Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease.

Certain types of foods are common trigger for bowel symptoms such as abdominal discomfort or pain in patients with inflammatory bowel disease (IBD). But indiscriminate food exclusions from their diet can lead extensive nutritional deficiencies. The aim of this study was to investigate nutritional status, food restriction and nutrient intake status in IBD patients. A total 104 patients (food exclusion group: n = 49; food non-exclusion group: n = 55) participated in the survey. The contents were examined by 3 categories: 1) anthropometric and nutritional status; 2) diet beliefs and food restriction; and 3) nutrient intake. The malnutrition rate was significantly higher in the food exclusion group (p = 0.007) compared to food non-exclusion group. Fifty-nine percent of patients in the food exclusion group held dietary beliefs and reported modifying their intake according to their dietary belief. The most common restricted food was milk, dairy products (32.7%), raw fish (24.5%), deep-spicy foods (22.4%), and ramen (18.4%). The mean daily intake of calcium (p = 0.002), vitamin A (p < 0.001), and zinc (p = 0.001) were significantly lower in the food exclusion group. Considering malnutrition in IBD patients, nutrition education by trained dietitians is necessary for the patients to acquire disease-related knowledge and overall balanced nutrition as part of strategies in treating and preventing nutrition deficiencies.

Relationship between Serum 25-hydroxy-vitamin D Concentration and Risk of Metabolic Syndrome in Patients with Fatty Liver.

BACKGROUND: The vitamin D deficiency rate in Koreans is still high and dietary intake is insufficient. The purpose of this study was to provide basic data for the management of metabolic syndrome (MetS) by analyzing the effect of vitamin D levels on the MetS in patients with fatty liver. METHODS: We analyzed the MetS ratio and serum 25-hydroxy-vitamin D (25[OH]D) concentration in 151 adults diagnosed with fatty liver by using obesity index and blood profiles. We collected data on demographic factors, nutrient intake, and lifestyle habits. RESULTS: The mean 25(OH)D concentration of all subjects was 14 ng/mL and the insufficiency and deficiency rates were 40.4% and 29.8%. The proportion of MetS was 38.4% and the mean 25(OH)D level of MetS group was 12.1 ng/mL. Low-density lipoprotein cholesterol, triglyceride, and blood glucose were higher in the MetS group than in the normal group, and the waist circumference of the male was significantly higher than that of the normal group. The results showed that the lower the vitamin D concentration, the higher the risk of MetS (odds ratio, 1.47, 95% confidence interval, 0.98-2.81; P=0.043). CONCLUSIONS: These results suggest that serum 25(OH)D levels may be a risk factor for MetS in patients with fatty liver.

Association between Nutrient Intake and Metabolic Syndrome in Patients with Colorectal Cancer.

The purpose of this study was to investigate the difference of nutritional status according to metabolic syndrome in colorectal cancer patients. The subjects were divided into 2 groups (metabolic syndrome group and normal group) according to the presence or absence of metabolic syndrome in 143 patients diagnosed with colorectal cancer, and their lifestyle and nutritional status were analyzed. Recall method was used for the dietary survey, and metabolic syndrome was defined as the presence of 3 or more of waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein (HDL)-cholesterol, and blood pressure. This study showed that the metabolic syndrome group had a low age, a high body mass index (BMI), and a high drinking rate. The intake of energy, protein, fat, calcium, and phosphorus was significantly higher in the metabolic syndrome group than in the normal group, and the intake of ß-carotene, vitamin C, and folic acid was significantly low. The intake of cholesterol, fatty acid, saturated fatty acid, and polyunsaturated fatty acid was also higher in the metabolic syndrome group. Higher BMI, alcohol consumption, intake of fat, total fatty acid or saturated fatty acid increased the risk of metabolic syndrome, but fiber, vitamin C, or folic acid intake lowered the risk.Weight management and balanced nutritional intake should be emphasized to prevent metabolic syndrome and to improve the condition in patients with colorectal cancer.

Comparison in Adherence to Osteoporosis Guidelines according to Bone Health Status in Korean Adult.

BACKGROUND: Osteoporosis one of the most serious disease to decrease the quality of life and cause economic loss. Thus, prevention of osteoporosis has become an important health concern. The study examined in adherence to osteoporosis guidelines and compared the levels of adherence to osteoporosis guidelines between bone health status in Korean adult. METHODS: This study used data from a nationally represented sample of Koreans (n=3,419) from 2008 to 2011 Korea National Health and Nutrition Examination Survey. We were divided into three groups by T-score: normal, osteopenia and osteoporosis. Assessment of adherence level was based on 5 components of osteoporosis guidelines, considering intake of sodium, calcium and protein, smoking and regular exercise. RESULTS: The sex, body mass index, income and educational level did not significantly differ between three groups. Deficient intake of calcium was significantly associated with a threefold greater odds in osteoporosis group (OR 3.6; 95% confidence interval [CI] 2.52-5.22). Excessive protein intake was significantly increased the risk only in osteoporosis group compared to the normal group (OR 1.71; 95% CI 1.15-2.62). Smoking increased the risk in osteoporosis group compared to the normal group (OR 2.88; 95% CI 1.75-4.76), osteoporosis group compared to the osteopenia group (OR 2.69; 95% CI 1.61-4.55). CONCLUSIONS: Nutritional factor (intake of calcium and protein) and lifestyle-related factor (smoking and exercise) must be accompanied the management for bone health. An adherence of guidelines is considered very important for the prevention of osteoporosis.

Relationship between Serum Inflammatory Marker and Bone Mineral Density in Healthy Adults.

BACKGROUND: Inflammatory markers have been shown to play an important role in bone remodeling. The purpose of this study was to investigate the relationship among serum C-reactive protein (CRP), adiponectin, tumor necrosis factor-alpha (TNF-α) and bone health in healthy adults. METHODS: We measured serum levels of CRP, adiponectin, TNF-α as well as lumbar spine and femoral neck bone mineral density (BMD) in 76 adults. Anthropometric measurements and nutrient intake survey of participants were carried out. The participants were divided into two groups (normal BMD group=40; 52.6%, decreased BMD group=36; 47.4%). RESULTS: The CRP concentration was significantly higher in the decreased BMD group. The adiponectin concentration was lower in the decreased BMD group but the difference was not significant. The TNF-α concentration was higher in the decreased BMD group, the difference was not significant. The participants in the decreased BMD group were found to have lower calcium intakes. The sodium intake of the decreased BMD group was significantly higher. The BMD in the decreased BMD group showed inverse correlations with CRP and dietary sodium intake. CONCLUSIONS: Serum CRP and dietary sodium intake is associated with BMD. Further research is needed to confirm the potential role of inflammatory marker to modulate the effects on bone.

Evaluation of Malnutrition Risk after Liver Transplantation Using the Nutritional Screening Tools.

Malnutrition is a common problem in patients with end-stage liver disease requiring liver transplantation. The aim of this study was to evaluate nutritional status by using nutritional screening tools [Nutritional Risk Screening (NRS) 2002, Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)] in patients before and after liver transplantation. We analyzed medical record, blood test, nutrient intake and malnutrition rate just before transplantation and at discharge, and at 3, 6, 12 months after transplantation respectively. Initially 33 patients enrolled as study subjects and finally 28 patients completed the study. Nutrients intake such as energy, fiber, calcium, potassium, vitamin C, and folate were insufficient at 12 months after transplantation. The rates of malnutrition before transplantation were very high, reported at 81.8% for the NRS 2002, 87.9% for the MUST, and 84.8% for the SGA. By 12 months after operation, malnutrition rates reported at NRS, MUST and SGA had decreased to 6.1%, 10.7%, and 10.7%, respectively. Sensitivity was 87.1% for the NRS 2002, 82.0% for the MUST, and 92.0% for the SGA. Of these screening tools the SGA was the highest sensitive tool that predict the risk of mortality in malnutrition patients who received transplantation. Further studies on nutritional status of patients and proper tools for nutrition intervention are needed to provide adequate nutritional care for patients.

Comparison of Calcium Intake Status by Region and Socioeconomic Status in Korea: The 2011-2013 Korea National Health and Nutrition Examination Survey.

BACKGROUND: Calcium is an essential element nutrient in our body, and insufficient calcium intake is very common in Korean. Socioeconomic status (SES) is known to be associated with quality of diet and health. The purpose of this study was to compare between calcium intake by region and SES. METHODS: This study used data from a nationally represented sample of Koreans (n=19,249) from 2011 to 2013 Korea National Health and Nutrition Examination Survey. We were divided into six regions: Seoul and Gyeonggi-do, Gangwon-do, Chungcheong-do, Jeolla-do, Gyeongsang-do, and Jeju-do. Daily calcium intake and dietary quality based on 24 hr recall data was calculated and analyzed by the sex, age, SES. RESULTS: The regions with the highest calcium intakes in both males and females were Seoul and Gyeonggi-do. The age groups with a significant difference in calcium intake, nutrient adequacy ratio, and nutrient density by region were 14 to 19, 20 to 29, and ≥65 years. Calcium intake and dietary quality were lowest in the low household income group. In terms of being a recipient of the dietary life supply, the calcium intake and dietary quality of the recipient group was low. CONCLUSIONS: We found that daily calcium intake was very different by region and was significantly lower in region with lower SES. The findings of this study suggest social inequalities in calcium intake by region can be addressed in the development and implementation of tailored nutritional interventions to promote calcium nutritional status of Koreans.

Comparison of Quality of Life and Nutritional Status in Gastric Cancer Patients Undergoing Gastrectomies.

The aim of this study was to compare the quality of life (QoL) depending on the postoperative survival period or nutritional status in gastric cancer patients. Surviving gastric cancer patients (n = 222) after the gastrectomy were included in the study at Soonchunhyang University Bucheon Hospital from April 2010 to August 2012. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and a gastric cancer-specific module, the EORTC QLQ-STO22, were used to assess the QoL. The postoperative survival period of the patients fell into two groups; the less-than-1-year group or the more-than-1-year group, and the nutritional status of the patients fell into three groups by a score of patient generated-subjective global assessment (SGA)-A, B, and C. As a result, the rate of malnutrition was 34.5% in the less-than-1-year group and 19.8% in the more-than-1-year group, respectively. Score for the fatigue (p = 0.006), loss of appetite (p = 0.002), reflux (p = 0.027) and body image (p = 0.004) in which the QoL was significantly lower in the less-than-1-year group than in the more-than-1-year group. The score of QoL according to the nutritional status of all subjects, overall health status (p = 0.043), physical functioning (p = 0.016), fatigue (p = 0.006), pain (p = 0.028), loss of appetite (p = 0.017), reflux (p = 0.003), eating restriction (p = 0.002), anxiety (p = 0.010), and body image (p = 0.001) was significantly lower in the SGA-C group than in other SGA groups. These results suggest that the nutritional status of the gastrectomy patients with stomach cancer may impact on their QoL. It is necessary to to develop nutritional intervention to improve QoL in gastric cancer patients with postoperative malnutrition.

Relationship between serum calcium and magnesium concentrations and metabolic syndrome diagnostic components in middle-aged Korean men.

It is thought that calcium and magnesium may be related to metabolic disorders such as obesity and metabolic syndrome; however, to date, there have been few studies investigating the association between serum calcium and magnesium levels and metabolic syndrome in middle-aged male adults. We aimed to investigate the association between serum calcium and magnesium levels and metabolic syndrome in Korean middle-aged male adults. Study subjects included 213 men aged 30∼60 years. MetS risk score is determined by adding the number of risk factors, waist circumference, triacylglyceride (TG), HDL cholesterol, glucose, and blood pressure (BP). The study population was divided into three groups according to the MetS risk score: group I (MetS risk score ≤1; n = 106), group II (MetS risk score = 2; n = 51), and group III (MetS risk score ≥3; n = 56). The serum Ca, according to increase of MetS risk score, was significantly higher (p < 0.001), and there was no significant difference in serum Mg concentration among the three groups. Subjects with high TG and high BP had higher serum calcium levels than those without such abnormalities. Subjects with higher glucose had lower serum magnesium levels than those without such abnormality. The correlation analysis indicated that the serum Ca had positive correlations with the MetS risk score (r = 0.1769, p < 0.01), serum TG (r = 0.2516, p < 0.001), and DBP (r = 0.2246, p < 0.01). The correlation analysis indicated that the serum Mg had an inverse relationship with serum glucose (r = -0.2404, p < 0.001). In conclusion, serum Ca had positive association with TG and BP, while serum Mg had negative association with serum glucose after adjusting age and BMI among the middle-aged Korean male adults.

Low dietary calcium is associated with self-rated depression in middle-aged Korean women.

It is thought that calcium (Ca) and magnesium (Mg) may be related to mental disorders such as depression; however, there have been few studies investigating the association between Ca and Mg nutrition status with depression in middle-aged female adults. Study subjects in this study included 105 women between the ages of 41 and 57 years. The subjects were divided into three groups according to the Zung Self-rating Depression Scale (SDS) score: Group I (SDS score < 33 percentile; n = 32), Group II (33 percentile ≤ SDS score < 67 percentile; n = 37), and Group III (67 percentile ≤ SDS score; n = 36). Anthropometric measurements, dietary intake survey using 3-day dietary records, SDS questionnaire and measurement of serum Ca and Mg were obtained and analyzed. No differences were observed in Ca, plant Ca, and Mg intake among the three groups. However, animal Ca intake by Group III was 141.3 mg, which was significantly lower than 207.6 mg by Group I and 198.3 mg by Group II (P = 0.0345). There were no significant differences in serum levels of Ca, and Mg among the three groups. Correlation analysis indicated that the SDS score had negative correlations with Ca intake (r = -0.2927, P < 0.01) and animal Ca (r = -0.3411, P < 0.001) after adjusting for age, menopause and energy intake. In conclusion, dietary Ca and animal Ca had negative associations with SDS score among middle-aged Korean female adults. Additional analysis of factors related to the association of calcium and magnesium nutritional status and depression is necessary.

Portion sizes of foods frequently consumed by the Korean elderly: Data from KNHANES IV-2.

The purpose of this study was to define a one-portion size of food frequently consumed by the Koreans aged 65 years or over. From the original 8,631 people who took part in the Forth Korea National Health and Nutrition Examination Survey (KNHANES IV-2) 2008, we analyzed the data on 1,458 persons (16.9%) aged 65 and over, and selected food items consumed based on the intake frequency of 30 or more by all participant. A total of 158 varieties of food items were selected. The portion size of food items was set on the basis of the median amount (50 percentile) in a single intake by a single person. In the cereals category, 13 items were selected, of which the most frequently consumed item was well-polished rice with portion size of 75 g. Among legumes, 7 items were selected, of which the most frequent item was dried black soybean with a portion size of 6 g. Among the 16 groups, the most varied food group (49 items) was vegetables, and among these the most frequently occurring item was garlic (5 g), while among the fruit group, only 11 items were selected, as their intake frequency was low. Fish and shellfish were more frequently consumed by the elderly than meats. The most frequently consumed meat was pork loin, with a portion size of 30 g. In fish and shellfish, the most frequently consumed item was dried and boiled large anchovy with a portion size of 2 g. Portion sizes for food items consumed regularly by the elderly may be conveniently and effectively used in dietary planning and in nutritional education programs, and in assessing the diet intake status of the elderly.

Long-term high copper intake: effects on copper absorption, retention, and homeostasis in men.

BACKGROUND: Numerous studies have examined the effect of low and adequate intakes of copper on absorption and retention, but little information is available on the regulation of absorption and retention of copper when intake is high. OBJECTIVE: A study was conducted in men to determine the effect of long-term high copper intake on copper absorption, retention, and homeostasis. DESIGN: Nine men were confined to a metabolic research unit (MRU) for 18 d and were fed a 3-d rotating menu containing an average of 1.6 mg Cu/d. They continued the study under free-living conditions for 129 d, supplementing their usual diets with 7 mg Cu/d. They then returned to the MRU for 18 d and consumed the same diet as during the first period, except that copper intake was 7.8 mg/d. The stable isotope (63)Cu was fed to 3 subjects and infused into the other 6 on day 7 of each MRU period, and complete urine and stool collections were made throughout the study. Total copper and (63)Cu were determined by inductively coupled plasma mass spectrometry. Copper absorption, excretion, and retention were calculated on the basis of dietary, urinary, and fecal copper and (63)Cu. RESULTS: Results were as follows when comparing the high copper intake with the usual intake: fractional copper absorption was significantly lower, but the amount absorbed was significantly higher; excretion of the infused (63)Cu was significantly faster; and total retention was significantly higher. CONCLUSIONS: Homeostatic regulation of copper absorption and retention helped to minimize the amount of copper retained with high copper intake but was not sufficient to prevent retention of >0.6 mg Cu/d.