Nutritional Interpretation of Hospital Diets for Elderly Patients With Chronic Diseases and Analysis of Factors Influencing Actual Intakes.

Background: The provision of hospital meals is considered a therapeutic intervention, and a therapeutic diet consisting of a post-discharge meal sample is provided. For elderly patients who require long-term care, it is important to determine the significance of nutrition by taking into account hospital meals, including therapeutic meals for conditions such as diabetes. Therefore, it is important to identify the factors that influence this judgment. This study aimed to investigate the difference between the expected nutritional intake via nutritional interpretation and actual nutritional intake. Methods: The study included 51 geriatric patients (77.7 ± 9.5 years; 36 males and 15 females) who could eat meals independently. The participants completed a dietary survey to determine the perceived nutritional intake obtained from hospital meal contents. Additionally, we investigated the amount of hospital meal leftovers from the medical records and the amount of nutrients from the menus to calculate the actual nutritional intake. We calculated the amount of calories, protein concentration, and non-protein/nitrogen ratio from the perceived and actual nutritional intake values. We then calculated the cosine similarity and conducted a qualitative analysis of factorial units to examine similarities between perceived and actual intake. Results: Among factors that constituted the large cosine similarity group (gender, age, etc.), gender was found as a particularly significant factor, with a high number of female patients (P = 0.014). Conclusions: Gender was found to influence the appropriate interpretation of the significance of hospital meals. The perception of such meals as samples for post-discharge dietary practice was more significant among female patients. This demonstrated that in elderly patients, it is important to consider gender differences when providing diet and convalescence guidance.

Positive Correlation Between Changes in Serum Albumin Levels and Breakfast Non-Protein Calorie/Nitrogen Ratio in Geriatric Patients.

Background: Differences in nutrition intake by meal intake time of geriatric patients may affect albumin (Alb) synthesis ability. Methods: We included 36 geriatric patients (81.7 ± 7.7 years; 20 males and 16 females) as subjects. We calculated their dietary patterns (DPs) by computing intake by breakfast, lunch, and dinner, as well as by nutrient, for a weight of 1 kg/day for 4 weeks after hospitalization. We confirmed the relationship between "DP with a positive correlation with breakfast protein" and the change rate of albumin (Alb-RC). Then, we performed linear regression analysis to explore factors influencing Alb-RC and compared non-protein calorie/nitrogen ratio (NPC/N) between the upper and lower Alb-RC groups. Results: It was observed that Alb-RC was negatively correlated with "DP with a positive correlation with breakfast protein" (B = -0.055, P = 0.038) and positively correlated with breakfast NPC/N (B = 0.043, P = 0.029). Breakfast NPC/N tended to be higher in the upper group than in the lower group (P = 0.058). Conclusion: The study revealed that there was a positive correlation between Alb-RC levels and breakfast NPC/N in geriatric patients at the care mix institution.

Nutritional Intake by Meal Time Zone in Geriatric Patients Is Related to Nutritional Assessment Index.

BACKGROUND: The blood metabolome profiles depend on the meal intake time zone regardless of having the same meal. The serum albumin (Alb) level, which is important in managing geriatric patients with chronic diseases, is included in the metabolome analysis. In this study, we aimed to examine the relationship between Alb and the nutritional value of hospital meals consumed at breakfast, lunch, and dinner among geriatric patients. Chrononutrition was considered while drawing inferences. METHODS: We retrospectively surveyed 52 geriatric patients with chronic diseases (aged 79.7 ± 8.7 years) admitted at a small-scale hospital providing combined healthcare measures and oral nutritional support. The dietary intake per kilogram of body weight of nutritional components for breakfast, lunch, and dinner was individually expressed as the ratio to the whole daily food intake. The dietary pattern was determined by principal component analysis. We also conducted linear regression analysis, with Alb as the dependent variable, and age, sex, and grade assigned in this study as well as the first, second, and third principal components of the dietary patterns as the independent variables. RESULTS: Three principal components with an eigenvalue of > 1 were extracted. The second principal component was a significantly negative determinant factor for Alb (B = -0.108, P = 0.016). In patients with high Alb levels, the energy, protein, and fat ratios at lunch were positively correlated, while the energy and carbohydrate ratios at dinner were negatively correlated. Mealtimes were fixed. CONCLUSIONS: The results of this study showed that the dietary pattern predominantly observed in patients with high Alb levels may be positively associated with Alb synthesis.

Influence of Geriatric Patients' Food Preferences on the Selection of Discharge Destination.

BACKGROUND: The nonprotein calorie/nitrogen (NPC/N) ratio of food remains poorly investigated. Thus, this study examined the nutritional factors that influence the choice of discharge destination for geriatric patients. METHODS: We retrospectively investigated the patient characteristics, clinical laboratory test results, and hospital food consumption of 65 geriatric patients (80.0 ± 8.2 years; 31 males, 34 females), who were receiving oral nutritional support at a small mixed-care hospital and further explored their discharge destinations. The NPC/N ratios were calculated according to the menus for the meals provided during the first 4 weeks after admission. For logistic regression analysis, the objective variables were discharge destinations (i.e., nursing care facilities including home or medical institutions) whereas the predictor variables were age, sex, nursing care level, hospitalization duration, serum albumin level (Alb), estimated glomerular filtration rate (eGFR), and NPC/N ratio. RESULTS: Compared with age and nursing care level, sex (partial regression coefficient (B) = -5.140, P = 0.002), hospitalization duration (B = 0.077, P = 0.004), Alb (B = 3.223, P = 0.013), eGFR (B = -0.071, P = 0.019), and NPC/N ratio (B = -0.224, P = 0.001) are significantly correlated with the selection of discharge destination. CONCLUSIONS: For geriatric patients who went to medical institutions, the need for prolonged hospitalization, male sex, hospitalization duration, stable serum Alb, low eGFR, low NPC/N ratio (i.e., high protein proportion), and the quantity of hospital food consumed were the possible factors that influence their discharge destination.

A Study of Dietary and BMI Changes Over Time in Mothers of Children with Food Allergies.

Few follow-up surveys have been conducted with regard to the changes in diet of mothers of children with food allergy. We examined changes in food and BMI over time in the mothers of children with food allergies. A total of 146 mothers completed a diet survey twice, with the first conducted in 2013-2016 and the second in 2018, and the dietary changes were examined. Furthermore, among the 120 mothers who eliminated eggs from their diet in the first survey, 98 continued to eliminate eggs and 22 reintroduced eggs during the second survey, and the change over time was examined. Additionally, factors related to BMI were analyzed. We observed a change in the amount of egg intake over time within each group. As the number of children who consumed eggs as the causative food declined, the amount of eggs consumed by the concerned mothers significantly increased (median: 7.8 g/1,000 kcal→12.7 g/1,000 kcal) (p<0.01), even in children who continued to not consume eggs. We found a negative correlation between BMI in mothers of children with FA and vegetable protein. The mothers indicated that their awareness on food allergy improved, which we believe led to increased consumption of foods that had been restricted thus far. BMI was believed to be related to synchronization with the elimination-substitution diet.

A study on the effect of nutrient intake on the body mass index of mothers of children with food allergies.

BACKGROUND: No previous studies have reported the effect of the presence of children with food allergies (FAs) on the diet and body mass index (BMI) of mothers. Therefore, we conducted a dietary survey and considered nutrients that influenced BMI of mothers. OBJECTIVE: Subjects included 554 mothers-305 mothers of children with FAs (FA mothers; aged 38.4 ± 5.1 years, FA group) and 249 mothers of children without FAs (non-FA mothers; aged 37.7 ± 5.5 years, NFA group). METHODS: We extracted dietary patterns from dietary survey results and investigated the correlation between nutrient intake and BMI. We divided the FA group into two groups (one containing 181 mothers whose children were allergic to ≤ 1 of the three major allergenic foods-eggs, milk and wheat-and another containing 124 mothers whose children were allergic to ≥ 2 of these foods) and conducted a comparative analysis. RESULTS: BMI was significantly lower in the FA group than in the NFA group (20.7 vs. 21.4 kg/m2). There was a significant negative correlation between BMI and vegetable protein intake (ß = -0.196, SE = 0.05). Vegetable protein intake was higher in the group that was allergic to ≥ 2 of the allergenic foods. CONCLUSIONS: BMI of FA mothers is affected by a diet that strictly follows their FA child's allergen-free state-a diet dominated by vegetable protein. These observations suggested that the degree to which an FA mother is affected depends on the number of the three major allergenic foods to which her FA child is allergic.

Association Between Lifestyle Characteristics and Body Mass Index of Mothers of Children With Allergic Diseases.

BACKGROUND: For mothers of children with allergic diseases, the amount of physical activity involved in childcare increases owing to factors, such as the need for diet therapy and environmental improvements. Reportedly, the body mass index (BMI) of mothers of children with food allergies (FAs) is significantly lower than that of those of children without allergies (non-FA mothers). The aim of this study was to evaluate the characteristics of diet and physical activity in FA mothers and to clarify their effects on BMI. METHODS: To investigate the association between lifestyle characteristics and BMI in 69 mothers of children with FA, bronchial asthma and atopic dermatitis, their diets and physical activity pattern (using a three-axis accelerometer) were investigated; dietary and physical activity patterns (every hour) were extracted using principal component analysis, and multiple regression analyses were performed. RESULTS: Multiple regression analyses revealed a significant positive correlation (P = 0.037) between BMI and the third principal component of dietary patterns (positive correlation with cereals and negative correlation with sweets), a significant negative correlation (P = 0.004) between BMI and FA and the total daily duration of performing low- and moderate-intensity physical activity (P = 0.031) and a significant positive correlation (P = 0.008) between FA and the first principal component of physical activity expenditure patterns (patterns of ongoing physical activity throughout the day). In FA mothers (n = 51), a significant positive correlation (P = 0.042) was observed between the third principal component of dietary patterns and BMI. CONCLUSION: Low BMI in FA mothers may be related to reduced cereal intake, increased sweets intake and prolonged and continuous low- and moderate-intensity physical activity.

Assessment of the Correlation Between Mother and Child Body Mass Index and Mother and Child Diet in Children With Food Allergies.

BACKGROUND: Children with food allergies (FA children) tend to be smaller in size, mothers of FA children (FA mothers) tend to have a significantly lower body mass index (BMI) than those of non-FA children (N mothers), and FA mothers' diets tend to be synchronous with the substitute diets for their children. The study aims to examine the correlation between the diets of FA children and FA mothers as well as the BMI of FA mothers. METHODS: In total, 41 pairs of FA children (age: 6.5 ± 2.5 years) and FA mothers (FA group) and 37 pairs of children without food allergies (N children, age: 7.0 ± 2.7 years) and N mothers (N group) were included. BMIs of mothers and children, nutrient intake adequacy, correlation of meal content between mothers and children, and sampling of the combined dietary patterns of mothers and children were compared and contrasted to identify factors that affected the BMIs of FA mothers. RESULTS: There were no differences in BMI between the two groups of children, confirming the typical growth of FA children. BMIs of FA mothers were significantly smaller than those of N mothers (P = 0.038). The intake adequacy of sweets was significantly higher in FA mothers than in N mothers (P = 0.041). The correlation of meal contents between mothers and children was significantly higher in the FA group than in the N group (P = 0.019). However, there was a discrepancy in the combined dietary patterns (first principal component) between mothers and children in the FA group. There was a significant negative correlation between the BMIs of FA mothers and responses to the use of substitute food (P = 0.016). CONCLUSIONS: Low BMI in FA mothers may be related to substitute diets that differ from those of the FA children, consumption of sweets in dietary habits, and the use of substitute food.

Analysis of Dietary Factors Affecting Body Mass Index in Elderly Patients With Type 2 Diabetes Mellitus.

BACKGROUND: Body mass index (BMI) is correlated with the outcomes of various metabolic and pathological conditions. To elucidate the factors affecting BMI in elderly persons, we studied elderly persons with and without diabetes mellitus for BMI management target values using receiver operating characteristic (ROC) analysis. METHODS: We conducted a dietary survey targeting 60 elderly outpatients with type 2 diabetes mellitus (diabetes group, 70.1 ± 7.8 years) and 66 elderly persons who participated in a health class offered by the municipality (health class group, 72.5 ± 5.7 years). RESULTS: In the diabetes group, positive correlations were observed between BMI and several variables including blood glucose levels (all P < 0.05), whereas BMI had negative correlations with the third principal component (positive weight for oils and fats). In addition, BMI was negatively correlated with the intake of oils and fats. In the health class group, BMI was positively correlated (all P < 0.05) with grip strength/sixth principal component (positive weight for sweets)/condiments. An analysis of dietary patterns revealed that dietary factors correlated with BMI in each group. The cutoff value of BMI was suggested to be near the normal upper limit or slightly higher in the subject group. CONCLUSION: We considered that BMI management was useful as an indicator for maintaining grip and muscle strength in elderly persons and as an indicator for diabetes care management. From the present study, we may propose the utility of a careful dietary survey as one of the approaches for these aims.

Relationship between Food-Intake Trends and Estimated Glomerular Filtration Rate in Elderly Patients with Type 2 Diabetes Mellitus.

The aim of this study is to investigate how vegetable and fruit intake trends affect the estimated glomerular filtration rate (eGFR) by analyzing therapeutic diet status in elderly type 2 diabetes mellitus patients. The study included 59 elderly patients with type 2 diabetes mellitus (mean age: 70.1±7.8 y) who had previously received therapeutic education for type 2 diabetes mellitus from a clinical team and were subsequently receiving outpatient treatment. Blood examination data were retrospectively collected from medical records and diet status was investigated using a simplified self-administered diet history questionnaire. Dietary patterns were extracted using principal component analysis, and the relationships with each blood examination data were investigated. Linear regression analysis was then used to examine the intake food groups related to eGFR. Energy intake was 27±9 kcal/kg. Overall, these results were in line with the Guidelines for the Treatment of Diabetes in Japan 2016. As a result of principal component analysis, seven dietary patterns were extracted, and the cumulative contribution ratio of the seven components was 74.0%. Among the dietary patterns, the 6th factor (positive weighting with fruit) for eGFR was a negative prognostic factor (p=0.010). Analysis of food group intake and eGFR indicated that green and yellow vegetables were positive prognostic factors, whereas fruits were negative prognostic factors (both p<0.05). The dietary patterns dependent on green and yellow vegetables and fruit intake appeared to influence eGFR positively and negatively, respectively.

Redox-assisted regulation of Ca2+ homeostasis in the endoplasmic reticulum by disulfide reductase ERdj5.

Calcium ion (Ca2+) is an important second messenger that regulates numerous cellular functions. Intracellular Ca2+ concentration ([Ca2+]i) is strictly controlled by Ca2+ channels and pumps on the endoplasmic reticulum (ER) and plasma membranes. The ER calcium pump, sarco/endoplasmic reticulum calcium ATPase (SERCA), imports Ca2+ from the cytosol into the ER in an ATPase activity-dependent manner. The activity of SERCA2b, the ubiquitous isoform of SERCA, is negatively regulated by disulfide bond formation between two luminal cysteines. Here, we show that ERdj5, a mammalian ER disulfide reductase, which we reported to be involved in the ER-associated degradation of misfolded proteins, activates the pump function of SERCA2b by reducing its luminal disulfide bond. Notably, ERdj5 activated SERCA2b at a lower ER luminal [Ca2+] ([Ca2+]ER), whereas a higher [Ca2+]ER induced ERdj5 to form oligomers that were no longer able to interact with the pump, suggesting [Ca2+]ER-dependent regulation. Binding Ig protein, an ER-resident molecular chaperone, exerted a regulatory role in the oligomerization by binding to the J domain of ERdj5. These results identify ERdj5 as one of the master regulators of ER calcium homeostasis and thus shed light on the importance of cross talk among redox, Ca2+, and protein homeostasis in the ER.

Factors underlying genotypic differences in the induction of photosynthesis in soybean [Glycine max (L.) Merr].

Crop leaves are subject to continually changing light levels in the field. Photosynthetic efficiency of a crop canopy and productivity will depend significantly on how quickly a leaf can acclimate to a change. One measure of speed of response is the rate of photosynthesis increase toward its steady state on transition from low to high light. This rate was measured for seven genotypes of soybean [Glycine max (L.) Merr.]. After 10 min of illumination, cultivar 'UA4805' (UA) had achieved a leaf photosynthetic rate (Pn ) of 23.2 µmol · m(-2) · s(-1) , close to its steady-state rate, while the slowest cultivar 'Tachinagaha' (Tc) had only reached 13.0 µmol · m(-2) · s(-1) and was still many minutes from obtaining steady state. This difference was further investigated by examining induction at a range of carbon dioxide concentrations. Applying a biochemical model of limitations to photosynthesis to the responses of Pn to intercellular CO2 concentration (Ci ), it was found that the speed of apparent in vivo activation of ribulose-1:5-bisphosphate carboxylase/oxygenase (Rubisco) was responsible for this difference. Sequence analysis of the Rubisco activase gene revealed single nucleotide polymorphisms that could relate to this difference. The results show a potential route for selection of cultivars with increased photosynthetic efficiency in fluctuating light.