Thiamine deficiency: a commonly unrecognised but easily treatable condition.

Thiamine is present in many foods and is well recognised as an essential nutrient critical for energy metabolism. While thiamine deficiency is commonly recognised in alcoholism, it can present in many other settings where it is often not considered and goes unrecognised. One challenging aspect to diagnosis is that it may have varied metabolic, neurological and cardiac presentations. Here we present an overview of the disorder, focusing on the multiple causes and clinical presentations. Interestingly, thiamine deficiency is likely increasing in frequency, especially among wildlife, where it is linked with changing environments and climate change. Thiamine deficiency should be considered whenever neurological or cardiological disease of unknown aetiology presents, especially in any patient presenting with lactic acidosis.

Effects of the Mediterranean diet adherence on body composition, blood parameters and quality of life in adults.

BACKGROUND: It has been reported that Mediterranean diet (MD) may improve quality of life and may reduce the risk of chronic diseases such as metabolic syndrome, type 2 diabetes, cardiovascular diseases (CVD), some neurodegenerative diseases and cancer. Therefore, this study aimed to determine adults' adherence to the MD and evaluate the effect of the adherence to the MD on anthropometric measurements, specific biochemical parameters and quality of life. METHODS: A total of 142 volunteer adults were included. Food frequency questionnaire, MD adherence with 14-item scale, quality of life, anthropometric measurements via bioelectrical impedance analysis and certain blood parameters were evaluated. RESULTS: Out of 14 points, the mean MD adherence score of the participants was 6.89. The mean fat mass was significantly higher in those with low MD adherence (p=0.024). The results of other anthropometric measurements (except height) were higher in those with low MD adherence, though results were non-significant. The participants with high adherence to the MD had lower levels of fasting blood glucose (FBG) (p=0.041), insulin (p=0.019) and triglyceride (TG) (p=0.012) compared with those with lower adherence. No significant relationship was found between the MD and quality of life and other blood parameters. CONCLUSION: According to our study, MD adherence was associated with decreased fat mass, FBG, insulin and TG levels which suggests that the MD may be useful in the treatment of some chronic diseases such as obesity, diabetes, metabolic syndrome and CVD. However, more clinical trials may be performed to determine the relationship between MD and chronic diseases.

Trends in the prevalence of cardiometabolic disease and cardiovascular events by body mass index category in adults from 1999 to 2016.

OBJECTIVES: An increasing percentage of the US population is obese. Cardiometabolic risk in the population increases with body mass index (BMI), but whether this correlation changes over time is unknown. We analysed the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2016 to determine if the prevalence of cardiometabolic disease and cardiovascular events within each BMI category is changing over time as the BMI of the population is increasing. STUDY DESIGN: For each of the nine survey cycles covering this period, we divided the population by BMI category (normal, overweight, class 1 obesity, class ≥2 obesity) and subsequently by the presence of cardiovascular events or cardiometabolic disease. NHANES participants are a group of 5000 individuals/cycle selected to be representative of the US population. We used the weighted data sets to perform trend analyses for each risk/BMI group adjusted for relevant confounders. RESULTS: The distribution of the highest risk category (cardiovascular event) has not changed over time within any BMI category. The distribution of the lowest risk category (cardiometabolically healthy) increased significantly over time in all BMI categories. This was noted in the 18- to 45-year subgroup but not in the group aged >45 years. CONCLUSIONS: The increase in the prevalence of overweight and obese individuals might be associated with a 'healthy obesity' phenotype in those <45 years; however, individuals >45 years showed a proportional increase in associated cardiometabolic risk.

Running on empty: a review of nutrition and physicians' well-being.

Resident and physician burnout is a complex issue. Adequate nutrition and hydration play important roles in the maintenance of health and well-being of all individuals. Given the high prevalence of burnout in physicians, we believe that in addition to issues related to heavy workload, structure and length of shifts, the current status of physicians' nutrition and hydration and their effects on their work performance and well-being should also be addressed. In this review, we summarise the current evidence on the potential effects of nutrition and hydration on physicians' occupational well-being and performance, identify gaps and discuss opportunities to address nutrition as one of the important means of improving physicians' well-being.

Family physicians prescribing lifestyle medicine: feasibility of a national training programme.

BACKGROUND: The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in 'Healthy Israel 2020', a national initiative created to enhance the health of Israelis. METHODS: Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants' attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants. RESULTS: Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes' meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in one's knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05). CONCLUSIONS: A training programme in LM appears feasible and could have a positive impact on interested family physicians' attitudes and confidence in prescribing LM. Thus, 'Healthy Israel 2020' and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training.

Severe childhood obesity: an under-recognised and growing health problem.

Childhood obesity is a serious and urgent public health problem. In the last 10 years, there has been a concerted effort in the USA and globally to develop and implement educational, medical and public health interventions designed to attenuate its growth. The success of these efforts was probably responsible for the plateau in the prevalence rate of childhood obesity noted in the last two years. While the attenuation of the overall prevalence of childhood obesity is promising, data from the same cohort reveal a concerning upward trend in the number of children with severe obesity. The consequences of severe childhood obesity can be devastating. When compared to their moderately obese peers, children with severe obesity are at greater risk for adult obesity, early atherosclerosis, hypertension, type 2 diabetes, metabolic syndrome, fatty liver disease and premature death. The determinants for severe obesity include the same lifestyle, environmental, familial and societal risk factors reported for overweight or obesity. While all these risk factors must be screened for, genetic influences are distinct considerations that may have greater bearing especially with early-onset obesity. Treatments for severe childhood obesity include lifestyle intervention, specialised low-calorie diets and bariatric surgery. Outcomes of these treatments vary, with bariatric surgery clearly the most successful of the three for both short-term and long-term weight loss. Severe obesity in children and adolescents remains a challenging health condition. The enormous medical, emotional and financial burden these children and their families endure signals an urgent need to further investigate and standardise treatment modalities and improve outcomes.

Low parent health literacy is associated with 'obesogenic' infant care behaviours.

Implications for practice and research: Obesogenic infant care behaviours may increase childhood obesity, and predict obesity and related health risks in adulthood. Poor parent health literacy predicts poor child health outcomes including childhood obesity. Nurses should assess parent health literacy and provide appropriate support to prevent obesogenic infant care behaviours. Future research could focus on evaluating parent educational programmes tailored to health literacy level and effectiveness on reducing obesogenic care behaviours.

Fasting may not be required before percutaneous coronary intervention.

Implications for practice and research: The results of this study suggest that percutaneous coronary intervention (PCI) can be safely conducted without preprocedural fasting. Revision is needed of current fasting protocols. The findings of Hamid and colleagues must be confirmed by further randomised trials.

Evaluation of frequency of consumption of cariogenic snacks by freshmen versus the senior dental students in Tehran and the related factors: a cross-sectional study.

BACKGROUND: Senior dental students are more aware of the harmful effects of cariogenic snacks and are expected to better watch their diet compared with freshmen dental students. This study aimed to compare the frequency of consumption of cariogenic snacks by senior and freshmen dental students of Tehran city and the related factors. METHODS: This cross-sectional study evaluated the senior and freshmen dental students attending dental schools in Tehran in 2018, who were selected by census sampling. A cariogenic snack record form was used to collect information regarding the frequency of consumption of cariogenic snacks both prospectively (within the upcoming week) and retrospectively (previous 24 hours). We also collected information on the demographic characteristics of the participants. The plaque-producing and decay-producing potential of the diet (PAP) index was calculated for each dental student. Data were analysed by the backward regression model using SPSS. RESULTS: A total of 294 dental students with a mean age of 22±2.85 years participated in this study. The mean PAP score was 76.48±49.91 for the freshmen and 89.87±49.41 for the senior dental students with a significant difference between them (p=0.023). Older dental students (p=0.008) and those not living with their parents (p=0.001) acquired a higher PAP score. CONCLUSION: The mean PAP score of freshmen and senior dental students in Tehran was slightly higher than the optimal level. So the instructional techniques of dental curricula are better to be revised to improve the performance of dental students to cut down the consumption of cariogenic snacks.

Dietary habit and lifestyle of postpartum women in South China: a mixed methods research.

OBJECTIVE: To investigate the dietary and hygiene behaviours and influencing factors of women during the puerperium in South China. DESIGN: A cross-sectional study. SETTING: Three tertiary hospitals in Guangdong Province, China PARTICIPANTS: From November 2022 to March 2023, 327 women with puerperal experience were enrolled using the purposive sampling method, with 323 valid questionnaires collected for data analysis. Semistructured interviews were conducted with six puerperium women and five primary caregivers. PRIMARY AND SECONDARY OUTCOME MEASURES: This study used a questionnaire survey to collect and analyse the current postpartum dietary and hygiene behaviours among women in the South China region, along with their influencing factors. RESULTS: Multinomial logistics regression revealed women residing in urban-rural fringe were more likely to use ventilated rooms (OR 4.496, 95% CI 2.363 to 8.552) and avoid hair washing (OR 0.345, 95% CI 0.159 to 0.749) compared with urban residents. Additionally, women who practiced Buddhism were more likely to wash their hair (OR 11.070, 95% CI 2.339 to 52.379) and take baths (OR 6.856, 95% CI 2.057 to 22.855) compared with those with no religious affiliation. Lastly, those whose primary caregiver was their husband were more likely to consume watermelon (OR 2.235, 95% CI 1.119 to 4.463), persimmon (OR 4.395, 95% CI 1.886 to 10.242) and longan (OR 2.612, 95% CI 1.362 to 5.010). The qualitative study identified five themes: dietary practices, hygiene habits, personal attitude, sources of information and support. CONCLUSION: The dietary and hygiene behaviours of puerperium women in South China are significantly influenced by the residen, primary caregivers and religious beliefs. Medical care providers should adopt a precision postpartum care strategy to improve the quality of care.

Role of vitamin C in treatment of community-acquired pneumonia in adult patients requiring hospitalisation: a systematic review protocol.

INTRODUCTION: Community-acquired pneumonia (CAP) is a leading cause of hospitalisation and is associated with a high mortality. Vitamin C is a powerful antioxidant and has been used in treatment of infections; however, its role as an adjunctive treatment in CAP is unclear. This review aims to assess the efficacy and safety of vitamin C in adults who require hospitalisation for CAP. METHODS AND ANALYSES: Searches will be conducted from inception to November 2023 on Ovid MEDLINE Daily and MEDLINE, Embase CINAHL, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science and ClinicalTrials.gov databases with the aid of a medical librarian. We will include data from randomised controlled trials reporting vitamin C supplementation in patients with CAP requiring hospitalisation. Two independent reviewers will select studies, extract data and will assess the risk of bias by use of the Risk of Bias tool. The overall certainty of evidence will be assessed by use of the Grading of Recommendations Assessment, Development and Evaluation framework. Random-effects meta-analyses will be conducted, and effect measures will be reported as relative risks with 95% CIs. ETHICS AND DISSEMINATION: No previous ethical approval is required for this review. The findings of this review will be submitted to a scientific journal and presented at an international medical conference. PROSPERO REGISTRATION NUMBER: 483860.

Long-term trajectories of weight loss and health outcomes: protocol of the SCOOP-RNPC nationwide observational study.

INTRODUCTION: Behavioural weight loss programmes are generally accepted as being beneficial in reducing cardiometabolic risk and improving patient-reported outcomes. However, prospective data from large real-world cohorts are scarce concerning the mid-term and long-term impact of such interventions. The objective of this large prospective cohort study (n>10 000 participants) is to demonstrate the effectiveness of the standardised Nutritional and Psycho-Behavioural Rehabilitation programme (RNPC Programme) in reducing the percentage of subjects requiring insulin and/or other diabetes drug therapy, antihypertensive drugs, lipid-lowering therapies and continuous positive airway pressure therapy for obstructive sleep apnoea after the end of the intervention. The rate of remission of hypertension, type 2 diabetes and sleep apnoea will also be prospectively assessed. METHODS: This is a prospective multicentre observational study carried out in 92 RNPC centres in France. Participants will follow the standardised RNPC Programme. The prospective dataset will include clinical, anthropometric and biochemical data, comorbidities, medications, body composition, patient-reported outcome questionnaire responses, sleep study data with objective measurements of sleep apnoea severity and surrogate markers of cardiovascular risk (ie, blood pressure and arterial stiffness). About 10 000 overweight or obese participants will be included over 2 years with a follow-up duration of up to 5 years. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the Ethics Committee (Comité de protection des personnes Sud-Est I) of Saint-Etienne University Hospital, France (SI number: 23.00174.000237). Results will be submitted for publication in peer-review journals, presented at conferences and inform the design of a future randomised controlled trial in the specific population identified as good responders to the RNPC Programme. TRIAL REGISTRATION NUMBER: NCT05857319.

Supplements for cognitive ability in patients with mild cognitive impairment or Alzheimer's disease: a protocol for systematic review and network meta-analysis of randomised controlled trials.

INTRODUCTION: Considering the increasing incidence of Alzheimer's disease (AD) and mild cognitive impairment (MCI) worldwide, there is an urgent need to identify efficacious, safe and convenient treatments. Numerous investigations have been conducted on the use of supplements in this domain, with oral supplementation emerging as a viable therapeutic approach for AD or MCI. Nevertheless, given the multitude of available supplements, it becomes imperative to identify the optimal treatment regimen. METHODS AND ANALYSIS: Eight academic databases and three clinical trial registries will be searched from their inception to 1 June 2023. To identify randomised controlled trials investigating the effects of supplements on patients with AD or MCI, two independent reviewers (X-YZ and Y-QL) will extract relevant information from eligible articles, while the risk of bias in the included studies will be assessed using the Rob 2.0 tool developed by the Cochrane Collaboration. The primary outcome of interest is the overall cognitive function. Pair-wise meta-analysis will be conducted using RevMan V.5.3, while network meta-analysis will be carried out using Stata 17.0 and ADDIS 1.16.8. Heterogeneity test, data synthesis and subgroup analysis will be performed if necessary. The GRADE system will be employed to assess the quality of evidence. This study is scheduled to commence on 1 June 2023 and conclude on 1 October 2023. ETHICS AND DISSEMINATION: Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer-reviewed journal or at a conference. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42023414700).

Evidence related to a vegetarian diet and metabolic dysfunction-associated steatotic liver disease: protocol for a scoping review.

INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MASLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease worldwide. Given that there is no pharmacological treatment for MASLD, it is imperative to understand whether lifestyle modifications may improve biochemical and pathological outcomes. One commonly proposed dietary modification is the Mediterranean diet; however, vegetarianism may also be a promising intervention. Vegetarianism has been shown to be associated with reduced morbidity and mortality in metabolic syndrome outcomes in coronary artery disease and diabetes; however, the relationship between vegetarian diet and MASLD is less clear. In this scoping review, we will provide a comprehensive overview of the current body of evidence related to a vegetarian diet and MASLD. METHODS AND ANALYSIS: The aim of this scoping review is to describe and summarise the current body of evidence related to MASLD and a vegetarian diet. This review will be conducted using Arksey and O'Malley's framework. The literature review will be conducted using the following databases: SCOPUS, Web of Science, CINAHL-Plus, Cochrane Library and Medline. No restriction will be made on publication date. Included studies will encompass clinical trials and observational designs that examine effects or association of vegetarian diet in adults (≥16 years) and report on the incidence, prevalence or progression of MASLD. Grey literature, non-human studies and articles focusing on changes in a specific food or nutraceutical will be excluded. Articles must have an English-language abstract available to be considered for inclusion. Screening and data extraction will be conducted by two independent reviewers. The findings will be summarised with descriptive statistics. ETHICS AND DISSEMINATION: Approval from a medical ethics committee is not required for this review. Once the review is complete, the findings will be submitted to a peer-reviewed journal.

Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study.

BACKGROUND AND AIMS: Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty. METHODS: This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients. RESULTS: Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients. CONCLUSIONS: Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients. TRIAL REGISTRATION NUMBER: China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).