Penn Healthy Diet survey: pilot validation and scoring.

Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017-2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.

Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey.

BACKGROUND: There is a need for a feasible, user-friendly tool that can be employed to assess the overall quality of the diet in U.S. CLINICAL SETTINGS: Our objectives were to develop the Penn Healthy Diet (PHD) screener, evaluate screener item correlations with Healthy Eating Index (HEI)-2015 components, and develop a simple scoring algorithm. METHODS: National Health and Nutrition Examination Survey (NHANES) 2017-18 dietary recall data in adults were used to define food examples in screener food groups based on components of the HEI-2015, Diet Approach to Stop Hypertension, and Alternative Mediterranean diet approaches. Instrument Content Validity Index (I-CVI) was used to evaluate the clarity and relevance of the screener. Patient acceptability was evaluated by completion time and response rates. NHANES 2017-18 food recall data were used to simulate responses to the screener items, which were evaluated for association with HEI-2015 components. A scoring algorithm was developed based on screener items moderately or strongly associated with HEI-2015 components. Reproducibility was tested using NHANES 2015-16 data. RESULTS: The screener had strong clarity (I-CVI = 0.971) and relevance for nutrition counseling (I-CVI = 0.971). Median (IQR) completion time was 4 (3-5) minutes on paper and 4 (4-8) minutes online, and 73% of patients invited online completed the survey. Based on simulated NHANES participant screener responses, 15 of the 29 screener items were moderately or strongly associated with HEI-2015 components, forming the basis of the scoring algorithm with a range of 0-63 points, where higher score indicates a healthier diet. The median (IQR) screener and HEI-2015 scores were 14.96 (11.99-18.36) and 48.96 (39.51-59.48), respectively. The simulated PHD score was highly correlated with the HEI-2015 score (Spearman rho 0.75) in NHANES 2017-18 and confirmed in NHANES 2015-16 data (Spearman rho 0.75). CONCLUSIONS: The Penn Healthy Diet screener may be a useful tool for assessing diet quality due to its acceptable content validity, ease of administration, and ability to distinguish between servings of key food groups associated with a healthy versus unhealthy diet according to the HEI-2015. Additional research is needed to further establish the instrument's validity, and to refine a scoring algorithm.

Increased Protein with Decreased Carbohydrate Intake Reduces Postprandial Blood Glucose Levels in Women with Gestational Diabetes: The iPRO Study.

Introduction: There is an urgent need to establish an evidence base for recommendations regarding proportions of macronutrients for optimized nutritional management of gestational diabetes mellitus (GDM). Our study compared isocaloric diets in women with GDM that differed in protein and carbohydrate content with fats held constant. We hypothesized that the glucose area under the curve (AUC) would be lower with the higher protein/lower carbohydrate diet. Research Design and Methods: This study used a random order crossover design within a controlled research unit environment. Nineteen women were randomized to treatment, with 12 participants completing both arms of the study. Blood sampling occurred preprandially and at t = 30, 60, 120, and 180" relative to meals. Inclusion criteria were confirmed diet-controlled GDMA1, singleton gestation, and with no pre-existing medical comorbidities. Mean gestational age at entrance to study = 32 (±1.76) weeks. Mean prepregnant body mass index of participants = 28.7 (±5.3) kg/m2 Participants were randomly assigned initially to either an increased protein/low carbohydrate (iPRO30%/CHO35%) diet or a lower protein/higher carbohydrate (LPRO15%/CHO50%) diet for a 36 hour inpatient stay on the research unit. All meals and snacks were prepared in a metabolic kitchen. After a 3-7 day washout period, participants were randomized to the opposite treatment. Results: On day 2 (with confirmed overnight fasting), the average 3-hour pre- through postprandial glucose AUC was lower in iPRO30%/CHO35% treatment arm (17395.20 ± 2493.47 vs. 19172.47 ± 3484.31, p = 0.01). Conclusion: This study is the first to demonstrate that a higher protein, lower carbohydrate meal, especially at breakfast, can result in lower postprandial blood glucose values in women with gestational diabetes. A lack of statistically significant differences at other collection time points could have been due to several factors, but most likely due to small sample size. Longer term outcomes of a higher protein diet, including maternal glycemic control, nitrogen balance, and impact on fetal growth outcomes, are needed.

A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease.

BACKGROUND & AIMS: This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean diet (MD) as treatment for Crohn's disease (CD) with mild to moderate symptoms. METHODS: Adult patients with CD and with mild-to-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6 weeks, participants received prepared meals and snacks according to their assigned diet. After 6 weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at week 6 included fecal calprotectin (FC) response (FC <250 µg/g and reduction by >50% among those with baseline FC >250 µg/g) and C-reactive protein (CRP) response (high-sensitivity CRP <5 mg/L and >50% reduction from baseline among those with high-sensitivity CRP >5 mg/L). RESULTS: The study randomized 194 patients, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with the SCD (SCD, 46.5%; MD, 43.5%; P = .77). FC response was achieved in 8 of 23 participants (34.8%) with the SCD and in 4 of 13 participants (30.8%) with the MD (P = .83). CRP response was achieved in 2 of 37 participants (5.4%) with the SCD and in 1 of 28 participants (3.6%) with the MD (P = .68). CONCLUSIONS: The SCD was not superior to the MD to achieve symptomatic remission, FC response, and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD and other health benefits associated with the MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms. ClinicalTrials.gov Identifier: NCT03058679.

Serum micronutrient status, sleep quality and neurobehavioural function among early adolescents.

OBJECTIVE: To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents. DESIGN: In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations. SETTING: Jintan, China. PARTICIPANTS: In total, 226 adolescents (106 females) from the Jintan Child Cohort study. RESULTS: Adolescents with low Fe (<75 µg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 µg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: ß = -1353·71, P = 0·002, Zn: ß = -2262·01, P = 0·02) but less-accurate (Fe: ß = -0·97, P = 0·04; Zn: ß = -1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (ß = 276·94, P = 0·04), and low Zn was associated with fast (ß = -1781·83, P = 0·03), but error-prone performance (ß = -1·79, P = 0·04) on spatial processing ability and slower reaction speed (ß = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 µg/dl for low serum Zn, except for the association with attention task speed (P > 0·05). CONCLUSION: Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.

Maternal gut microbiota reflecting poor diet quality is associated with spontaneous preterm birth in a prospective cohort study.

BACKGROUND: A processed diet, high in fat and low in fiber, is associated with differences in the gut microbiota and adverse health outcomes in humans; however, little is known about the diet-microbiota relation and its impact on pregnancy. Spontaneous preterm birth (SPTB), a pregnancy outcome with serious short- and long-term consequences, occurs more frequently in black and in obese women in the United States. OBJECTIVES: In a prospective, case-control sample matched for race and obesity (cases = 16, controls = 32), we compared the fecal gut microbiota, fecal and plasma metabolites, and diet in the late second trimester. We hypothesized that a Western diet would be associated with reduced microbiota richness and a metabolic signature predicting incidence of SPTB. METHODS: The fecal microbiota was characterized by 16S-tagged sequencing and untargeted metabolomics was used to analyze both plasma and fecal metabolites. Wilcoxon's rank-sum test was used for the comparison of microbiota genera, α-diversity, fecal and plasma metabolites, and dietary variables between term and SPTB. ß-Diversity was analyzed using permutational multivariate ANOVA, and metabolite associations were assessed by module analysis. RESULTS: A decrease in α-diversity was strongly associated with the development of SPTB, especially in the taxonomic class of Betaproteobacteria. Of 824 fecal metabolites, 22 metabolites (mostly lipids) differed between cases and controls (P < 0.01), with greater DHA (22:6n-3) and EPA (20:5n-3) in cases [false discovery rate (FDR) < 0.2]. The most significant fecal metabolite module (FDR-adjusted P = 0.008) was dominated by DHA and EPA. Dietary saturated fat (primarily palmitate) intake was greater in cases (31.38 ± 7.37 compared with 26.08 ± 8.62 g, P = 0.045) and was positively correlated with fecal DHA and EPA (P < 0.05). CONCLUSIONS: Reduced α-diversity of the gut microbiota and higher excretion of omega-3 (n-3) fatty acids in stool may provide a novel biomarker signature predicting SPTB in women with a low-fiber, high-fat diet. Further investigation of these markers in a larger sample is needed for validation.

[ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients with Enterocutaneous Fistula]. / Guías Clínicas ASPEN-FELANPE: Terapia Nutricional en Pacientes Adultos con Fístulas Enterocutáneas.

INTRODUCTION: Background: the management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to surgeons, gastroenterologists, intensivists, wound/stoma care specialists, and nutrition support clinicians. Available guidelines for optimizing nutritional status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual or institutional experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing nutrients, and use of somatostatin analogs in the management of patients with ECF remain a challenge for the clinician. The purpose of this clinical guideline is to develop recommendations for the nutritional care of adult patients with ECF. Methods: a systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. An anonymous consensus process was used to develop the clinical guideline recommendations prior to peer review and approval by the A.S.P.E.N. and FELANPE Board of Directors. Questions: in adult patients with enterocutaneous fistula: 1) What factors best describe nutritional status? 2) What is the preferred route of nutritional therapy (oral diet, EN or PN)? 3) What protein and energy intake provide best clinical outcomes? 4) Is fistuloclysis associated with better outcomes than standard care? 5) Are immune-enhancing nutrients associated with better outcomes? 6) Does the use of somatostatin provide better outcomes than standard medical therapy? 7) When is home parenteral nutrition support indicated?

INTRODUCCIÓN: Introducción: el manejo de las fístulas enterocutáneas (FEC) es un reto que requiere enfoque interdisciplinario y plantea un desafío importante. Las guías para optimizar el estado nutricional en estos pacientes están basadas en estudios que dependen de la experiencia individual y, ocasionalmente, institucional; que se focalizan en el tratamiento integral de las FEC, centrándose en el manejo médico y quirúrgico, mientras que la terapia nutricional se revisa solo superficialmente. Los requerimientos nutricionales, vía de administración, uso de inmunonutrición y de análogos de la somatostatina en el tratamiento de estos pacientes no están bien definidos. El objetivo de esta guía es desarrollar recomendaciones específicas para la terapia nutricional de los pacientes adultos con FEC. Método: revisión sistemática de la mejor evidencia disponible para responder a una serie de preguntas sobre la terapia nutricional de los adultos con FEC, evaluada utilizando la metodología GRADE. Se utilizó un proceso de consenso anónimo para desarrollar las recomendaciones de la guía clínica antes de la revisión por pares y la aprobación por las Juntas Directivas de ASPEN y FELANPE. Preguntas: 1) ¿Qué factores describen mejor el estado nutricional de los adultos con FEC? 2) ¿Cuál es la mejor vía para administrar la terapia nutricional (oral, nutrición enteral o parenteral)? 3) ¿Qué aporte energético y proteico proporciona mejores resultados clínicos? 4) ¿El uso de la fistuloclisis se asocia a mejores resultados? 5) ¿Las fórmulas inmunomoduladoras se asocian a mejores resultados? 6) ¿El uso de la somatostatina proporciona mejores resultados? 7) ¿Cuándo está indicada la terapia nutricional parenteral domiciliaria?

Guías Clínicas ASPEN-FELANPE: Terapia Nutricional en Pacientes Adultos con Fístulas Enterocutáneas / ASPEN-FELANPE Clinical Guidelines: Nutrition Support of Adult Patients with Enterocutaneous Fistula

INTRODUCCIÓN: el manejo de las fístulas enterocutáneas (FEC) es un reto que requiere un enfoque interdisciplinario y plantea un desafío importante. Las guías para optimizar el estado nutricional en estos pacientes están basadas en estudios que dependen de la experiencia individual y, ocasionalmente, institucional; que se focalizan en el tratamiento integral de las FEC, centrándose en el manejo médico y quirúrgico, mientras que la terapia nutricional se revisa solo superficialmente. Los requerimientos nutricionales, la vía de administración, el uso de inmunonutrición y el de análogos de la somatostatina en el tratamiento de estos pacientes no están bien definidos. El objetivo de esta guía clínica es desarrollar recomendaciones específicas para la terapia nutricional de los pacientes adultos con FEC. MÉTODO: revisión sistemática de la mejor evidencia disponible para responder a una serie de preguntas sobre la terapia nutricional de los adultos con FEC, evaluada utilizando la metodología GRADE. Se utilizó un proceso de consenso anónimo para desarrollar las recomendaciones de la guía clínica antes de la revisión por pares y la aprobación por las Juntas Directivas de ASPEN y FELANPE. Preguntas: 1) ¿Qué factores describen mejor el estado nutricional de los adultos con FEC? 2) ¿Cuál es la mejor vía para administrar la terapia nutricional (oral, nutrición enteral o parenteral)? 3) ¿Qué aporte energético y proteico proporciona mejores resultados clínicos? 4) ¿El uso de la fistuloclisis se asocia a mejores resultados? 5) ¿Las fórmulas inmunomoduladoras se asocian a mejores resultados? 6) ¿El uso de la somatostatina proporciona mejores resultados? 7) ¿Cuándo está indicada la terapia nutricional parenteral domiciliaria?

BACKGROUND: the management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to surgeons, gastroenterologists, intensivists, wound/stoma care specialists, and nutrition support clinicians. Available guidelines for optimizing nutritional status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual or institutional experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing nutrients, and use of somatostatin analogs in the management of patients with ECF remain a challenge for the clinician. The purpose of this clinical guideline is to develop recommendations for the nutritional care of adult patients with ECF. METHODS: a systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. An anonymous consensus process was used to develop the clinical guideline recommendations prior to peer review and approval by the A.S.P.E.N. and FELANPE Board of Directors. Questions: in adult patients with enterocutaneous fistula: 1) What factors best describe nutritional status? 2) What is the preferred route of nutritional therapy (oral diet, EN or PN)? 3) What protein and energy intake provide best clinical outcomes? 4) Is fistuloclysis associated with better outcomes than standard care? 5) Are immune-enhancing nutrients associated with better outcomes? 6) Does the use of somatostatin provide better outcomes than standard medical therapy? 7) When is home parenteral nutrition support indicated?

Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure.

BACKGROUND AND AIM: No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS: At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS: Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS: The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

Evaluation of Lean Body Weight Equation by Dual-Energy X-Ray Absorptiometry Measures.

BACKGROUND: When managing patients with disorders that require clinical intervention, a practical assessment of body habitus is valued. The Duffull-Green lean body weight (LBW) equation was derived and validated in adults across a wide body mass index (BMI) range. Whether this predictive equation will perform well in patients at BMI extremes or perform better than a widely used empiric "ideal" body weight (IBW) equation is unknown. MATERIALS AND METHODS: Calculated LBW and calculated IBW were each compared with the dual-energy x-ray absorptiometry (DXA)-derived lean body mass (LBM) by simple linear regression. A mixed model was used to determine how well the LBW equation performed over time in patients with more than 1 DXA measurement. RESULTS: At time 0, 32 patients were 18-67 years old, and all were obese (BMI: 36-65 kg/m2), while the remaining 7 had parenteral nutrition-dependent intestinal failure (BMI: 17-25 kg/m2). A subset of patients underwent bariatric surgery after time 0 (BMI at follow-up: 22-49 kg/m2). The LBW equation was a predictor of LBM ( R2 = 0.67, P < .0001), while the IBW equation was not ( R2 = 0.04, P = .25). The LBW equation remained a predictor of LBM over time ( P < .0001) without significant interaction by number of months since time 0. CONCLUSION: The Duffull-Green LBW equation successfully predicted lean body mass in a patient population with a wide range of BMIs at both a single point in time and after considerable weight loss. In the clinical setting, an equation that performs well in various disease states and body sizes is advantageous.

ASPEN-FELANPE Clinical Guidelines.

BACKGROUND: The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined. The purpose of this clinical guideline is to develop recommendations for the nutrition care of adult patients with ECF. METHODS: A systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. An anonymous consensus process was used to develop the clinical guideline recommendations prior to peer review and approval by the ASPEN Board of Directors and by FELANPE. QUESTIONS: In adult patients with enterocutaneous fistula: (1) What factors best describe nutrition status? (2) What is the preferred route of nutrition therapy (oral diet, enteral nutrition, or parenteral nutrition)? (3) What protein and energy intake provide best clinical outcomes? (4) Is fistuloclysis associated with better outcomes than standard care? (5) Are immune-enhancing formulas associated with better outcomes than standard formulas? (6) Does the use of somatostatin or somatostatin analogue provide better outcomes than standard medical therapy? (7) When is home parenteral nutrition support indicated?

25-Hydroxyvitamin D and glycemic control: A cross-sectional study of children and adolescents with type 1 diabetes.

AIM: The objective of this study was to describe the vitamin D status of children and adolescents with type 1 diabetes and to evaluate whether levels of 25-hydroxyvitamin D are significantly associated with HbA1c in this population. METHODS: 197 children and adolescents from a diabetes center in a children's hospital were recruited during regular follow up visit. Non-fasting blood samples were collected to measure 25-hydroxyvitamin D and blood glucose levels. HbA1c and other key variables were abstracted from patients' medical records. RESULTS: Of the 197 children and adolescents, more than half were adolescents, males, and Caucasian. 23% were overweight, while 13% were obese. Mean HbA1c was 8.6±1.4% (70±15.3mmol/mol). 40.6% of patients had 25-hydroxyvitamin D levels ≤50nmol/L; 49.2% had 25-hydroxyvitamin D levels between 51 and 75nmol/L and 10.2% had 25-hydroxyvitamin D levels >75nmol/L. The bivariate relationship between 25-hydroxyvitamin D and HbA1c almost reached statistical significance (P=0.057), while no significance was established in the multivariate model. CONCLUSIONS: To the best of our knowledge this is the first study that has been adequately-powered to examine the association between 25-hydroxyvitamin D and HbA1c in children and adolescents with T1DM. This study demonstrated the high prevalence of patients with low levels of 25-hydroxyvitamin D specifically in healthy weight and Caucasian children and adolescents with T1DM. These data suggest the need for monitoring of 25-hydroxyvitamin D in all youth with T1DM.

Maternal concern about child weight in a study of weight-discordant siblings.

OBJECTIVE: This study examined concern about child weight in mothers of weight-discordant siblings and determined the accuracy of maternal self-report versus measured child height, weight, and corresponding body mass index (BMI; kg/m(2) ) z-score. DESIGN AND SAMPLE: Discordant sibling design. Forty-seven mothers of 5- to 12-year-old, weight-discordant siblings. MEASURES: Mothers self-reported their concern about child weight for each child separately and for a subset of children, self-reported their heights and weights. Siblings' height, weight, waist circumference, and adiposity were measured. RESULTS: The majority (83%) of mothers expressed concern about their overweight/obese child's weight and 20% of mothers expressed concern about their normal-weight child's weight (p < .001). Difference scores in maternal concern about child weight were positively associated with difference scores in sibling BMI z-score (r = 0.42; p = .01) and percent body fat (r = 0.56; p < .001). For overweight/obese children only, maternal-reported child heights and weights were significantly lower compared to the measured values (p < .03). CONCLUSIONS: One fifth of mothers of weight-discordant siblings were unconcerned about their overweight/obese child's weight and for overweight/obese children only, mothers tended to underreport children's height and weight. Mothers' concern for their overweight/obese child's weight was greater for sibling pairs who were more discordant in their weight.

Feasibility of accessing data in hospitalized patients to support diagnosis of malnutrition by the Academy-A.S.P.E.N. malnutrition consensus recommended clinical characteristics.

BACKGROUND: The feasibility of accessing data in hospitalized patients to support a malnutrition diagnosis using the new Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-A.S.P.E.N.) consensus recommended clinical characteristics of malnutrition is largely unknown. We sought to characterize baseline practice to guide the development of appropriate interventions for implementation of the recommended approach. MATERIALS AND METHODS: A cross-sectional survey was conducted of 262 consecutive adults who were referred for dietitian or nutrition support team assessments at 2 tertiary teaching hospitals in Pennsylvania. The availability of data to support the proposed AND-A.S.P.E.N. approach and the resulting malnutrition diagnoses were examined. RESULTS: Mean ± SD age was 58.2 ± 17.1 years, and half were female. Food intake history was available for 76%, weight history for 67%, and physical examination for loss of fat and muscle mass for 94% and for edema for 84%. Hand-grip strength was not available. The prevalence of malnutrition among the patients referred for nutrition assessment was 6.7% moderate, 7.6% severe with acute illness; 12.2% moderate, 11% severe with chronic illness; and 0.8% moderate, 0.4% severe with social circumstances. Decline in typical food intake and weight loss were the most commonly used clinical characteristics. CONCLUSION: Data could generally be accessed to support the AND-A.S.P.E.N. consensus clinical characteristics for malnutrition diagnosis, but further testing in multiple care settings is needed before these observations may be generalized. Training in assessment methods and dissemination of the necessary tools will be necessary for full implementation.

Serum 25(OH) vitamin D concentration changes after Roux-en-Y gastric bypass surgery.

OBJECTIVE: To describe serum 25(OH)D changes after Roux-en-Y gastric bypass (RYGB) and to determine if fat mass (FM) loss and vitamin D intake are associated with changes in serum levels. DESIGN AND METHODS: The relationship between serum 25(OH)D and 1) FM, 2) weight, 3) % excess weight loss (EWL), and 4) BMI was investigated after controlling for potential confounders using a mixed effects linear model in 20 women before and up to 1-year post-RYGB. Subcutaneous (SAT) and visceral adipose tissue (VAT) vitamin D concentrations at time of RYGB were also evaluated. RESULTS: Weight and FM decreased 1-year after surgery by 45 ± 1 kg and 37 ± 1 kg, respectively while 25(OH)D increased by 10 ± 2 ng mL(-1) . Weight, FM, BMI, and %EWL changes were associated with 25(OH)D change. VAT had an average 21% more vitamin D per gram than SAT and concentrations were highly correlated. CONCLUSIONS: Although weight loss may lead to increased serum 25(OH)D after RYGB, low levels remain a concern in some patients 1-year postsurgery. Additional research is needed to clarify the relationship between adipose storage of vitamin D and serum 25(OH)D in obesity, and how that relationship might change after surgery. This could lead to improved clinical management of vitamin D in this ever-growing clinical population.

Resting energy expenditure at 3 months of age following neonatal surgery for congenital heart disease.

OBJECTIVE: Infants with Congenital Heart Disease (CHD) often exhibit growth failure. This can affect anthropometric and neurodevelopmental outcomes well into childhood. To determine the resting energy expenditure (REE), body composition, and growth in infants with CHD at 3 months of age, with the secondary aim to identify predictors of REE as compared with healthy infants. DESIGN AND METHODS: This descriptive study is a subanalysis of a prospective study investigating predictors of growth in postoperative infants with CHD compared with healthy infants. Growth measurements, REE, and body composition were obtained in all infants. Analysis included chi-square for association between categorical variables, t-tests, ANOVA and ANCOVA. Outcome measures included the REE as determined by indirect calorimetry, anthropometric z-scores and body composition at 3 months of age. SETTING: Participants were recruited from the Cardiac Intensive Care Unit of a large, urban, pediatric cardiac center and pediatric primary care practices. RESULTS: The analysis included 93 infants, 44 (47%) with CHD. Of the infants with CHD, 39% had single ventricle (SV) physiology. There was no difference in REE related to cardiac physiology between infants with CHD and healthy infants or between infants with SV and biventricular (BV) physiology. Anthropometric z-scores for weight (-1.1 ± 1.1, P < 0.001), length (-0.7 ± 1.1, P < 0.05), and head circumference (-0.6 ± 1.2, P < 0.001) were lower in infants with CHD at 3 months of age. The percentage of body fat (%FAT) in postoperative infants with SV (24% ± 6, P = 0.02) and BV (23% ± 5, P < 0.001) physiology were lower than in healthy infants (27% ± 5), with no difference in REE. CONCLUSION: At 3 months of age, there was no difference in REE between postsurgical infants with CHD and healthy infants. Infants with CHD had lower growth z-scores and %FAT. These data demonstrate decreased %FAT contributed to growth failure in the infants with CHD.

Children's food store, restaurant, and home food environments and their relationship with body mass index: a pilot study.

This pilot research assessed the feasibility and utility of a study designed to examine the relationship between children's BMI and food store, restaurant, and home food environments. Home visits were conducted with sixth-grade children (N = 12). BMI z-scores were calculated with weight and height measurements. Nutrition Environment Measures Surveys evaluated children's food environments. The study protocol involved a feasible time duration, minimal missing data for primary variables, and participant satisfaction. Potential design problems included the homogeneous store environments and low restaurant exposure of the sample recruited from one school, and the adequacy of a single cross-sectional measure of the home environment.

Children's food choice process in the home environment. A qualitative descriptive study.

This qualitative descriptive study explored children's food choices in the home with particular attention to environmental influences. Semi-structured interviews were conducted with 11- to 14-year-old children (n=47) from one middle school. A data-driven content analysis using selected principles of grounded theory was performed. Children's food choices in the home emerged as a process that involved three interacting components, the child, the parent, and the food, embedded within the context of time. Children's structured activities throughout the day, week, and year provided an overall context for food choices. Parents affected children's food choices through their presence in the home, time pressure and activity prioritization, incorporation of family members' preferences, food preparation effort and skills, and financial and health concerns. Parents created food options through food purchasing and preparation and indirectly affected children's food choices by setting rules, providing information, and modeling behaviors. Children affected parents' decisions by communicating food preferences. For children, important aspects of the food itself included its availability at home and attributes related to taste, preparation, and cost. Children evaluated potential food options based on their hunger level, food preferences, time pressure and activity prioritization, food preparation effort and skills, and expected physical consequences of food.