Diagnostic Stewardship on the Extra-Analytical Phase to Secure Quality Assurance of Diagnostic Tests for Clostridioides difficile Infection

Background@#Clostridioides difficile infection (CDI) is the most essential cause of antimicrobial-related diarrhea in hospitalized patients. It is also considered as an important hospital-acquired infection. Adequately performing the laboratory diagnostic tests for CDI is critical for the control and treatment of CDI in healthcare facilities. This study focused on the management of the extra-analytical phase to secure quality assurance of the diagnostic tests for CDI. @*Methods@#We analyzed the volume and pattern of requested C. difficile - related tests from patients in 2018. The culture-positive rate was compared with the stool quality. Finally, the clinical characteristics of antibiotic-related diarrhea were compared based on whether toxigenic C. difficile was isolated. @*Results@#Culture plus toxin enzyme immunoassay was the most common pattern; however, it showed low positive rates for toxigenic C. difficile . The culture-positive rates were not different according to the Bristol stool form scale. The significant risk factors for the detection of toxigenic C. difficile in patients with antibiotic-associated diarrhea were inhibitor-combined penicillin or cephalosporin (odds ratio [OR], 5.060; 95% confidence interval [CI], 1.317–19.447; P =0.0183) and extended-spectrum cephalosporin (OR, 16.224; 95% CI, 3.166–83.134; P =0.0008). @*Conclusions@#The pre-pre-analytical errors are easy to overlook in routine laboratory procedures. Our findings could provide a good example of the management of the extra-analytical phase to secure quality assurance of the diagnostic tests for CDI.

Effects of sun exposure and dietary vitamin D intake on serum 25-hydroxyvitamin D status in hemodialysis patients

BACKGROUND/OBJECTIVES: Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects. SUBJECTS/METHODS: A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and 1,25(OH)2D levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml. RESULTS: Mean 25(OH)D and 1,25(OH)2D levels were 13.5 +/- 5.8 ng/ml and 20.6 +/- 11.8 pg/ml, respectively. The proportions of serum 25(OH)D deficiency ( or = 30 ng/ml) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise. CONCLUSIONS: Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.

Effects of sun exposure and dietary vitamin D intake on serum 25-hydroxyvitamin D status in hemodialysis patients

BACKGROUND/OBJECTIVES: Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects. SUBJECTS/METHODS: A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and 1,25(OH)2D levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml. RESULTS: Mean 25(OH)D and 1,25(OH)2D levels were 13.5 +/- 5.8 ng/ml and 20.6 +/- 11.8 pg/ml, respectively. The proportions of serum 25(OH)D deficiency ( or = 30 ng/ml) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise. CONCLUSIONS: Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.

Comparative analysis of food intake according to the family type of elderly women in Seoul area / 한국영양학회지

PURPOSE: As the rate of senior citizens living alone increases in the current aging society, there is much concern regarding the health and nutritional intake of solitary senior citizens. Therefore, this study compared the nutritional intake of senior citizens according to their family type. METHODS: In July and August of 2011, two senior citizen welfare centers in Seoul were visited to survey 267 elderly women. Excluding 54 subjects for which the data were incomplete, information from 213 subjects was analyzed. The subjects were divided into three family types, living alone (LA, n = 74), living with spouse (LS, n = 78), and living with children (LC, n = 61). RESULTS: The mean age of the LA group was the highest, while the mean age of the LS group was the lowest (p < 0.001) , and WHR of the LC group was the highest (p = 0.049). Income was the highest in the LS group (p < 0.001). Frequency of eating out was the lowest in the LA group (p = 0.031). By Duncan's multiple analysis, the amounts of energy intake, vegetable protein, fat, calcium, phosphorus, potassium, selenium, Vit D, Vit E, Vit B2, niacin, Vit B6, Vit B12, and cholesterol were significantly higher in the LS group compared with the LA or LC group (p < 0.05). The intakes of calcium, Vit D, Vit B12, and cholesterol were still significantly different among the three groups, even after adjustment for age and monthly income. The LA group ate less fruit and fish than the LS or LC group (p < 0.05). The LA group showed the lowest dietary diversity and the LS group showed the highest diversity (p = 0.014), however, the significance of dietary diversity score among the three groups disappeared after adjustment for age and monthly income. CONCLUSION: Elderly women living with spouse were receiving better nutrition than elderly women living alone or living with children. Therefore, solitary elderly women who do not live with their spouse or children should be offered greater opportunities to receive a balanced meal at a congregational kitchen or welfare center. To ensure their healthy diet, it is essential to provide continuous nutrition education with these groups in mind.

Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients / 한국영양학회지

PURPOSE: Elevated serum phosphorus and potassium levels are a major problem for hemodialysis (HD) patients. Hyperphosphatemia and hyperkalemia are closely related to intake of dietary phosphorus and potassium. METHODS: This study was conducted in order to investigate the effects of food consumed on serum phosphorus and potassium levels in 48 HD patients (20 males and 28 females). We collected anthropometric data, biochemical parameters, and dietary data of the subjects. Dietary data for usual intake were obtained by use of a food-frequency questionnaire (FFQ) consisting of 21 food items. RESULTS: The mean body mass index (BMI) was 22.2 +/- 3.0 kg/m2, mean serum phosphorus level was 4.50 +/- 1.52 mg/dl, and mean serum potassium level was 4.74 +/- 0.73 mEq/l. Hyperphosphatemia (> 4.5 mg/dl) was found in 45.8% of subjects, and hyperkalemia (> 5.0 mEq/l) in 35.4%. Subjects who took medication only were 56% of total, and those who took medication with dietary therapy were 27%. Patients with medication and dietary therapy showed significantly lower serum phosphorus levels compared to patients with medication only (p < 0.05). Mean duration of HD was 7.9 +/- 7.3 years and it showed positive correlation with serum potassium levels (p < 0.05). Serum phosphorus levels showed positive correlation with intake of mixed grains and soybean milk (p < 0.05). Serum potassium levels showed positive correlation with intake of mixed grains (p < 0.01), potatoes, fish, and high-potassium vegetables (p < 0.05). On the other hand, intake of white rice showed negative correlation with serum potassium levels (p < 0.05). CONCLUSION: The results of our study suggest that intake of white rice rather than mixed grains is an important factor in sustaining normal serum phosphorus and potassium levels. In addition, limiting intake of soybean milk, potatoes, and fish to under three serving per week is recommended. Finally, conduct of a strict dietary therapy along with medical treatment is desirable because inappropriate food intake increases serum phosphorus and potassium levels to a higher than normal range.

Effects of calcium and vitamin D intake level on lipid metabolism in growing rats / 한국영양학회지

PURPOSE: Association of low intake of calcium (Ca) and inadequate vitamin D (VD) status with higher prevalence rates of obesity has been reported. This study was conducted in order to investigate the effects of different levels of whey Ca and VD intake on lipid metabolism in growing rats. METHODS: A total of 56 five-week-old male Sprague-Dawley rats were divided into seven groups and fed for five weeks. Ca groups were divided into three levels, low, normal, and high (0.25%, 0.5%, 1%). VD subgroups in the low and high Ca groups were divided into three levels, low, normal, and high (10 IU, 1,000 IU, and 5,000 IU). The effects of Ca and VD on each group were evaluated by two way ANOVA. RESULTS: Significantly higher amounts of abdominal fat, visceral fat, and epididymal fat were observed in the Low-Ca groups than in the Normal-Ca and High-Ca groups. Serum leptin levels of Low-Ca groups were higher than those of Normal-Ca and High-Ca groups. The highest serum parathyroid hormone concentration was observed in the low Ca.low VD group. The levels of serum 25(OH)D were significantly increased with increasing dietary VD levels. Significantly higher serum levels of triglycerides, total cholesterol, and HDL-cholesterol were observed in the low Ca groups than in the normal Ca and high Ca groups. CONCLUSION: These results indicate that low calcium intake increased serum lipid level and body fat amount.

Obesity Increases Blood Pressure Variability during the Night

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.

Postimplantation Syndrome After Endovascular Aortic Aneurysm Repair in an Elderly Patient

Endovascular procedures have been proposed as minimally invasive alternative treatments, allowing safe and effective aortic aneurysm repair. Despite the potential benefits, endovascular stent grafting may elicit an unexpected systemic inflammatory response, called postimplantation syndrome (PIS). The main features of PIS include fever, elevated C-reactive protein levels, leukocytosis and/or coagulation disturbances, perigraft air on abdominal computed tomography, and no evidence of infection. The main management of PIS is supportive care. Antibiotics have no clinical benefit. We report a case of PIS after endovascular aortic aneurysm repair in an elderly patient.

The effects of elimination diet on nutritional status in subjects with atopic dermatitis

A food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly upon exposure to a given food. In those with food allergies that are thought to cause aggravation of eczema, food avoidance is important. The objective of this study was to research the nutritional status of patients with food allergies. A total of 225 subjects diagnosed with atopic dermatitis underwent a skin prick test as well as measurement of serum immunoglobulin E. Food challenge tests were conducted using seven food items: milk, eggs, wheat, soybeans, beef, pork, and chicken. At post-food challenge visits to the test clinic, participants completed a three-day dietary record, which included two week days and one weekend day, in order to evaluate energy intake and diet quality during the challenge. We analyzed nutrient intake based on differential food allergens. Subjects with a food allergy to milk showed lower intake of Ca, Zn, and vitamin B2, and subjects with a food allergy to egg showed lower intake of vitamin A, B1, B2, niacin, and cholesterol. Subjects with a food allergy to wheat and soybean showed lower intake of Ca, P, Fe, K, Zn, vitamin B2, vitamin B6, and niacin; and subjects with a food allergy to beef, pork, and chicken showed lower intake of Fe and higher intake of K, vitamin A, B2. Subjects with atopic dermatitis were lacking in several nutrients, including vitamin A and vitamin C. A greater number of food allergies showed an association with a greater number of nutrient intake deficiencies. Allergen avoidance is the basic treatment for atopic dermatitis. However, when the allergen is food, excessive restriction can lead to nutrition deficiency. Findings of this study suggest the necessity for enhanced nutritional education in order to provide substitute foods for patients with food allergies who practice food restriction.

Comparative study of serum levels of albumin and hs-CRP in hemodialysis patients according to protein intake levels / 한국영양학회지

Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake or = 1.0 g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p < 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p < 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p < 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p < 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p < 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.

Characterization of food allergies in patients with atopic dermatitis

We examined the characteristics of food allergy prevalence and suggested the basis of dietary guidelines for patients with food allergies and atopic dermatitis. A total of 2,417 patients were enrolled in this study. Each subject underwent a skin prick test as well as serum immunoglobulin E (IgE) measurement. A double-blind, placebo-controlled food challenge was conducted using milk, eggs, wheat, and soybeans, and an oral food challenge was performed using beef, pork, and chicken. Food allergy prevalence was found among 50.7% in patients with atopic dermatitis. Among patients with food allergies (n = 1,225), the prevalence of non-IgE-mediated food allergies, IgE-mediated food allergies, and mixed allergies was discovered in 94.9%, 2.2%, and 2.9% of the patients, respectively. Food allergy prevalence, according to food item, was as follows: eggs = 21.6%, milk = 20.9%, wheat = 11.8%, soybeans = 11.7%, chicken = 11.7%, pork = 8.9% and beef = 9.2%. The total number of reactions to different food items in each patient was also variable at 45.1%, 30.6%, 15.3%, 5.8%, 2.2%, and 1.0% for 1 to 6 reactions, respectively. The most commonly seen combination in patients with two food allergies was eggs and milk. The clinical severity of the reactions observed in the challenge test, in the order of most to least severe, were wheat, beef, soybeans, milk, pork, eggs, and chicken. The minimum and maximum onset times of food allergy reactions were 0.2-24 hrs for wheat, 0.5-48 hrs for beef, 1.0-24 hrs for soybeans, 0.7-24 hrs for milk, 3.0-24 hrs for pork, 0.01-72 hrs for eggs, and 3.0-72 hrs for chicken. In our study, we examined the characteristics of seven popular foods. It will be necessary, however, to study a broader range of foods for the establishment of a dietary guideline. Our results suggest that it may be helpful to identify food allergies in order to improve symptoms in patients with atopic dermatitis.

The Effects of Nutrition Education and Regular Exercise on Nutritional Status, Quality of Life and Fatigue in Hemodialysis Patients

The purpose of this study was to investigate the effects of a nutrition education and exercise on nutritional status in hemodialysis patients, with regard to quality of life (QoL), and fatigue. The subjects were divided into two groups : an educated (E) group (11 men and 9 women) and a non-educated (NE) group (7 men and 22 women). The educated group received a nutrition education and a regular exercise program for 3 months. Data on anthropometric indices and biochemical parameters were obtained from medical records. Dietary habits and nutrient intake were assessed through questionnaires and three-day food records. QoL (through the SF-36 questionnaire) and fatigue (measured by a visual analogue scale questionnaire) were assessed before and after the interventions. Dietary habit scores regarding food variety and fluid intake control significantly increased (P<0.05) after the nutrition education. Furthermore, the intake of total energy, carbohydrates, Fe, and vitamin A significantly increased (P<0.05). Vitamin C intake also significantly increased (P<0.01). Hb levels decreased whereas TG levels increased in the NE group. BUN levels decreased in the E group. After the nutrition education, QoL aspects, such as feelings of pain and general health, and the total score significantly increased (P<0.05) and the level of fatigue score decreased (P<0.01). The results of this study indicate that nutrition education and exercise for hemodialysis patients provides changes in dietary habit, daily nutrient intake, biochemical parameters, QoL, and the level of fatigue. Therefore, nutrition education and exercise help improve nutritional status and QoL.

A Case of Periaortitis Diagnosed with Abdomen CT in a Patient with Malignant Fibrous Histiocytosis

Periaortitis is a very rare disease, characterized by a fibro-inflammatory tissue which develops around abdominal aorta and iliac arteries, and spreads into the structures of retroperitoneum. Computed tomography (CT) or magnetic resonance imaging (MRI) is the modality of choice for the diagnosis. Here, we report a case of periaortitis diagnosed with abdomen CT in patient with malignant fibrous histiocytoma.

Effects of adlay, buckwheat, and barley on transit time and the antioxidative system in obesity induced rats

In the present study, we examined whether four grains including adlay (AD), buckwheat (BW), glutinous barley (GB), and white rice (WR) affect the duration of food residence in the gastrointestinal tract and hepatic enzyme activities in rats fed different combinations of the grains. The rats were raised for 4 weeks on a high fat diet based on the American Institute of Nutrition-93 (AIN-93G) diets containing 1% cholesterol and 20% dietary lipids. Forty male rats were divided into four groups and raised for 4 weeks with a diet containing one of the grains. Corresponding to the dietary fiber contents of the experimental grains, gut transit time was shortest in the rats fed GB and increased in the order of BW, AD, and WR. In addition, the accumulated shortest transit time occurred in the GB group. Gut transit time affected weight gain and major organ weight, as it was closely related to the absorption of nutrients. The level of thiobarbituric acid reactive substance (TBARS) in liver was higher in rats fed WR, AD, BW, and GB, indicating that the other grains decreased oxidative stress in vivo more than WR. Glutathione, glutathione peroxidase, and glutathione S-transferase levels in the AD, BW, and GB groups were significantly higher than those in the WR group. In conclusion, reduced colonic transit time has been implicated in reducing the incidence of colon cancer, as evidenced by populations consuming diets rich in fiber. Whole grains such as AD, BW, and GB may contribute to a significant supply of antioxidants to prevent oxidative stress if they are consumed in large amounts.

A comparison of food frequency for the elderly regarding different family types: Based on Community Health Survey for 2008

This study analyzes the food frequency for the elderly regarding different family types and finds the factors for nutritional risk, offers a basic reference for providing nutritional support for them. The study referred to the dietary behavioral survey data of 3,680 elderly people (1652 male and 2028 female) from 21 regions in the northern Kyeonggi province. The data was collected through the method of one-to-one interviews and was a part of the Community Health Survey for 2008 by the Korea Centers for Disease Control and Prevention (KCDC). We classified family types as a household for elderly people living alone, a household of elderly people with a spouse, a household of the elderly with unmarried children and a household of the elderly with married children, and as for intakes of foods, the frequencies of taking fruits, vegetables, kimchi, rice with mixed cereals, meat, fish, bean/tofu/soymilk, milk and dairy products, as well as sweet beverages are calculated on a daily basis and skipped meals are calculated on a weekly basis. Elderly women showed lower income, lower education level, higher unemployment rates, and a higher rate of government healthcare subsidies than elderly men. Elderly women tend to live alone and with their children while elderly men tend to live with their spouse. In both males and females, the intake of fruits and vegetables were the least in the elderly living alone, while the elderly with married children ate the most. In both males and females, the household of the elderly living alone ate significantly less amounts of Kimchi than other family types. Elderly people living alone tended to have significantly less meat and fish, especially women. In the case of rice with mixed cereals, the elderly men living alone and the elderly men with unmarried children ate significantly less amounts than the elderly men living with a spouse. The elderly men living alone took significantly less milk and dairy products than the elderly men with unmarried children while the elderly women living with a spouse took significantly less milk and dairy products than the elderly women with married children. With regards to the frequency of meal-skipping, the elderly living alone had the highest frequency for skipping meals. From this result, having various foods is difficult for the elderly living alone. Furthermore, the elderly living with unmarried children demonstrated a low quality of dietary life compared to those of married children. Hence, it can be concluded that social support is important in order for the elderly to have a balanced diet.

The intake of food and nutrient by the elderly with chronic disease in the Seoul area

This study was carried out in order to investigate the status of food and nutrient intakes depending on the types of chronic disease of the elderly at welfare centers in Seoul. The total number of subjects was 299 elderly over the age of 60 (82 men and 217 women); they were grouped by the disease status: normal, cardiovascular disease (CVD), diabetes mellitus (DM) and arthritis patients groups. The dietary intakes were obtained by a 24-hour recall and analyzed by CAN-Pro 4.0; they were then compared with the dietary reference intakes for the Korean (KDRIs). In the results of anthropometric data according to chronic disease, the waist circumference of the normal group in males and females was lower than the other groups; in particular, the normal female group showed a lower level of waist-hip ratio, body mass index (BMI) and body fat % than those of the other groups. The arthritis group showed a higher intake of milk products than the other groups (p < 0.05); consequently, calcium intake was significantly higher than that of the other groups (p < 0.001). Vitamin A intake in the arthritis group was significantly higher than the intake in the normal and DM groups (p < 0.01). Normal and arthritis groups showed significantly higher intake of zinc and copper than the CVD group (p < 0.01). In general, about 80% of the subjects in this study revealed insufficient intakes of riboflavin, vitamin C, calcium, dietary fiber, vitamin D, biotin and potassium, compared with the estimated average requirement (EAR) or adequate intake (AI). However, sodium intake of all groups was higher than the AI of KDRIs. In conclusion, nutrient intake, according to the chronic disease, showed significant difference in some of the micronutrients, vitamin A, Ca, Zn and Cu. Therefore, we suggest that dietary guidelines, such as reducing the intake of salty foods and sweet drinks and increasing the intake of foods with sufficient calcium, vitamin D and vitamin C, are necessary to the improvement of eating habits for the elderly.

The effect of a healthy school tuck shop program on the access of students to healthy foods

The objective of this study was to evaluate the effect of a healthy school tuck shop program, developed as a way of creating a healthy and nutritional school environment, on students' access to healthy foods. Five middle schools and four high schools (775 students) participated in the healthy school tuck shop program, and nine schools (1,282 students) were selected as the control group. The intervention program included restriction of unhealthy foods sold in tuck shops, provision of various fruits, and indirect nutritional education with promotion of healthy food products. The program evaluation involved the examination of students' purchase and intake patterns of healthy foods, satisfaction with the available foodstuffs, and utilization of and satisfaction with nutritional educational resources. Our results indicated that among of the students who utilized the tuck shop, about 40% purchased fruit products, showing that availability of healthy foods in the tuck shop increased the accessibility of healthy foods for students. Overall food purchase and intake patterns did not significantly change during the intervention period. However, students from the intervention schools reported higher satisfaction with the healthy food products sold in the tuck shop than did those from the control schools (all P < 0.001), and they were highly satisfied with the educational resources provided to them. In conclusion, the healthy school tuck shop program had a positive effect on the accessibility of healthy food. The findings suggest that a healthy school tuck shop may be an effective environmental strategy for promoting students' access to healthy foods.

IL-10 is Predominantly Produced by CD19(low)CD5(+) Regulatory B Cell Subpopulation: Characterisation of CD19 (high) and CD19(low) Subpopulations of CD5(+) B cells

IL-10 production by CD19(+)CD5(+) B cells was investigated, by determining the expression levels of CD19, a classical B cell marker. Peripheral mononuclear cells were stained with fluorescence-conjugated anti-CD5, anti-CD19, anti-IL-10, and Annexin V. Interestingly, IL-10-producing B cells were found to be localised within the CD19(low)CD5(+) B cell subset. Apoptotic changes were also observed mainly in CD19(low) cells among B cells. Thus, CD5(+) B cells should be classified as CD19(high) and CD19(low) cells, and the immunological significance of CD19 for the IL-10 production by CD5(+) B cells requires further studies.

Effect of processed foods on serum levels of eosinophil cationic protein among children with atopic dermatitis

The prevalence of atopic dermatitis (AD) in school-age children has increased in industrialized countries. As diet is one of the main factors provoking AD, some studies have suggested that food additives in processed foods could function as pseudoallergens, which comprise the non-immunoglobulin E-mediated reaction. Eosinophil cationic protein (ECP) is an eosinophil granule protein released during allergic reactions to food allergens in patients with AD. Thus, serum ECP levels may be a useful indicator of ongoing inflammatory processes in patients with AD. The purpose of this study was to investigate the effect of consuming MSG in processed foods on serum ECP levels among children with AD. This study was performed with 13 patients with AD (age, 7-11 years) who had a normal range of total IgE levels (< 300 IU/ml). All participants ate normal diets during the first week. Then, six patients were allocated to a processed food-restricted group (PRDG) and seven patients were in a general diet group (GDG). During the second week, children in the PRDG and their parents were asked to avoid eating all processed foods. On the third week, children in the PRDG were allowed all foods, as were the children in the GDG throughout the 3-week period. The subjects were asked to complete a dietary record during the trial period. Children with AD who received the dietary restriction showed decreased consumption of MSG and decreased serum ECP levels and an improved SCORing score on the atopic dermatitis index (P < 0.05). No differences in serum ECP levels or MSG consumption were observed in the GDG. Serum total IgE levels were not changed in either group. In conclusion, a reduction in MSG intake by restricting processed food consumption may lead to a decrease in serum ECP levels in children with AD and improve AD symptoms.

Association of Nutrient Intake and Pregnancy Outcome with Gestational Weight Gain

Gestational age and infant birth weight are influenced by gestational weight gain. This study was aimed to examine the effects of gestational weight gain on pregnancy outcomes. Pregnant women were recruited at two hospitals in Seoul area. Characteristics and dietary intakes of pregnant women were obtained using 24-hour recall questionnaires. Gestational weight gain was categorized as less (Under-gain) than, within (Recommended gain), or greater (Over-gain) than the Institute of Medicine guidelines. Maternal height and pre-pregnancy weight in the over-gain group significantly higher than under-gain and recommended gain group. Mini dietary assessment score of eating bean has significantly higher in under-gain group than recommended gain group and eating kimchi has significantly higher in under-gain group than over-gain group. Score of eating fruit was significantly higher in over-gain group than other groups. The mean intake of carbohydrate in the recommended gain group were significantly higher than under-gain group, and mean intake of potassium in the over-gain group were significantly higher than under-gain group. Under-gain group showed the high rate of the preterm delivery and low birth weight infant delivery. However recommended gain group showed 46% reduced risk of preterm delivery (OR = 0.54 CI = 0.30-0.98). Risk of macrosomia increased with increasing gestational weight gain (p for trend < 0.05). In conclusion, pregnancy outcomes were influenced by gestational weight gain. Therefore, these finding suggested adequate gestational weight gain according to BMI for reducing the risk of preterm delivery, low birth weight and macrosomia.