risk of CVD was attributed to the aforementioned intermediate factors.


Provided by Kelsey McGuire

Kramer, C. K., Zinman, B., Retnakaran, R. (2013). Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Annals of Internal Medicine.159(11),758-769.

Background: Recent interest has focused on a unique subgroup of overweight and obese individuals who have normal metabolic features despite increased adiposity. Normal-weight individuals with adverse metabolic status have also been described. However, it remains unclear whether metabolic phenotype modifies the morbidity and mortality associated with higher body mass index (BMI).

Purpose: To determine the effect of metabolic status on all-cause mortality and cardiovascular events in normal-weight, overweight, and obese persons.

Data Sources: Studies were identified from electronic databases.

Study Selection: Included studies evaluated all-cause mortality or cardiovascular events (or both) and clinical characteristics of 6 patient groups defined by BMI category (normal weight/overweight/obesity) and metabolic status (healthy/unhealthy), as defined by the presence or absence of components of the metabolic syndrome by Adult Treatment Panel III or International Diabetes Federation criteria.

Data Extraction: Two independent reviewers extracted the data. Metabolically healthy people of normal weight made up the reference group.

Data Synthesis: Eight studies (n = 61 386; 3988 events) evaluated participants for all-cause mortality and/or cardiovascular events. Metabolically healthy obese individuals (relative risk [RR], 1.24; 95% CI, 1.02 to 1.55) had increased risk for events compared with metabolically healthy normal-weight individuals when only studies with 10 or more years of follow-up were considered. All metabolically unhealthy groups had a similarly elevated risk: normal weight (RR, 3.14; CI, 2.36 to 3.93), overweight (RR, 2.70; CI, 2.08 to 3.30), and obese (RR, 2.65; CI, 2.18 to 3.12).

Limitation: Duration of exposure to the metabolic–BMI phenotypes was not described in the studies and could partially affect the estimates.

Conclusion: Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.

Primary Funding Source: Intramural funds from the Leadership Sinai Centre for Diabetes.


Provided by Kelsey McGuire

Henry R., Chilton, R., & Garvey, T. (2013). New options for the treatment of obesity and type 2 diabetes mellitus. Journal of Diabetes and Its Complications, 27. 508-518.


Moderate weight loss (>5%), which has been associated with improvements in glycemic parameters in patients with dysglycemia, also reduces the presence of other comorbidities, including dyslipidemia and hypertension, culminating in a reduced risk of cardiovascular disease. Lifestyle changes are the recommended preliminary approach to weight loss, with an initial weight-loss goal of 10% of body weight achieved over 6 months at a rate of 1–2 pounds per week selected as an appropriate target to decrease the severity of obesity- related risk factors. Implementing and maintaining the lifestyle changes associated with weight loss can, however, be challenging for many patients. Therefore, additional interventions sometimes may be necessary. Bariatric surgery can also be a highly effective option for weight loss and comorbidity reduction, but surgery carries considerable risks and is still applicable only to selected patients with type 2 diabetes. Thus, attention is turning to the use of weight-loss medications, including 2 recently approved compounds: twice-daily lorcaserin and a once-daily combination of phentermine and topiramate extended-release, both shown to be safe and effective therapies in the management of obesity in patients with type 2 diabetes.


Provided by Elizabeth Prendergast

Rani, P., Raman, R., Rachepalli, S., Pal, S., Kulothungan, V., Lakshmipathy, P., et al.. (2010). Anemia and Diabetic Retinopathy in Type 2 Diabetes Mellitus. Journal of the Association of India, 58, 91-94.

This study was done to look into the prevalence of anemia in patients with type 2 diabetes, as well as how anemia may play a role in diabetic retinopathy’s presence and severity among this diabetic population. This study included 5999 subjects, greater or equal to 40 years of age, from the Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular- genetics Study. Of the 5999 subjects, 1414 fit the established WHO criteria for Diabetes. The diabetic participants then had a comprehensive eye examination completed and a stereoscopic digital fundus photograph was used to evaluate the retinopathy level present. These subjects then had blood tested to determine if they were considered to be anemic. Anemia was present if Hb was <12 g/dL in women and <13g/dL in men. Statistical analyses were done using SPSS to provide both univariate and multivariate analysis. The significance level was set as less than or equal to 0.05 at the multivariate level. The total prevalence of anemia was 12.3%, with 11.6% of the men and 13.1 % of the women fitting the anemic criteria. Between the ages of 40-49, women had a 26.4% of prevalence for anemia and men had a 10.3% prevalence of anemia. The multivariate analysis identified different predictors for anemia, which included: an age over 69 years, having a duration of diabetes lasting over 5 years and presence of diabetic retinopathy. Anemia affects about 10% of the Diabetic population, according to this study. Anemia can interfere with how nutrients are transported throughout the blood- therefore increasing the retinopathy risk for these Diabetic patients.


 

Provided by Elizabeth Prendergast
Heyman, H., Van De Looverbosch, D., Meijer, E. & Schols, J. (2008). Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care residents. Journal of Wound Care, 17, 476-480.

This study was done to further explore how a Oral Nutrition Supplement in addition to a appropriate diet and standardized pressure ulcer care could effect the healing process of a pressure ulcer. This study took place over period of nine weeks in Belgium and Luxembourg. The sample studied included 245 patients with an average age of 82.2±10.1 years, with stage II-stage IV pressure ulcers and no exclusion criteria to gain the best insight into a long-term care facility population. The oral nutrition supplement administered to the patients over the nine weeks study period, was compromised of 250 kilocalories, 20 grams of protein, 3 grams of arginine, 250 milligrams of vitamin C, 38 milligrams of vitamin E and 9 mg of zinc. The suggested consumption of the oral nutrition supplement was three times a day in addition to the patients normal diet or enteral feeds, the actual consumption for the study participants average about 2.3±.56 servings per day as measured by a medical practitioner through patient questionnaires’. To measure the supplementations’ effect on the pressure ulcer, the area in millimeters of the pressure ulcer was measured. Measurements were taken at the start of the study, three weeks into the study and at the conclusion of the study, at nine weeks. When compared to the initial data of the study, there was a 53% reduction in average size from 1580±3743 mm3 to 743±1809 mm3, therefore creating a p value of <0.0001- this p value indicates that this change was significant from the beginning of the study to the end of the study. These results led to a conclusion that by following an oral supplement regimen with a supplement, such as the oral supplement used in the study, better outcomes of pressure ulcer severity may be seen by pressure ulcer patients.


 

 

Provided by Kaitlan Beretich
Importance of Early Nutritional Screening in Patients with Gastric Cancer
. Gavazzi, C., Colatruglio, S., Sironi, A., Mazzaferro, V., & Miceli, R. (2011). Importance of early nutritional screening in patients with gastric cancer. British Journal of Nutrition, 106(12), 1773-1778.

 

In the present study, we evaluated the relationship between nutritional status, disease stage and quality of life (QoL) in 100 patients recently diagnosed with gastric carcinoma. The patients' nutritional status was investigated with anthropometric, biochemical, inflammatory and functional variables; and we also evaluated the nutritional risk with the Nutritional Risk Screening 2002. Oncological staging was standard. QoL was evaluated using the Functional Assessment of Anorexia/Cachexia Therapy questionnaire. The statistical correlation between nutritional risk score (NRS) and oncological characteristics or QoL was evaluated using both univariable and multivariable analyses. Weight loss and reduction of food intake were the most frequent pathological nutritional indicators, while biochemical, inflammatory and functional variables were in the normal range. According to NRS, thirty-six patients were malnourished or at risk for malnutrition. Patients with NRS ≥ 3 presented a significantly greater percentage of stage IV gastric cancer and pathological values of C-reactive protein, while no correlation was found with the site of tumor. NRS was negatively associated with QoL (P < 0·001) and this relation was independent from oncological and inflammatory variables as confirmed by multivariable analysis. In the present study, we found that in patients with gastric cancer malnutrition is frequent at diagnosis and this is likely due to reduction in food intake. Moreover, NRS is directly correlated with tumor stage and inversely correlated with QoL, which makes it a useful tool to identify patients in need of an early nutritional intervention during oncological treatments.


Provided by Kaitlan Beretich
Carbohydrate Diet Links to Higher Risk of Significant Coronary Artery Disease in Young Indonesian Patients: Cardiometabolic Investigation Study.
Sugiri, Noventi, S., Hisatome, I., & Bahrudin, U. (2012). Carbohydrate diet links to higher risk of significant coronary artery disease in young Indonesian patients: Cardiometabolic Investigation study. Biomedical Research, 23(2), 159-165.

Coronary artery disease (CAD) remains the leading cause of cardiovascular death. The CAD risk factors dyslipidemia, hypertriglyceridemia, and diabetes are related to dietary intake and their metabolism. However, the association between carbohydrate, lipid, and protein components of dietary intake and the significant CAD remains elusive; and it never been reported among Asian population. The purpose of this study was to identify the risk factor profile of significant CAD of young Indonesian patients and to compare those components of dietary intake in those patients with and without significant CAD. Within the framework of this Cardiometabolic Investigation study, a case / control group was established comprising 22 patients with significant CAD (case group) and 14 patients without or non-significant CAD (control group) aged ≤50 years all of whom were admitted to the Dr. Kariadi Hospital. The multivariate analysis of the risk factors for significant CAD were energy intake >1750 kcal/day (OR=14.4; p=0.005) and smoking habit (OR=7.7; p=0.036). The energy intake of the patients with significant CAD was significantly higher than that of the control (2005.25±85.91 vs. 1695.56±128.19 kcal/day; p=0.003). While the lipid and protein component of the energy intake did not vary significantly between those two groups, the carbohydrate intake in the significant CAD group was significantly higher than that of the control group (1142.99±38.11 vs. 950.00±75.88 kcal/day; p=0.018). Conclusion: In addition to the smoking habit, a high carbohydrate intake could pose a risk factor for the significant CAD in young Indonesian patients.