Nutritional risk assessment at admission can predict subsequent muscle loss in critically ill patients.

Muscle loss in critically ill patients may be related to nutrition. We study the association between modified NUTrition RIsk in the Critically ill (mNUTRIC) score obtained at admission to intensive care unit (ICU) and subsequent muscle loss. We measured rectus femoris cross-sectional area (RFCSA) by ultrasound on days 1, 3, 7, and 10 of ICU admission. We used linear mixed effects model following natural logarithmic transformation of the data. Forty-eight patients (median (IQR) age 66 (55-72.5) years, 71% male, APACHE II score 31 (25-34), BMI 24.2 (21.5-27.1) kg/m2) were analyzed. The high mNUTRIC score (>5) cohort (n = 35) lost significantly more muscle as compared to the low (≤5) group (n = 13); the adjusted ratio (high versus low group) of the geometric mean RFCSA were (0.58, 95% CI 0.46-0.75) for right and (0.61, 95% CI 0.49-0.77) for left, both p < 0.001. mNUTRIC score obtained at admission to ICU can identify patients at risk of subsequent muscle loss.

Glycemic Index of a Novel High-Fiber White Rice Variety Developed in India--A Randomized Control Trial Study.

BACKGROUND: White rice, a common Indian staple, has a high glycemic response and is associated with high risk of type 2 diabetes. The aim of this study was to compare the Glycemic Index (GI) of a newly developed high-fiber white rice (HFWR) with that of commercial white rice (WR). MATERIALS AND METHODS: HFWR was developed using biochemical screening approaches and classical plant breeding techniques. The GI of HFWR was determined using a validated protocol in 30 healthy participants in the year 2013 and repeated in a subsample of 15 participants in the year 2014; the results were compared with the value for WR. The incremental area under the curve was calculated geometrically by applying the trapezoid rule for both reference food (glucose) and the test foods (HFWR and WR). Proximate principles along with dietary fiber, resistant starch, and amylose content were analyzed using standardized methods. RESULTS: The dietary fiber content of HFWR was fivefold higher (8.0 ± 0.1 vs. 1.58 ± 0.17 g%), resistant starch content was 6.5-fold higher (3.9 ± 0.2 vs. 0.6 ± 0.03 g%) (P < 0.001), and amylose content was significantly higher (32.8 ± 1.1 vs. 26.0 ± 0.2 g%) (P < 0.001), compared with WR. HFWR was found to be of medium GI (61.3 ± 2.8), whereas WR was of high GI (79.2 ± 4.8). Overall, HFWR had 23% lower GI compared with WR (P = 0.002). CONCLUSIONS: The new HFWR variety can be considered as a potentially healthier alternative to commercial WR in rice-eating populations, on account of its lower GI and high fiber content.

The adductor pollicis muscle: a poor predictor of clinical outcome in ICU patients.

No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world.

Total antioxidant capacity and starch digestibility of muffins baked with rice, wheat, oat, corn and barley flour.

Muffins are a popular snack consumed in western and emerging countries. Increased glycemic load has been implicated in the aetiology of diabetes. This study examined the starch digestibility of muffins baked with rice, wheat, corn, oat and barley flour. Rapidly digested starch (RDS) was greatest in rice (445 mg/g) and wheat (444 mg/g) muffins, followed by oat (416 mg/g), corn (402 mg/g) and barley (387 mg/g). Total phenolic content was found to be positively correlated with total antioxidative capacity and inversely related to the RDS of muffins. The phenolic content was highest in muffin baked with barley flour (1,687 µg/g), followed by corn (1,454 µg/g), oat (945 µg/g), wheat (705 µg/g), and rice (675 µg/g) flour. Browning was shown not to correlate with free radical scavenging capacity and digestibility of muffins. The presence of high phenolic content and low RDS makes barley muffin an ideal snack to modulate glycemic response.

Effect of brown rice, white rice, and brown rice with legumes on blood glucose and insulin responses in overweight Asian Indians: a randomized controlled trial.

BACKGROUND: Improving the carbohydrate quality of the diet by replacing the common cereal staple white rice (WR) with brown rice (BR) could have beneficial effects on reducing the risk for diabetes and related complications. Hence we aimed to compare the effects of BR, WR, and BR with legumes (BRL) diets on 24-h glycemic and insulinemic responses among overweight Asian Indians. SUBJECTS AND METHODS: Fifteen overweight (body mass index, ≥23 kg/m(2)) Asian Indians without diabetes who were 25-45 years old participated in a randomized crossover study. Test meals (nonisocaloric, ad libitum) were identical except for the type of rice and the addition of legumes (50 g/day) and were provided for 5 consecutive days. Glucose profiles were assessed using the Medtronic MiniMed (Northridge, CA) iPro™2 continuous glucose monitoring device. The mean positive change from baseline glucose concentration was calculated as the daily incremental area under the curve (IAUC) on each test day for 5 days and averaged. Fasting serum insulin was measured prior to and at the end of each test diet. RESULTS: The percentage difference in 5-day average IAUC was 19.8% lower in the BR group than in the WR group (P=0.004). BRL further decreased the glycemic response (22.9% lower compared with WR (P=0.02). The 5-day percentage change in fasting insulin was 57% lower (P=0.0001) for the BR group and 54% lower for the BRL group compared with the 5-day percentage change observed in the WR group. The glycemic and insulinemic responses to the BR and BRL diets were not significantly different. CONCLUSIONS: Consumption of BR in place of WR can help reduce 24-h glucose and fasting insulin responses among overweight Asian Indians.

26th Hohenheim Consensus Conference, September 11, 2010 Scientific substantiation of health claims: evidence-based nutrition.

OBJECTIVE: The objective was to define the term evidence based nutrition on the basis of expert discussions and scientific evidence. METHODS AND PROCEDURES: The method used is the established Hohenheim Consensus Conference. The term "Hohenheim Consensus Conference" defines conferences dealing with nutrition-related topics. The major aim of the conference is to review the state of the art of a given topic with experts from different areas (basic science, clinicians, epidemiologists, etc.). Based on eight to 12 questions, the experts discuss short answers and try to come to a consensus. A scientifically based text is formulated that justifies the consensus answer. To discuss the requirements for the scientific substantiation of claims, the 26th Hohenheim Consensus Conference gathered the views of many academic experts in the field of nutritional research and asked these experts to address the various aspects of a claims substantiation process and the possibilities and limitations of the different approaches. RESULTS: The experts spent a day presenting and discussing their views and arrived at several consensus statements that can serve as guidance for bodies performing claims assessments in the framework of regulatory systems. CONCLUSION: The 26th Hohenheim Consensus Conference addresses some general aspects and describes the current scientific status from the point of view of six case studies to illustrate specific areas of scientific interest: carotenoids and vitamin A in relation to age-related macular degeneration, the quality of carbohydrates (as expressed by the glycemic index) in relation to health and well-being, probiotics in relation to intestinal and immune functions, micronutrient intake and maintenance of normal body functions, and food components with antioxidative properties and health benefits.

Gastrostomy feeding in cerebral palsy: too much of a good thing?

Gastrostomy tube (GT) feeding in children with cerebral palsy (CP) is associated with significant increases in weight gain and, potentially, with overfeeding. This study aimed to measure energy balance and body composition in children with CP who were fed either orally or by GT. Forty children (27 males, 13 females; median age 8y 6mo; range 1y 4mo-18y 11mo) with spastic quadriplegic CP, of whom 22 were gastrostomy-fed and 18 orally-fed, underwent anthropometry, indirect calorimetry, and total energy expenditure determination (doubly-labelled water method). Total body water content (estimated by the 18O dilution method) was used to determine body composition. The Gross Motor Function Classification System (GMFCS) was used to determine the degree of motor impairment. GMFCS levels ranged from I to V; in the gastrostomy group 19 out of 22 were Level V and two out of 22 were Level IV. Within the orally-fed group, 11 out of 18 were Level V and four out of 18 were Level IV. Resting metabolic rate and total energy expenditure of the gastrostomy-fed children were lower but they had a significantly larger triceps skinfold thickness (p=0.01) and fat mass index (p=0.02) than the orally-fed children. Both groups had consistently higher body-fat content and lower fat-free (i.e. muscle and bone) content than the reference population of age- and sex-matched children without disabilities. This study has demonstrated the relatively low energy expenditure and high body-fat content of children with severe CP and highlighted the potential risk of overfeeding with available enteral feeds administered via GT.

Xanthophyll and hydrocarbon carotenoid patterns differ in plasma and breast milk of women supplemented with red palm oil during pregnancy and lactation.

Currently limited information exists on how maternal supplementation with provitamin A carotenoids might influence the carotenoid pattern in breast milk during lactation. This study was designed to investigate the effect of maternal red palm oil supplementation ( approximately 12 g/d) throughout the 3rd trimester of pregnancy and the first 3 mo postpartum on carotenoid pattern in both plasma and breast milk. Plasma and breast milk alpha- and beta-carotene concentrations increased in response to red palm oil supplementation and were different (P < 0.001) from the control group at both 1 and 3 mo postpartum. Plasma lutein and zeaxanthin concentrations were reduced (P < 0.001) from pregnancy to 1 mo postpartum and remained stable until 3 mo postpartum. However, breast milk lutein concentrations, expressed per gram of milk fat, increased (P < 0.05) in both groups from 1 to 3 mo postpartum. The results of this study show that there are proportionally more hydrocarbon carotenoids such as alpha- and beta-carotene in plasma than in breast milk, whereas xanthophylls, such as lutein and zeaxanthin, are proportionally more prevalent in breast milk. More importantly, red palm oil supplementation increases the milk concentrations of provitamin A carotenes without decreasing the milk concentrations of xanthophylls. In summary, this study demonstrates that a regulated uptake of polar carotenoids into breast milk exists and that supplementation with alpha- and beta-carotene does not negatively affect this transfer. The mechanisms behind this transport are not fully understood and merit further study.

Plasma levels of retinol, carotenoids, and tocopherols in relation to dietary pattern among pregnant Tanzanian women.

In Tanzania, as in other developing countries, dietary intake of nutrients in pregnant women is marginal or lower than the recommended intakes and therefore these women are at high risk for deficiencies. Our aim was to evaluate the relationship between diet and plasma levels of retinol, carotenoids, and alpha-tocopherol in the third trimester of pregnancy. Ninety pregnant women aged between 18 and 45 years were equally recruited from three villages. Seven-day food frequency data was collected by questionnaire. Plasma levels of retinol, carotenoids, and tocopherols were assessed by high-performance liquid chromatography (HPLC). Results indicated that cooked green leafy vegetables constituted the major source of provitamin A carotenoids, with low intake of yellow/orange fruits and preformed vitamin A. Lutein, lycopene, and beta-carotene were the predominant carotenoids in the plasma with mean values of 1.61, 0.84, and 0.63 mumol/L, respectively. There was no significant correlation between frequencies of vegetable consumption and either plasma retinol or carotenoids. However, increased consumption of green leafy vegetables with oil, which increases bioavailability, was correlated with high plasma retinol levels (p = 0.03). Low retinol levels (< or = 0.70 mumol/L) were present in 26% of women. The mean plasma retinol concentration was 0.89 mumol/L and 63% of the women had values below 1.05 mumol/L. The mean plasma alpha-tocopherol concentration was 15.4 mumol/L and women with plasma retinol concentration > 1.05 mumol/L had significantly higher mean alpha-tocopherol than women with plasma retinol concentration < or = 0.70 mumol/L (p < or = 0.01). Twenty-four percent of the women were anemic (hemoglobin: Hb < 110 g/L) and the mean Hb value was 116.3 g/L.

Dietary advice for patients undergoing coronary artery bypass surgery: falling on deaf ears?

Coronary heart disease (CHD) is the most common cause of death in the UK, accounting for around 125,000 deaths per year. Diet is a CHD risk factor that is modifiable, and therefore has the potential to alter the risk for CHD. At present, little is known about the dietary patterns of CHD patients. The present study aimed to assess the effectiveness of dietary advice administered to patients undergoing coronary artery bypass grafting (CABG) surgery. Dietary intake was assessed on three occasions (pre-operatively, 2 months after surgery and 1 year after surgery) by use of a food amount frequency questionnaire that had been previously validated. Patients were also asked to provide information on any dietary advice they had received. Complete data were available for 15 males, aged 51-79 years, who were admitted for CABG surgery. The absolute mean intakes of total fat, saturated fat and dietary cholesterol significantly increased 1 year after CABG surgery by 21%, 36% and 51%, respectively, and the choice of food items reflected this change in nutrient intake. These undesirable changes occurred despite the provision of dietary advice. This may consequently increase the risk of recurrent problems, and serve to promote further atherosclerosis in the arteries of such patients. The observations highlight the need to better understand the barriers to nutritional advice and compliance seen in CABG patients.