The Future of Obesity Management through Precision Nutrition: Putting the Individual at the Center.

PURPOSE OF REVIEW: The prevalence of obesity continues to rise steadily. While obesity management typically relies on dietary and lifestyle modifications, individual responses to these interventions vary widely. Clinical guidelines for overweight and obesity stress the importance of personalized approaches to care. This review aims to underscore the role of precision nutrition in delivering tailored interventions for obesity management. RECENT FINDINGS: Recent technological strides have expanded our ability to detect obesity-related genetic polymorphisms, with machine learning algorithms proving pivotal in analyzing intricate genomic data. Machine learning algorithms can also predict postprandial glucose, triglyceride, and insulin levels, facilitating customized dietary interventions and ultimately leading to successful weight loss. Additionally, given that adherence to dietary recommendations is one of the key predictors of weight loss success, employing more objective methods for dietary assessment and monitoring can enhance sustained long-term compliance. Biomarkers of food intake hold promise for a more objective dietary assessment. Acknowledging the multifaceted nature of obesity, precision nutrition stands poised to transform obesity management by tailoring dietary interventions to individuals' genetic backgrounds, gut microbiota, metabolic profiles, and behavioral patterns. However, there is insufficient evidence demonstrating the superiority of precision nutrition over traditional dietary recommendations. The integration of precision nutrition into routine clinical practice requires further validation through randomized controlled trials and the accumulation of a larger body of evidence to strengthen its foundation.

The effect of black mulberry (Morus nigra) consumption on cognition in patients with mild-to-moderate Alzheimer's dementia: A pilot feasibility study.

The purpose of this study was to test the feasibility and the possible effects of black mulberry on cognitive functions in Alzheimer's disease (AD). A total of 39 participants aged 65+ with mild-to-moderate AD were involved and 20 subjects were administered 20g of black mulberry concentrate daily for 12 weeks (intervention group), while 19 received no intervention (control group). Cognitive assessment utilized with Mini-Mental State Examination (MMSE) and AD Assessment Scale-Cognitive Subscale (ADAS-Cog) tests; Geriatric Depression Scale (GDS-15) used for depression screening. At the end of the study, although MMSE scores decreased (p = 0.003) and GDS-15 scores increased (p = 0.034) in control group, there was no change in intervention group. On the contrary, ADAS-Cog scores decreased in intervention group (p = 0.002) while the control group showed no improvement. This study showed that treatment of black mulberry (Morus nigra) for 12 weeks may slightly improve cognitive function in patients with AD.

Effect of body composition on the athletic performance of soccer referees.

Nutrition plays an important role in improving sports performance. The present study aimed at nutritional assessment and examined the relationship between athletic performance and body composition in soccer referees at different levels. The study participants were 120 male soccer referees. 5, 10 and 30 metres (m) sprint tests to measure speed and cooper test for physical fitness were applied in the referees. Participants were divided into two groups as city and class soccer referee. The anthropometric measurements, excluding fat mass (FM) (%), were higher in class referees. Fat mass (%) differences (14⋅1 ± 4⋅28 v. 12⋅3 ± 4⋅41) were statistically significant (P < 0⋅05). Daily energy and nutrient intakes were similar. The inadequacy percentages of energy, vitamin A and calcium were the highest (29⋅2, 30⋅0 and 34⋅2 %, respectively). It was found that a negative significant correlation between FM% and cooper test score (P < 0⋅01; r = -0⋅35), a positive significant correlation between FM% and 5, 10 and 30 m sprint test scores (P < 0⋅01, r = 0⋅38; P < 0⋅01, r = 0⋅38 and P < 0⋅01, r = 0⋅48, respectively). Similarly, there was a negative significant correlation between waist circumference (WC) and cooper test score (P < 0⋅01; r = -0⋅31), a positive significant correlation between WC and 5, 10 and 30 m sprint test scores (P < 0⋅01, r = 0⋅33; P < 0⋅01, r = 0⋅40; P < 0⋅01, r = 0⋅33, respectively). Nutritional recommendations for soccer referees should be made specific to the individual, considering body composition, training intensity and match frequency by a dietician.

The Evaluation of Dietary Antioxidant Capacity, Dietary Inflammatory Index and Serum Biomarkers in Breast Cancer: A Prospective Study.

Dietary antioxidant capacity (dTAC) and dietary inflammatory index (DII) are commonly used to assess nutrition. This prospective study examined dTAC, DII, and serum biomarkers in women with breast cancer (BC). Patients were followed-up before surgery (T1), before chemotherapy (T2), at 6th (T3) and 12th months of chemotherapy (T4). Serum tumor necrosis factor alpha, interleukin 1ß, interleukin 6, protein carbonyl, malondialdehyde, total antioxidant capacity (TAC), and total oxidant status levels were analyzed. Dietary antioxidant intake, dTAC, and DII were determined using a three-day dietary record. dTAC was calculated using vitamin C equivalent (VCE), oxygen radical absorption capacity (ORAC), trolox equivalent antioxidant capacity (TEAC), total radical-trapping antioxidant parameter (TRAP), and ferrous ion reducing antioxidant potential (FRAP). This study included 32 women with BC and 32 controls (CG). ORAC, TEAC, TRAP, and FRAP were significantly lower in BC than in CG. During follow-up, only ORAC increased significantly at T2 compared to T1. A weak positive correlation was found between dTAC (VCE) and serum TAC levels at T2 (rho = 0.371, p = 0.036). The relationship between diet and serum biomarkers was not significant. Multicenter prospective studies on different age groups are needed to understand the association between diet and serum biomarkers levels in patients with BC.

Are dietary and serum advanced glycation end-products related to inflammation and oxidation biomarkers in breast cancer patients: a follow-up study.

PURPOSE: This study is aimed at evaluating the relationship between dietary and serum advanced glycation end-products (AGEs) with serum inflammatory and oxidative stress biomarkers in breast cancer (BC). METHODS: A sample of BC patients was followed for 12 months (March 2020-January 2022). Three-day food consumption record and serum samples were taken before surgery (T1), before chemotherapy (T2), at the 6th month of chemotherapy (T3), and at the 12th month of chemotherapy (T4). Dietary AGE intake was represented by carboxymethyl lysine (dCML). Serum levels of CML, inflammation, and oxidation biomarkers were determined with biochemical blood tests. The results were compared according to human epidermal growth factor receptor-2 (HER2) status. RESULTS: Thirty-two women with BC and 32 age and body mass index-matched healthy women participated. No significant correlation was found between dCML and serum CML, inflammatory or oxidative stress biomarkers at T1, T2, and T4. A weak positive correlation was demonstrated between dCML and serum malondialdehyde levels (rho=0.355, p=0.046) at T3. The serum CML, inflammation, and oxidation biomarker levels of the HER2- group were significantly higher than those of the HER2+ group at T1. CONCLUSION: This study suggests that there is limited correlation between dCML and serum inflammation and oxidative stress biomarkers in BC patients. Inflammation and oxidative biomarker levels appear to decline with treatment although dietary and serum AGE levels show not a corresponding significant decline. The HER2- subtype appears to be associated with higher dietary and serum AGEs and higher inflammatory and oxidative stress biomarkers.

Dietary total antioxidant capacity and serum 8-OHdG in patients with schizophrenia.

BACKGROUND: Dietary total antioxidant capacity serves as an indicator for dietary quality and reflects daily antioxidant intake. This study aimed to determine the oxidative stress status of patients with schizophrenia and to examine the relationship between dietary total antioxidant capacity (dTAC) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker for oxidative stress. METHODS: This study was conducted in Turkey and involved 40 patients diagnosed with schizophrenia or schizoaffective disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., and 30 healthy controls matched for age and gender. The participants' sociodemographic characteristics and nutritional habits were determined through face-to-face interviews and through the use of questionnaires. The dTAC and dietary oxidative balance scores were calculated using a three-day dietary intake record. 8-OHdG levels were analyzed in the serum samples collected from the subjects. RESULTS: Dietary ferric reducing antioxidant power (FRAP-1, FRAP-2), Trolox equivalence antioxidant capacity (TEAC), and oxygen radical absorbance capacity (H-ORAC) values were lower in patients with schizophrenia than in the healthy controls (P < 0.05). Serum 8-OHdG levels were found similar in both groups (P > 0.05). CONCLUSION: Nutritional interventions are needed in patients with schizophrenia given that insufficient antioxidant intake may increase oxidative stress, which in turn affects disease development. Therefore, healthy nutrition, especially sufficient intake of dietary antioxidants, should be encouraged in patients with schizophrenia.

Anthropometric measurements and serum TNF-α, IL-6 and adiponectin in type 2 diabetes.

Objective: To investigate the effect of anthropometric measurements on serum adiponectin and inflammatory markers in Type 2 diabetes mellitus (T2DM). Methods: This study was conducted with 46 subjects newly diagnosed with T2DM and 30 healthy volunteers free from pre-existing inflammatory disease, cancer, Type 1 diabetes and using any medications. Demographic, clinical and anthropometric data were collected. The anthropometric measurements and insulin resistance components (fasting plasma glucose (FPG), HbA1c, fasting insulin, HOMA-IR) were analyzed. HOMA-ß values were calculated to measure pancreatic beta cell functions. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured to determine the presence of inflammation and serum adiponectin levels were assessed. Results: Individuals with T2DM showed higher body mass index (BMI), body fat percentage, waist circumference (WC), waist-to-hip ratio and waist-to-height ratio values. Serum cytokine levels were higher but adiponectin levels were lower in diabetic patients. Serum concentrations of CRP were found to be significantly correlated with WC and body fat mass (kg and %); TNF-α was significantly associated with WC and waist-to-hip ratio in individuals with T2DM. Adiponectin was negatively correlated with WC and waist-to-hip ratio in healthy subjects. Conclusions: Prevention of obesity and central adiposity is an important factor to prevent elevations in inflammatory cytokine levels in diabetic patients.

Validation of MEDFICTS Dietary Assessment Questionnaire in Turkish Population.

OBJECTIVE: The purpose of this study was to assess the validity of MEDFICTS (Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table, Snacks) questionnaire in Turkish population. DESIGN: MEDFICTS questionnaire is a brief dietary assessment tool developed as part of the National Cholesterol Education Program Adult Treatment Panel guidelines, and it measures the adherence to Step 1 and Step 2 diets that are recommended for the prevention and treatment of CVD. MEDFICTS questionnaire was administered with 3-d food record to compare overall dietary fat intake. SETTING: This study was conducted at the Hacettepe University (Ankara, Turkey) in 2017. PARTICIPANTS: Subjects were university students, recruited from several departments of Hacettepe University by trained dietitians. A total of 442 adults (249 females and 194 males) between the ages of 18 and 31 years participated in the study. Students with CVD were excluded. RESULTS: Total fat intake ratio was higher than the recommended level for both males and females (39·4 % and 39·9 %, respectively). Mean MEDCISTS score was 66·3 ± 27·24 points. Total energy, total fat, SFA and cholesterol intakes from 3-d food records within the different MEDFICTS diet groups significantly differed (P < 0·001 for all). Receiver operating characteristics curve analysis demonstrated that a cut-off point of 60 showed 80 % sensitivity and 65 % specificity. CONCLUSIONS: Our data indicate that the MEDFICTS questionnaire is moderately accurate; however, sensitivity analysis did not demonstrate the recommended 40 points as an optimal cut-off point for Turkish population.

Do Rotating Night Shifts Change Nurses' Nutritional Status? A Cross-Sectional Study.

OBJECTIVE: Shift work disrupts circadian rhythms through environmental factors such as disruption of the light-dark and rest-activity cycle. This study aims to evaluate the nutritional status, circadian phenotype, sleep quality, and anthropometric measurements in nurses working in rotating night shifts. METHOD: The study included 44 nurses working in rotating night shifts. Physical activity records for 4 days and 24-hour dietary recalls for 7 days were taken. To evaluate the circadian phenotypes and sleep quality, the Morningness-Eveningness Questionnaire and the Pittsburg Sleep Quality Index were used, respectively. RESULTS: Most nurses were evening chronotype and had poor sleep quality. Shift work was associated with higher daily energy intake and lower total daily energy expenditure (p < 0.05). On the night shifts, while fiber-rich foods such as beans and fruit consumption decrease, the consumption of fats, sweets, and cereals increases. While carbohydrates, total fat, and cholesterol intake were higher in only women on the night shift (p < 0.05), saturated fat and calcium intake were higher in all nurses (p < 0.05). While the water intake of the nurses was lower on the night shift (p < 0.05), tea intake was higher in women (p < 0.05). A correlation was found between total shift work duration, body mass index (r = 0.525), waist circumference (r = 0.577), waist-height ratio (r = 0.584), and body fat percentage (r = 0.513) (p < 0.001). CONCLUSIONS: Nurses should be encouraged to ensure adequate water intake and to make healthy food choices during the night shift to maintain health and work performance.

Dietary Antioxidant Capacity and Serum Inflammatory Biomarkers Levels in Cancer Survivors.

This study aimed to compare the dietary intake of carotenoids, tocopherols, ascorbic acid, flavonoids, and dietary total antioxidant capacity (dTAC) and to evaluate relationship of dTAC with serum inflammatory biomarkers in patients with gastrointestinal system (GIS) and non-GIS cancer. In total, 104 adult cancer survivors (52 GIS and 52 non-GIS cancer cases) were included. 24-hour dietary recalls were obtained and dTAC was calculated on the basis of oxygen radical absorption capacity (ORAC), Trolox equivalent antioxidant capacity (TEAC), total radical-trapping antioxidant parameter (TRAP), ferric reducing antioxidant potential (FRAP), and vitamin C equivalents (VCE). Serum C-reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were used as inflammatory biomarkers. Routinely analyzed serum CRP, neutrophil, lymphocyte, and platelet levels every day in hospital biochemistry laboratory were obtained from patients' file. There was no significant difference between patients with GIS and non-GIS cancer in terms of dietary intake of carotenoids, tocopherols, and flavonoids. While there was no significant difference between groups in terms of the mean dietary ORAC, TEAC, and FRAP, the mean TRAP of patients with GIS cancer was significantly higher than patients with non-GIS cancer. Serum inflammatory markers (CRP and NLR) were found to have an inverse relationship with dTAC.

Effect of Dialysis Time on Dietary Intake, Body Composition, Muscle Strength, and Nutritional Status of Hemodialysis Patients.

The aim of this study is to evaluate the long-term changes that occur in the nutrition status, dietary intake, biochemical values, anthropometric measurements, body composition, and muscle strengths of hemodialysis patients. A total of 60 patients aged between 18 and 64 who were on dialysis for six months were included in the study. During the four-year follow-up; 17 patients died, four were transferred, and 6 moved to other provinces. The patient's food intake, biochemical values, anthropometric measurements, body compositions, handgrip strengths (HGS), and physical activity status were reviewed and subjective global assessment (SGA) was assessed at the beginning and the end of the four-year follow-up period. A statistically significant difference was found between the baseline and end-of-period SGA classifications of the patients (P <0.05). While there were no statistically significant differences at the end of the follow-up period in terms of the body weight, body mass index, mid-upper arm circumference, mid-upper arm muscle circumference, body water, lean body mass, creatinine, energy intake, protein intake values of the patients; there were significant differences in terms of their triceps skin-fold thicknesses, percentage of body mass, HGS, blood urea nitrogen levels, total protein, and albumin values (P <0.05). Extended time on dialysis leads to decrease values of albumin and HGS, increased rates of malnutrition.

Effect of seasonal changes on nutritional status and biochemical parameters in Turkish older adults.

BACKGROUND/OBJECTIVES: Available data suggest that seasonal changes may influence the nutritional status and overall health of elderly individuals. Therefore, this study was conducted to investigate the effects of seasonal changes and related factors on energy and nutrient intake of older adults. SUBJECTS/METHODS: Individuals aged 65 years or over were prospectively enrolled in this single-center study (male: 11, female: 20). Data were collected between May 2013 and February 2014 during winter, spring, summer and autumn. Food consumption and biochemical parameters were taken during each season to assess the seasonal nutrition status of the elderly. Upon analysis of biochemical parameters (retinol, vitamin D and vitamin C), an high-performance liquid chromatography device was utilized whereas an Immulite 2000 device was utilized during analysis of serum folic acid and parathyroid hormone. RESULTS: Fruit, fat, egg and bread consumption varied seasonally in males and females (P < 0.05). During winter, daily energy intake was found to be greater than in other seasons in males (557 kcal) and females (330 kcal) (P < 0.05). Additionally, carbohydrates, vegetable protein, n-3 fatty acid and sodium intake increased in winter, while the n-6/n-3 ratio increased in summer among males (P < 0.05). Dietary fiber and sodium intake in winter, vitamin C, iron and zinc intake in spring, and cholesterol, retinol, vitamin D and niacin intake in autumn were found to be higher in females when compared to other seasons (P < 0.05). Serum parathyroid hormone level was higher in winter, and vitamin D level was higher in autumn in both genders (P < 0.05). In males, blood folic acid level was higher in winter, while vitamin C level was higher in females, and there was no seasonal variation in retinol concentration (P < 0.05). CONCLUSION: Food consumption and biochemical parameters showed significant seasonal variations in older adults. It is not clear if nutrition plans in older adults will benefit from consideration of seasonal changes in eating habits.

The relationship between nutritional status and handgrip strength in adult cancer patients: a cross-sectional study.

PURPOSE: Malnutrition is a common complication in head, neck and lung cancer patients, particularly in cases of gastrointestinal system (GIS) cancer. Therefore, an assessment of malnutrition is crucial for early nutritional interventions. It was conducted as a cross-sectional study to evaluate nutritional status of adult cancer patients. METHODS: The nutritional status of 104 cancer patients (52 GIS and 52 non-GIS cancer cases) using a Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength, certain anthropometric measurements and food consumption in and outside of the hospital were assessed. RESULTS: The percentages of malnutrition were 64.6 and 64.3% in the male patients with and without GIS cancer, respectively. They were 61.9 and 45.8% in the female patients with GIS and without GIS cancer, respectively. However, no significant difference was found between these two groups according to the malnutrition classification, PG-SGA score, handgrip strength and other anthropometric measurements (p > 0.05). The daily energy and protein intakes (per body weight) of the female patients in the hospital were significantly lower than those outside (p < 0.05). In addition, there was a positive moderate and significant relationship between the handgrip strength and lean body mass (r = 0.522, p = 0.000). A negative relationship was observed between the PG-SGA score and the handgrip strength (r = - 0.117, p = 0.071), but it was not statistically significant. CONCLUSIONS: Cancer patients could be provided with nutritional education, and arrangements could be made with hospital nutritional services in order to prevent malnutrition.

The effects of meal glycemic load on blood glucose levels of adults with different body mass indexes.

AIMS: The aim was to determine the effect of meal glycemic load (GL) on blood glucose levels of healthy people with different body mass indexes (BMIs). METHODS: Thirty healthy controls were included in this study. The participants were divided into two groups according to their BMI as normal group (BMI = 18.5-24.9 kg/m2, n = 15) and overweight group (BMI = 25.0-29.9 kg/m2, n = 15). Dietary assessment was done by the 24-h recall method for 3 successive days. Cases were fed by breakfasts with two different GL on consecutive days. Energy values of the test meal, adjusted to meet 25% of daily energy requirements of each case, were identical in low and high GL meal (483 kcal and 482 kcal, respectively). Finger-prick capillary blood samples were taken on 0, 15, 30, 45, 60, 90, and 120 min. RESULTS: Average daily energy intake in normal and overweight group was found as 2514.3 ± 223.8 kcal, 2064.1 ± 521.6 kcal and 2211.4 ± 368.7 kcal, 2494.8 ± 918 kcal in males and females, respectively. Blood glucose level was increased and remained more stable in both high GL meal groups compared to low (P < 0.05). The effects of GL on BMI classified groups were also found different. High GL meal was found to be more effective for increasing blood glucose level, especially on overweight group (P < 0.05). CONCLUSIONS: The effects of GL meal were found to be different on normal and overweight individuals. The high GL meals were more effective to increase the blood glucose level than low GL meal, especially on overweight people.

Nutritional status and dietary intake of institutionalized elderly in Turkey: a cross-sectional, multi-center, country representative study.

OBJECTIVE: To evaluate the nutritional status and dietary intake of institutionalized elderly in Turkey. DESIGN: Cross-sectional study. SETTING: 25 institutions in 19 cities throughout Turkey. PARTICIPANTS: Elderly residents aged 65 years and older (n=554). MEASUREMENTS: Nutritional status using Mini Nutritional Assessment (MNA), food consumption with 24-h dietary recall and anthropometric measurements (body weight, height, body mass index (BMI), waist circumference (WC), hip circumference, waist/hip ratio, mid-upper arm circumference (MUAC)). RESULTS: The mean age of the elderly was 76.1±7.3 years. BMI of elderly men and women were found to be 26.59±4.58kg/m(2) and 30.07±6.32kg/m(2), respectively. WC of elderly men and women were found to be 98.90±1.33cm and 100.62±1.34cm, respectively. Most of the elderly were overweight based on BMI and at risk of metabolic diseases based on WC. According to MNA, 44.2% had normal nutritional status, 49.1% were at risk of malnutrition, 6.7% had malnutrition. All nutrients intake was favorable according to requirements, except for calcium and magnesium. Energy, protein, carbohydrate, fat, vitamins A, E, B1, B2, B6, C folat, iron, zinc intake of elderly who had normal nutritional status, who were at risk of malnutrition and malnourished were significantly different. Energy and nutrients intake of elderly who had normal nutritional status was found to be better than the others. CONCLUSION: Nutritional status should be periodically screened in the institutionalized elderly to prevent malnutrition. Also, it was noted that adequate energy and nutrients intake of the elderly played a crucial role in maintaining nutritional status and preventing malnutrition within residential homes.

Energy and nutrient intake and food patterns among Turkish university students

The goal of this study was to determine the nutritional value and nutrients provided by each meal and snack of consumed by university students. Subjects were randomly selected from volunteer students at five universities in Ankara. A sample of 400 students (167 female and 233 male) aged between 19 and 24 years participated in this study. A questionnaire designed to assess general characteristics, anthropometric measurements, and 24 hours dietary records was administered using face to face interviews. According to body mass index classifications, 69.5% of male students, and 77.7% of female students were found to be in the normal weight categories. Overweight categories were found to be 25.1% and 5.6% for males and females, respectively. Breakfast and lunch were the most frequently skipped meals, with a total of 47.7% of students skipping breakfast and 25.2% skipping lunch. The percentages of energy deficiency were found to be 78.4% in males, and 81.1% in females. Dinner was the main meal for consumption of energy and the other nutrients, except saturated fatty acids, for both genders. Also, dinner was the largest contributor of energy in both genders. Students ate more bread, cereals, and meat at dinner than during the other meals and snacks. Fruit was consumed more during snacks than at the other meals by all students. It was concluded that students need more nutritional information about healthy nutritional habits, adequate intake of nutrients, and ideal body weights.

Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults.

OBJECTIVE: To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults. DESIGN: Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score >or=2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 - specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity - 1). SETTING: Turkey, 2003. SUBJECTS: Adults (1121 women and 571 men) aged 18 years and over were examined. RESULTS: Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0.55 and 0.60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0.63 and 0.81, the specificities were between 0.42 and 0.71 and the accuracies were between 0.65 and 0.73, for men and women. The cut-off point of 0.59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR >or= 0.59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0.59, except for diabetes in men. CONCLUSIONS: We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0.59 in Turkish adults.

Anthropometric indices and their relationship with cardiometabolic risk factors in a sample of Turkish adults.

OBJECTIVE: To identify the best anthropometric index that predicts cardiometabolic risk factors.Design and settingCross-sectional study in Turkey, in 2003. SUBJECTS: Turkish men and women aged 18 years and over (n 1692) were examined. Body weight, height, waist and hip circumferences, blood pressure, total cholesterol, HDL cholesterol, TAG, glucose and insulin were measured. Metabolic syndrome score was calculated as the sum of modified National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS: BMI, waist:hip ratio (WHpR), waist:height ratio (WHtR), waist circumference (WC) and hip circumference (HC) were significantly correlated with each other. Partial correlation coefficients between systolic blood pressure, HDL cholesterol, TAG levels or HOMA-IR and BMI, WC or WHtR were similar and higher than correlation coefficients of WHpR and HC. The association of anthropometric indices with metabolic syndrome score and Framingham risk score was highest for WHtR. Areas under the receiver-operating characteristic curves showed that WHtR was the best anthropometric index that discriminated between the presence and absence of hypertension, diabetes and metabolic syndrome, whereas WHpR was better for dyslipidaemia. CONCLUSIONS: WHtR was the best anthropometric index for predicting most cardiometabolic risk factors. WC and BMI ranked second for their predictive capability of cardiometabolic risk, followed by WHpR and HC.

The effect of Ramadan on maternal nutrition and composition of breast milk.

BACKGROUND: There are many advantages of breast milk for infants. Many factors can affect the volume and composition of breast milk. One of them is the maternal diet. The objective of this study is to determine the effect of Ramadan fasting on maternal nutrition and breast milk composition. METHODS: A total of 21 breast-feeding mothers aged between 17 and 38 years who fasted during Ramadan month and volunteered to give milk samples were surveyed. The ages of the infants were between 2 and 5 months. The study was performed during Ramadan and 2 weeks after the end of Ramadan. RESULTS: The results showed that during Ramadan, zinc, magnesium and potassium levels in breast milk decreased significantly (P<0.05). The mother's weight increased approximately 1 kg after Ramadan. Changes in body mass index of the mother were not statistically significant. A significant decrease in vitamin A intake was observed after Ramadan (P < 0.05). During Ramadan, energy and most nutrient intakes except protein and vitamins A and C were found below daily recommended dietary allowances necessary for lactating women. CONCLUSIONS: Ramadan fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. There were significant differences in some of the micronutrients such as zinc, magnesium and potassium. The nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. For these reasons, it would seem prudent to excuse lactating women from fasting during Ramadan.

Assessment and evaluation of the nutritional status of the elderly using 2 different instruments.

OBJECTIVES: The elderly population continues to increase in most countries and inadequate nutrition is a common problem affecting their functional and physical status. Therefore, we should periodically assess the nutritional status of the elderly using practical methods. Our study objectives are to assess the nutritional status of the elderly using 2 different methods: Mini Nutritional Assessment (MNA) and Nutritional Screening Initiative Checklist (NSIC), and to evaluate the consistency of the methods. METHODS: We carried out a cross-sectional study between February 2003 and March 2004. We included a total of 1,564 elderly volunteers living in Ankara, Turkey, with median (+/- inter quartile range [IQR]) age of 70 +/- 8 (Male: 71 +/- 9; Female: 70 +/- 9 ) years. We utilized 2 frequently used instruments; MNA and NSIC in this study. RESULTS: The MNA results (<17 points) indicated that 6.5% of the male and 8.8% of the female participants had inadequate nutrition. According to NSIC, 34.3% of males and 36.9% of females were classified as having a high risk of nutritional deficiency. We observed a decrease in MNA and an increase in NSIC scores with the increase of age (p<0.01). We determined a negative correlation of MNA and positive correlation of NSIC with body weight, body mass index (BMI), mid-upper arm circumference (MUAC), and calf circumference (CC) (p<0.01). We did not find correlations between MNA and NSIC score to be statistically significant (r:-0.318; p>0.05). We analyzed agreements between MNA and NSIC score by Kappa statistical method (kappa: 0.13, p: 0.285) and determined that neither of these 2 methods can be used in lieu of the other. CONCLUSION: For the assessment of the nutritional status of the elderly, we could use both MNA and NSIC instruments but depending on the facilities and preferences, we cannot use one to replace the other. The MNA includes both anthropometric measurements and various nutritional parameters, and is a practical and most valid method.