Relationship Between Grocery Shopping Frequency and Home- and Individual-Level Diet Quality Among Low-Income Racial or Ethnic Minority Households With Preschool-Aged Children.

BACKGROUND: The home food environment can shape the diets of young children. However, little is known about modifiable factors that influence home food availability and dietary intake. OBJECTIVE: The purpose of this study was to examine the relationship between grocery shopping frequency with home- and individual-level diet quality. DESIGN: This was a secondary, cross-sectional analyses of data from the Study on Children's Home Food Availability Using TechNology. Data were collected in the homes of participants from November 2014 through March 2016. PARTICIPANTS/SETTINGS: A purposive sample of 97 low-income African American and Hispanic or Latinx parent-child dyads residing in Chicago, IL, enrolled in the study. MAIN OUTCOME MEASURES: The main outcomes were home- and individual-level diet quality. Healthy Eating Index-2010 (HEI-2010) scores were calculated from home food inventory data collected in participants' homes to assess home-level diet quality. To assess individual-level diet quality, HEI-2010 scores were based on multiple 24-hour diet recalls from parent-child dyads. STATISTICAL ANALYSES: Grocery shopping frequency was examined in relation to diet quality at the home and individual levels. Grocery shopping frequency was defined as the number of times households shopped on a monthly basis (ie, once a month, twice a month, 3 times a month, or 4 times or more a month). Multivariable linear regression analysis, controlling for covariates, tested the relationships between grocery shopping frequency and HEI-2010 total and component scores at the home and individual levels. RESULTS: Grocery shopping frequency was positively associated with home-level HEI-2010 scores for total diet, whole grains, and empty calories (higher scores reflect better diet quality) and with individual-level HEI-2010 scores for total and whole fruit (parents only), vegetables (children only), and sodium (children only). CONCLUSIONS: Grocery shopping frequency was associated with multiple dimensions of diet quality at the home and individual levels. These results offer a potential strategy to intervene on home food availability and individual dietary intake.

Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis.

BACKGROUND: Our trial INTACT (Intensive Nutrition in Acute Lung Injury Trial) was designed to compare the impact of feeding from acute lung injury (ALI) diagnosis to hospital discharge, an interval that, to our knowledge, has not yet been explored. It was stopped early because participants who were randomly assigned to energy intakes at nationally recommended amounts via intensive medical nutrition therapy experienced significantly higher mortality hazards than did those assigned to standard nutrition support care that provided energy at 55% of recommended concentrations. OBJECTIVE: We assessed the influence of dose and timing of feeding on hospital mortality. DESIGN: Participants (n = 78) were dichotomized as died or discharged alive. Associations between the energy and protein received overall, early (days 1-7), and late (days ≥8) and the hazards of hospital mortality were evaluated between groups with multivariable analysis methods. RESULTS: Higher overall energy intake predicted significantly higher mortality (OR: 1.14, 95% CI: 1.02, 1.27). Among participants enrolled for ≥8 d (n = 66), higher early energy intake significantly increased the HR for mortality (HR: 1.17, 95% CI: 1.07, 1.28), whereas higher late energy intake was significantly protective (HR: 0.91, 95% CI: 0.83, 1.0). Results were similar for early but not late protein (grams per kilogram) exposure (early-exposure HR: 8.9, 95% CI: 2.3, 34.3; late-exposure HR: 0.15, 95% CI: 0.02, 1.1). Threshold analyses indicated early mean intakes ≥18 kcal/kg significantly increased subsequent mortality. CONCLUSIONS: Providing kilocalories per kilogram or grams of protein per kilogram early post-ALI diagnosis at recommended levels was associated with significantly higher hazards for mortality, whereas higher late energy intakes reduced mortality hazards. This time-varying effect violated the Cox proportionality assumption, indicating that feeding trials in similar populations should extend beyond 7 d and use time-varying statistical methods. Future trials are required for corroboration. INTACT was registered at clinicaltrials.gov as NCT01921101.

Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results.

INTRODUCTION: The preschool years provide a unique window of opportunity to intervene on obesity-related lifestyle risk factors during the formative years of a child's life. The purpose of this study was to assess the impact of a preschool-based obesity prevention effectiveness trial at 1-year follow-up. DESIGN: RCT. SETTINGS/PARTICIPANTS: Primarily African American children (aged 3-5 years, N=618) attending Head Start preschool programs administered by Chicago Public Schools. METHODS: Eighteen preschools were randomly assigned in 2007-2008 to receive either (1) a 14-week teacher-delivered intervention focused on healthy lifestyle behaviors or (2) a 14-week teacher-delivered general health curriculum (control group). MAIN OUTCOME MEASURES: The primary outcome, BMI, was measured at baseline, postintervention, and 1-year follow-up. Diet and screen time behaviors were also assessed at these time points. Multilevel mixed effects models were used to test for between-group differences. Data were analyzed in 2014. RESULTS: Significant between-group differences were observed in diet, but not in BMI z-score or screen time at 1-year follow-up. Diet differences favored the intervention arm over controls in overall diet quality (p=0.02) and in subcomponents of diet quality, as measured by the Healthy Eating Index-2005, and in fruit intake (servings/day, excludes juice) (p=0.02). Diet quality worsened more among controls than the intervention group at 1-year follow-up. CONCLUSIONS: The adaptation of Hip-Hop to Health Jr. produced modest benefits in diet quality but did not significantly impact weight gain trajectory. Not unlike other effectiveness trials, this real-world version delivered by Head Start teachers produced fewer benefits than the more rigorous efficacy trial. It is important to understand and build upon the lessons learned from these types of trials so that we can design, implement, and disseminate successful evidence-based programs more widely and effectively. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT00241878.

Vitamin D, inflammation, and relations to insulin resistance in premenopausal women with morbid obesity.

OBJECTIVE: In this study, the associations between vitamin D, insulin sensitivity, and inflammation and their relationships with adipose tissue expression of vitamin D receptor (VDR) and inflammatory markers in women with morbid obesity were determined. METHODS: An oral glucose tolerance test prior to surgery was completed by healthy premenopausal women (n = 76) seeking bariatric surgery. Abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were collected during surgery. RESULTS: Approximately, 70% of our subjects were vitamin D sufficient or optimal, and 80% had normal glucose tolerance. No significant association between serum 25-hydroxyvitamin D [25(OH)D] with circulating inflammatory markers or insulin sensitivity was identified. In subjects with waist circumference of <139 cm (n = 42), log25(OH)D positively predicted VAT logIL-6 mRNA expression (P = 0.003). LogVDR expression was positively correlated with the expression of inflammatory markers in both SAT (logIL-1ß mRNA: r = 0.95, P < 0.0001; logTNF mRNA: r = 0.82, P < 0.0001) and VAT (logIL-1ß mRNA: r = 0.89, P < 0.0001; logTNF mRNA: r = 0.75, P < 0.0001). VAT logVDR expression positively predicted logHOMA-IR in non-African American subjects (P = 0.05). CONCLUSIONS: The beneficial effects of vitamin D on inflammation and insulin sensitivity were not supported by our findings. VDR does not appear to possess a protective effect in adipose tissue.

Video telehealth for weight maintenance of African-American women.

We evaluated the effect of home telehealth on weight maintenance after a group-based weight loss programme. The home telehealth intervention comprised telephone counselling and home Internet-enabled digital video recorders (DVRs) with three channels of video programmes. The video content provided reinforcement and support to promote problem solving, prevent relapse and sustain motivation. Eighty-eight obese or overweight African-American women were randomized to receive monthly telephone counselling (control) or the home telehealth intervention. The weight change during maintenance was not significant in either group (0.6 kg in the intervention group, 0.0 kg in the control group), and there was no significant difference between them. Changes in diet, physical activity, social support and self-efficacy during the maintenance period did not differ significantly between groups. DVR use was low: during the intervention, the number of valid DVR viewings ranged from zero to 42 per person. DVR use was positively associated with previous attendance at the weight loss classes. Home video-based telehealth is a new method of delivering a weight loss maintenance intervention to African-American women. It had no effect on weight maintenance in the present study.

Family-based hip-hop to health: outcome results.

OBJECTIVE: This pilot study tested the feasibility of Family-Based Hip-Hop to Health, a school-based obesity prevention intervention for 3-5-year-old Latino children and their parents, and estimated its effectiveness in producing smaller average changes in BMI at 1-year follow-up. DESIGN AND METHODS: Four Head Start preschools administered through the Chicago Public Schools were randomly assigned to receive a Family-Based Intervention (FBI) or a General Health Intervention (GHI). RESULTS: Parents signed consent forms for 147 of the 157 children enrolled. Both the school-based and family-based components of the intervention were feasible, but attendance for the parent intervention sessions was low. Contrary to expectations, a downtrend in BMI Z-score was observed in both the intervention and control groups. CONCLUSIONS: While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at 1-year follow-up (15%) than those reported by the National Health and Nutrition Examination Survey (2009-2010) for 2-5-year-old children (12.1%). Developing evidence-based strategies for obesity prevention among Hispanic families remains a challenge.

Trends in the nutritional content of television food advertisements seen by children in the United States: analyses by age, food categories, and companies.

OBJECTIVE: To examine trends in children's exposure to food-related advertising on television by age, product category, and company. DESIGN: Nutritional content analysis using television ratings data for 2003, 2005, 2007, and 2009 for children. SETTING: Annual age-specific television ratings data captured children's exposure to broadcast network, cable network, syndicated, and spot television food advertising from all (except Spanish-language) programming. PARTICIPANTS: Children aged 2 to 5 and 6 to 11 years. Main Exposure  Television ratings. MAIN OUTCOME MEASURES: Children's exposure to food-related advertising on television with nutritional assessments for food and beverage products for grams of saturated fat, sugar, and fiber and milligrams of sodium. RESULTS: Children aged 2 to 5 and 6 to 11 years saw, respectively, on average, 10.9 and 12.7 food-related television advertisements daily in 2009, down 17.8% and 6.9% from 2003. Exposure to food and beverage products high in saturated fat, sugar, or sodium fell 37.9% and 27.7% but fast-food advertising exposure increased by 21.1% and 30.8% among 2- to 5- and 6- to 11-year-olds, respectively, between 2003 and 2009. In 2009, 86% of ads seen by children were for products high in saturated fat, sugar, or sodium, down from 94% in 2003. CONCLUSIONS: Exposure to unhealthy food and beverage product advertisements has fallen, whereas exposure to fast-food ads increased from 2003 to 2009. By 2009, there was not a substantial improvement in the nutritional content of food and beverage advertisements that continued to be advertised and viewed on television by US children.

Effect of variable energy served on 24-hour energy intake in 16 preschools, Chicago, Illinois, 2007.

INTRODUCTION: The effect of varying portion size in a natural environment on the self-regulation of 24-hour energy intake has not been evaluated. We studied students at 16 preschools in Chicago to determine the effect of meals with variable energy and macronutrients on the amount consumed over a 24-hour period (ie, at preschool and outside of preschool). METHODS: The food items and portion sizes served at 16 preschools in the Chicago Public Schools early childhood education programs were observed for 3 to 8 days. Children were assessed for total energy and selected macronutrients consumed at preschool and outside of preschool for a 24-hour period; their data were pooled and reported by school. RESULTS: The students were predominantly African American (96%); on average, 32 students (range, 21-38) participated at each of the 16 preschools, and the age range of students was 4.0 to 4.5 years. The energy served at preschools ranged from 48% to 90% of the daily recommended energy allowance (REA). The mean energy intake at school was significantly higher (39% of REA) at 2 preschools, including 1 that served 90% of the REA. Mean energy consumption outside of preschool and total 24-hour energy consumption did not differ by preschool, adjusting for body mass index z score and sex. CONCLUSION: The preschools served meals that widely varied by portion size and energy; however, this variation did not result in differences in mean 24-hour nutrient intakes for the students attending these schools.

Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results.

The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children. The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-randomized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children. The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools. Children enrolled in the nine schools randomized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers. Children in the nine control schools received a general health intervention. Height and weight, physical activity, screen time, and diet data were collected at baseline and postintervention. At postintervention, children in the intervention schools engaged in more moderate-to-vigorous physical activity (MVPA) than children in the control schools (difference between adjusted group means = 7.46 min/day, P = 0.02). Also, children in the intervention group had less total screen time (-27.8 min/day, P = 0.05). There were no significant differences in BMI, BMI Z score, or dietary intake. It is feasible to adapt an obesity prevention program to be taught by classroom teachers. The intervention showed positive influences on physical activity and screen time, but not on diet. Measuring diet and physical activity in preschool children remains a challenge, and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision.

Orally fed patients are at high risk of calorie and protein deficit in the ICU.

PURPOSE OF REVIEW: Malnutrition can lead to serious complications in the ICU. Less than half of patients admitted to ICU require ventilation and for many, their optimal route of feeding is oral medical nutrition therapy, rather than enteral or parenteral nutrition. Inadequate oral intake is a prevalent and often difficult problem within this population, as increased calorie deficits are common in the ICU and associated with worse outcomes. RECENT FINDINGS: Consuming less than 75% of daily calorie requirements in the hospital setting is associated with worse outcomes. Unfortunately, oral intake is often inadequate. Little is known about the consequences of inadequate oral intake in the ICU; however, data have described worse outcomes with large calorie deficits from enteral and parenteral nutrition. Whether or not these data can be extrapolated to patients in the ICU with poor oral intake remains uncertain. SUMMARY: Despite evidence-based guidelines directing the delivery of nutrition support in the ICU, there is limited research focused on oral intake during this time of hospitalization. Future research is needed to determine the long-term associations of inadequate versus adequate oral intake in the ICU.

Adequacy of oral intake in critically ill patients 1 week after extubation.

Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to intensive care units (ICUs). The purpose of this observational study (August to November 2007) was to examine the adequacy of oral intake and to identify predictors of oral intake after ICU patients were removed from invasive mechanical ventilation. Patients aged > or = 18 years who required mechanical ventilation for at least 24 hours, advanced to an oral diet postextubation, and did not require supplemental enteral or parenteral nutrition were included. The first 7 days of oral intake after extubation were assessed via modified multiple-pass 24-hour recall and the numbers of days on therapeutic diets and reasons for decreased intake were collected. Oral intake <75% of daily requirements was considered inadequate. Descriptive statistics, chi2, Student t tests, and logistic regression analyses were conducted. Of the 64 patients who met eligibility criteria, 50 were included. Of these 50 patients, 54% were women and intubated for 5.2 days, with a mean age of 59.1 years, body mass index of 28.7, and Acute Physiology and Chronic Health Evaluation II score of 21.9. Subjective Global Assessment determined 44% were malnourished upon admission to the ICU. The average daily energy and protein intake failed to exceed 50% of daily requirements on all 7 days for the entire population. The majority of patients who consumed <75% of daily requirements were prescribed a therapeutic diet and/or identified "no appetite" and nausea/vomiting as the barriers to eating. Although more research is needed, these data call into question the use of restrictive oral diets and suggest that alternative medical nutrition therapies are needed to optimize nutrient intake in this unique patient population.

Degree of weight loss required to improve adipokine concentrations and decrease fat cell size in severely obese women.

Adipose tissue physiology plays an important role in mediating disease risk. Weight loss in obese individuals improves indicators of adipocyte physiology. However, the minimum degree of weight loss required to elicit improvements remains unknown. The objective of the present study was to determine the minimum weight loss required to improve adipokine profile and decrease fat cell size in severely obese women. Thirteen severely obese women (body mass index, 50 +/- 3 kg/m(2); age, 35 +/- 1 years) consumed a low-calorie diet for 3 weeks with the goal of losing 5% of their initial weight. Subjects were divided into 2 weight loss groups posttreatment: less than 5% weight loss and 5% to 10% weight loss. Body weight was reduced (P < .05) in both groups (-1.4 +/- 1.0 and -6.8 +/- 0.6 kg, respectively). Adiponectin concentrations increased (P < .05) by 20% in the 5% to 10% weight loss group only. Likewise, leptin and resistin decreased (P < .05) by 37% and 27%, respectively, in the group that lost more weight. Visceral and subcutaneous fat cell size was 41% and 37% smaller (P < .01), respectively, in the 5% to 10% weight loss group. Smaller visceral adipocyte size was related to lower insulin (r = 0.82, P = .01) and glucose (r = 0.58, P = .04) concentrations posttreatment. These findings suggest that a minimum weight loss of 5% is required to improve adipokine profile and decrease fat cell size in severely obese women. These changes in adipocyte physiology may be linked to reductions in metabolic disease risk in this population.

Environmental barriers to and availability of healthy foods for people with mobility disabilities living in urban and suburban neighborhoods.

OBJECTIVE: To assess the impact of the built environment on access to healthy foods for people with mobility disabilities by measuring wheelchair accessibility of grocery stores and availability of healthy affordable foods. DESIGN: A survey consisting of 87 questions. SETTING: A low-income, multiracial urban Chicago neighborhood with a 3-mile radius was compared with a suburban neighborhood of the same size in which the population is similar in income level and racial distribution. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accessibility issues outside and within grocery stores and the availability of healthy affordable food items in these grocery stores. RESULTS: The urban area had more stores (n=48) than the suburban area (n=34); however, only 46% of urban stores had an entrance that would allow an individual requiring a ramp or level entrance to gain access compared with 88% of suburban stores (P<.001). Wheelchair accessibility characteristics of grocery and convenience stores did not differ between the urban and suburban areas. The availability of healthy affordable foods in urban and suburban stores was relatively low, with only 33% to 40% of the 18 items available, and did not differ between urban and suburban stores. CONCLUSIONS: People with mobility impairments are at a disadvantage in maintaining healthy food choices because of limited access to stores and healthy foods.

Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men.

OBJECTIVES: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). DESIGN: A cross-sectional study. SETTING: Urban university. PARTICIPANTS: Men with SCI (N=131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. RESULTS: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR]=.19; 95% confidence interval [CI], .04-.80), metabolic syndrome (OR=.15; 95% CI, .03-.66) and high CRP (OR=.17; 95% CI, .04-.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR=.14; 95% CI, .04-.49) than their counterparts. CONCLUSIONS: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome, and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.

Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury.

OBJECTIVES: To determine if people with spinal cord injury (SCI) have elevated C-reactive protein (CRP), to examine the association of CRP with high-density lipoprotein cholesterol (HDL-C), and to assess the influence of completeness and level of injury on these parameters. DESIGN: Cross-sectional. SETTING: Urban university. PARTICIPANTS: Men with SCI (n=129) who were free of infection and/or recent anti-inflammatory medication use as well as their 1:1 age- and race-matched able-bodied counterparts from the 1999-2002 National Health and Nutrition Examination Surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: High CRP was defined as 3 mg/L or higher and low HDL-C as less than 1.04 mmol/L. RESULTS: Men with SCI were more likely to have high CRP (odds ratio [OR]=2.29; 95% confidence interval [CI], 1.33-3.95) and low HDL-C (OR=1.81; 95% CI, 1.01-3.27). The OR for low HDL-C in SCI was no longer significant when high CRP was controlled. CRP was higher in complete versus incomplete injury (median, 3.7 mg/L vs 1.2mg/L; P=.005), and this elevation was independent of age, smoking, physical activity, waist circumference, and weight. No conclusion can be made on the association of injury level and CRP because of a lack of power. CONCLUSIONS: The elevated CRP, possibly the major risk factor, together with decreased HDL-C may contribute to greater incidence for cardiovascular disease in the SCI population.

Determinants of physical activity in low-income, overweight African American girls.

OBJECTIVES: To examine the relationship between puberty, sedentary behaviors, and psychosocial influences with intention for physical activity (PA) and PA. METHODS: Low-income, overweight African American girls (n=72) completed 5 questionnaires that assessed PA, sedentary behaviors, and psychosocial influences. Puberty was assessed using Tanner stages. Multiple linear regression was used to examine the relationships between these measures and intention for PA. RESULTS: Puberty was significantly associated with lower intention for PA, whereas health beliefs such as "staying in shape" and social support were significantly associated with greater intention for PA. CONCLUSIONS: Puberty, health beliefs for PA, and social support from parents and peers were significant predictors of intention for PA in low-income, overweight African American girls.

Nutritional content of television food advertisements seen by children and adolescents in the United States.

OBJECTIVE: In light of the high rates of child and adolescent obesity, we examined the nutritional content of food advertising seen by American children and adolescents. METHODS: We drew samples of top-rated television shows by using ratings data to examine the nutritional content for fat, saturated fat, sugar, sodium, and fiber of food-product advertisements seen on television by both children and adolescents. Food products were examined in aggregate and by 5 separate categories that included cereal, sweets, snacks, drinks, and other food products. For 2- to 11-year-olds and 12- to 17-year-olds, respectively, a sample of 50,351 and 47,955 30-second-equivalent food-product advertisements and their related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content of food advertising seen by children and adolescents. RESULTS: Study results showed that 97.8% and 89.4% of food-product advertisements viewed by children 2 to 11 years old and adolescents 12 to 17 years old, respectively, were high in fat, sugar, or sodium. On average, 46.1% and 49.1% of total calories among the products advertised came from sugar in the advertisements seen by these respective age groups. A total of 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. No substantial differences were found in the nutritional content of advertisements seen by black and white children 2 to 11 years old. However, a slightly higher proportion of food advertisements in general and across all food-product categories seen by black versus white adolescents were for high-sugar products. CONCLUSION: The overwhelming majority of food-product advertisements seen on television by American children and adolescents are of poor nutritional content.

Different risk factor patterns for metabolic syndrome in men with spinal cord injury compared with able-bodied men despite similar prevalence rates.

OBJECTIVE: To determine if the prevalence of metabolic syndrome and risk factors differs between age- and race-matched men with spinal cord injury (SCI) and able-bodied men. DESIGN: Cross-sectional. SETTING: Urban university. PARTICIPANTS: Men with SCI (n=185), ages 20 to 59 years, were matched 1 to 1 with able-bodied men from the 1999-2002 National Health and Nutrition Examination Surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Waist circumference, blood pressure, glucose, triglyceride (TG), total (TC), and low- (LDL) and high-density lipoprotein (HDL) cholesterol. RESULTS: Despite similar prevalence for metabolic syndrome, different risk factor patterns were found between groups. Men with SCI had a significantly lower mean HDL, TG, and glucose in addition to lower TC and LDL. After adjusting for smoking, education, and household income by using conditional logistic regression, men with SCI had a higher risk for abdominal obesity (odd ratio [OR]=1.78; 95% confidence interval [CI], 1.07-2.96) and reduced HDL (OR=1.76; 95% CI, 1.06-2.94) but lower risks for elevated glucose (OR=0.55; 95% CI, 0.33-0.94) than their able-bodied counterparts. By using linear regression and controlling for waist circumference, men with SCI had lower TC, LDL, TG, and glucose concentrations but lower HDL. Racial differences in risks were found in both SCI and able-bodied men; however, among the SCI men, prevalence for low HDL and elevated glucose was similar between whites and African Americans. CONCLUSIONS: Men with SCI do not appear to have an increased prevalence of metabolic syndrome compared with able-bodied counterparts, suggesting that other nontraditional risks may contribute to their increased mortality from cardiovascular disease and diabetes.

Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials.

BACKGROUND: Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. OBJECTIVE: The objective was to assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available RCTs. DESIGN: We conducted a systematic review. RCTs comparing EN or VNS with untreated controls, or comparing EN with PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least three RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B, respectively, indicated the presence of strong or weak (low-quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. PATIENTS AND SETTINGS: RCTs could include either hospitalized or nonhospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. INTERVENTIONS: The RCT had to compare recipients of either EN or VNS with controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. OUTCOME MEASURES: These were mortality, morbidity (disease specific), duration of hospitalization, cost, or interventional complications. SUMMARY OF GRADING: A: No indication was identified. B: EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low-quality trials found a significant difference in survival favoring the VNS recipients in the malnourished geriatric patient trials; two high-quality trials found nonsignificant differences that favored VNS as well.) C: EN or VNS in liver transplantation, cystic fibrosis, renal failure, pediatric conditions other than low birth weight infants, well-nourished geriatric patients, nonstroke neurologic conditions, AIDS; EN in acute pancreatitis, chronic obstructive pulmonary disease, nonmalnourished geriatric patients; VNS in inflammatory bowel disease, arthritis, cardiac disease, pregnancy, allergic patients, preoperative bowel preparation. D: EN or VNS in patients receiving nonsurgical cancer treatment or in patients with hip fractures; EN in patients with inflammatory bowel disease; VNS in patients with chronic obstructive pulmonary disease. E: EN in the first week in dysphagic, or VNS at any time in nondysphagic, stroke patients who are not malnourished; dysphagia persisting for weeks will presumably ultimately require EN. CONCLUSIONS: There is strong evidence for not using EN in the first week in dysphagic, and not using VNS at all in nondysphagic, stroke patients who are not malnourished. There is reasonable evidence for using VNS in malnourished geriatric patients. The recommendations to consider EN/VNS in perioperative/liver/critically ill/low birth weight patients are limited by the low quality of the RCTs. No evidence could be identified to justify the use of EN/VNS in other disease states.