Associations Between Serum TNF-α, IL-6, hs-CRP and GLMD in Obese Children and Adolescents: A Cross-Sectional Study.

Purpose: To explore the relationships between serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) levels and glucolipid metabolism disorders (GLMD) in obese children and adolescents. Patients and Methods: In this cross-sectional study, 105 obese children and adolescents were selected for the detection of TNF-α, IL-6, hs-CRP, and glycolipid metabolism indicators. All participants were divided into elevated TNF-α group (≥8.1 pg/mL; n=49) and normal TNF-α group (<8.1 pg/mL; n=56), elevated IL-6 group (≥5.9 pg/mL; n=13) and normal IL-6 group (<5.9 pg/mL; n=92), elevated hs-CRP group (≥3.0 mg/L; n=44) and normal hs-CRP group (<3.0 mg/L; n=61), respectively. Results: Low-density lipoprotein cholesterol (LDL-C) in the elevated TNF-α group was higher than that in the normal TNF-α group (P=0.010). TNF-α was positively correlated with LDL-C (P=0.005). Fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR) in the elevated IL-6 group were higher than those in the normal IL-6 group (all for P <0.05), while high-density lipoprotein cholesterol (HDL-C) in the elevated IL-6 group was lower than that in the normal IL-6 group (P<0.001). IL-6 was positively correlated with FINS, 2-hour postprandial insulin, HOMA-IR and triglyceride (all for P <0.01), while was negatively correlated with HDL-C (P=0.006). Moreover, hs-CRP was positively correlated with FINS and HOMA-IR (all for P <0.05). Conclusion: There may be correlations between serum TNF-α, IL-6, hs-CRP levels and GLMD in obese children and adolescents. Attention should be paid to monitoring serum inflammatory factors and preventing their elevation in obese children and adolescents, thus reducing the occurrence of GLMD.

Efficacy and safety of parenteral nutrition with iron sucrose for anemia prevention in preterm infants: A randomized, double-blind controlled study.

BACKGROUND AND OBJECTIVES: Our objective is to study the efficacy and safety of parenteral nutrition (PN) with iron sucrose to prevent anemia in preterm infants. METHODS AND STUDY DESIGN: We performed a randomized, double-blind controlled trial in which preterm infants were divided into five groups randomly: a control group (PN without iron sucrose, namely group Iron-0), and intervention groups (PN with iron sucrose 100 µg/kg/d, 200 µg/kg/d, 300 µg/kg/d and 400 µg/kg/d, namely group Iron-1, 2, 3, and 4, respectively). The indicators were red blood cell (RBC) parameters, iron storage and oxidant stress. RESULTS: One hundred infants completed this study. Excepting the RBC count in Iron-2, the value of erythrocyte parameters in intervention groups decreased less than that in the control group. And the decrease of RBC count in Iron-1 (-0.6×1012/L vs -0.9×1012/L, p=0.033), hemoglobin in Iron-4 (-26.0 g/L vs -41.0 g/L, p=0.03) and hematocrit in Iron-1(-9.5% vs -14.0%, p=0.014) was significantly less than in the control group. The change of ferritin in Iron-4 was significantly higher than in the control group (280 ng/ml vs 118 ng/ml, p=0.04). There was no difference in serum iron in intervention groups when compared to the control group (p>0.05). Except for the change of malondialdehyde (MDA) in Iron-1, the increase in other intervention groups was higher than in the control group (p>0.05). CONCLUSIONS: PN with iron sucrose for prevention of anemia in preterm infants is safe and efficacious to some extent.

Effect of Decaffeinated Green Tea Polyphenols on Body Fat and Precocious Puberty in Obese Girls: A Randomized Controlled Trial.

Background: Obesity has been reported to be an important contributing factor for precocious puberty, especially in girls. The effect of green tea polyphenols on weight reduction in adult population has been shown, but few related studies have been conducted in children. This study was performed to examine the effectiveness and safety of decaffeinated green tea polyphenols (DGTP) on ameliorating obesity and early sexual development in girls with obesity. Design: This is a double-blinded randomized controlled trial. Girls with obesity aged 6-10 years old were randomly assigned to receive 400 mg/day DGTP or isodose placebo orally for 12 weeks. During this period, all participants received the same instruction on diet and exercise from trained dietitians. Anthropometric measurements, secondary sexual characteristics, B-scan ultrasonography of uterus, ovaries and breast tissues, and related biochemical parameters were examined and assessed pre- and post-treatment. Results: Between August 2018 and January 2020, 62 girls with obesity (DGTP group n = 31, control group n = 31) completed the intervention and were included in analysis. After the intervention, body mass index, waist circumference, and waist-to-hip ratio significantly decreased in both groups, but the percentage of body fat (PBF), serum uric acid (UA), and the volumes of ovaries decreased significantly only within the DGTP group. After controlling confounders, DGTP showed a significantly decreased effect on the change of PBF (ß = 2.932, 95% CI: 0.214 to 5.650), serum UA (ß = 52.601, 95% CI: 2.520 to 102.681), and ovarian volumes (right: ß = 1.881, 95% CI: 0.062 to 3.699, left: ß = 0.971, 95% CI: 0.019 to 1.923) in girls with obesity. No side effect was reported in both groups during the whole period. Conclusion: DGTP have shown beneficial effects of ameliorated obesity and postponed early sexual development in girls with obesity without any adverse effects. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT03628937], identifier [NCT03628937].

Primary intestinal lymphangiectasia in children: Twelve years of experience in the diagnosis and management.

BACKGROUND AND OBJECTIVES: Primary Intestinal Lymphangiectasia (PIL) is a rare congenital and digestive disease, which could present through a broad spectrum of clinical manifestations, diagnostic and treatment management. The aim of this study was to introduce the diagnosis and nutrition treatment of children with PIL through the twelve years of experience. METHODS AND STUDY DESIGN: The patients diagnosed with PIL admitted to the Department of Gastroenterology and Nutrition in Xinhua Hospital from June 2006 to September 2017 were included in the study. RESULTS: Ten patients were found to have PIL, and 5 of them were male. The mean age was 66 months at the time of diagnosis and 11 months at onset. The main clinical manifestations were diarrhea, edemas and abdominal distention. Marked dilatation of the intestinal lymphatic vessels was the characteristic of the endoscopic. All the patients presented with hypoproteinemia and hypoimmunoglobulinia. Six of them were treated with parenteral nutrition, and 9 of them were treated with a low-long-chain triglycerides (LCT), high-protein diet supplemented with medium-chain triglycerides (MCT). The clinical symptoms of the patients have improved after the MCT diet therapy. CONCLUSIONS: PIL should be considered first when there are clinical manifestations of chronic diarrhea, edema and abdominal distention, and biochemical results indicated the hypoproteinemia and hypoimmunoglobulinia, and the general treatment is invalid. Gastroscopy and E-colonoscopy with biopsies are the preferred method of diagnosis. Diet intervention (MCT diet) is the cornerstone and longtime medical treatment, which can improve the nutritional status and promote the survival quality of patients with PIL.

Relationship between energy intake, prognosis and related indicators in adults after cardiac, thoracic, and vascular surgery: A prospective observational study.

BACKGROUND AND OBJECTIVES: The study aimed to explore the association between energy intake (EI), the proportion of enteral nutrition intake (EN%), and prognostic-related indicators. METHODS AND STUDY DESIGN: This was a prospective observational study. Patients aged 18-80 years old, who had undergone cardiothoracic surgery, were enrolled between January 2017 and January 2018. The measured REE (mREE) was evaluated by indirect calorimetry (IC). The observational data on EI, EN% and EI/mREE% were collected following admission to ICU, ICU discharge, and prior to discharge. RESULTS: A total of 160 patients (60.6% male) were studied. The prealbumin and total protein were positively correlated with EN% at the time of ICU discharge; liver function index levels were negatively correlated with EI/mREE% at discharge (p<0.05). Multiple linear regression indicated that ALT levels as well as EI/mREE% were related to the duration of mechanical ventilation; ALT, AST, APACHE II were related to the ICU duration; EN% and EI/mREE% were related to the length of stay (LOS) following ICU discharge. EN% was related to the LOS in the hospital. CONCLUSIONS: The patients treated cardiothoracic surgery demonstrated associations of EN% with LOS in the hospital. Increased EN% and EI/mREE% were associated with higher serum protein levels and maintain normal liver function.

Resting Energy Expenditure Early after Cardiac Surgery and Validity of Predictive Equations: A Prospective Observational Study.

OBJECTIVE: Several predictive equations have been used to estimate patients' energy expenditure. The study aimed to describe the characteristics of resting energy expenditure (REE) in patients undergoing mechanical ventilation during early postoperative stage after cardiac surgery and evaluate the validity of 9 REE predictive equations. METHODS: This was a prospective observational study. Patients aged 18-80 years old, undergone open-heart surgery, were enrolled between January 2017 and 2018. The measured REE (mREE) was evaluated via indirect calorimetry (IC). The predictive resting energy expenditure (pREE) was suggested by 9 predictive equations, including Harris-Benedict (HB), HB coefficient method, Ireton-Jones, Owen, Mifflin, Liu, 25 × body weight (BW), 30 × BW, and 35 × BW. The association between mREE and pREE was assessed by Pearson's correlation, paired t test, Bland-Altman method, and the limits of agreement (LOA). RESULTS: mREE was related to gender, BMI, age, and body temperature. mREE was significantly correlated with pREE, as calculated by 9 equations (all p < 0.05). There was no significant difference between pREE and mREE, as calculated by 30 × BW kcal/kg/day (t = 0.782, p = 0.435), while significant differences were noted between mREE and pREE calculated by other equations (all p < 0.05). Taking the 30 × BW equation as a suitable candidate, most of the data points were within LOA, and the percentage was 95.6% (129/135). Considering the rationality of clinical use, accurate predictions (%) were calculated, and only 40.74% was acceptable. CONCLUSIONS: The 30 × BW equation is relatively acceptable for estimating REE in 9 predictive equations in the early stage after heart surgery. However, the IC method should be the first choice if it is feasible.

Nutrition profile of very low birth weight infants with extrauterine growth restriction in NICU.

BACKGROUND & AIMS: Extrauterine growth restriction (EUGR) is associated with long-term complications such as neurodevelopmental dysplasia, increased mortality, and chronic metabolic disease. The incidence of EUGR in very low birth weight infants (VLBWIs) is generally high. This study's objectives were to (1) evaluate the nutritional support of VLBWIs with EUGR in our hospital NICU in the past 2 y and (2) provide guidance for improving clinical practice. METHODS: Preterm infants (birth weight < 1500 g) admitted to our hospital from February 2017 to July 2019 were enrolled in the study. Nutrient intakes were recorded daily, and growth parameters were regularly measured. Based on whether the infants reached the 10th percentile of the 2013 Fenton growth curve at discharge, the infants were divided into a EUGR group (n = 134) and a non-EUGR group (n = 34) and their nutrition support were compared with current ESPGHAN guidelines. RESULTS: A total of 138 VLBWIs were enrolled in the study. Growth restriction was 18.1% at birth and 75.4% at discharge for weight. Enteral nutrition (EN) was initiated late compared with the guidelines. The cumulative EN interruption time was long, especially in the EUGR group. Insufficient energy and amino acid intakes were prevalent, and cumulative energy and amino acid deficits failed to be compensated at discharge. Lower Z-score at birth (OR = 0.055, 95% CI = 0.018-0.172, p < 0.001) and long cumulative interruption time (OR = 1.058, 95% CI = 1.001-1.119, p = 0.046) were risk factors for EUGR incidence. CONCLUSION: In general, the nutritional support for VLBWIs was inadequate, conservative enteral feeding was the main reason.

Milk Fat Globule Membrane Enhances Colonic-Mucus-Barrier Function in a Rat Model of Short-Bowel Syndrome.

BACKGROUND: Clinical research reveals that colon plays an important role in mitigating the effects of short-bowel syndrome (SBS). Previously, we showed that the milk fat globule membrane (MFGM) had protective effects on gut barrier integrity in the rat SBS model. Here, we used the same rat model to investigate the effects of enteral MFGM supplementation on gut microbiota and colonic-mucus-barrier function and its related mechanisms. METHODS: We randomly divided 24 male Sprague-Dawley rats into 3 groups: Sham, SBS (rats with massive small-bowel resection), and SBS+MFGM (SBS rats supplemented with 1.5 g/kg/d MFGM). We then evaluated gut permeability, crypt depth, goblet-cell count, mucin 1 (MUC1), mucin 2 (MUC2), microbiota, short-chain fatty acids, and protein expressions of nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain-containing protein 6 (NLRP6) pathway of the colon. RESULTS: Compared with SBS rats, SBS+MFGM rats exhibited lower intestinal permeability, increased crypt depth, more goblet cells, and more MUC1/MUC2-positive cells. The SBS+MFGM group also had greater Firmicutes abundance and lower acetate concentration (P < .05). Sham rats had significantly lower Bacteroidetes abundance than SBS rats, but SBS+MFGM and SBS groups did not differ. Additionally, the SBS+MFGM group had higher NLRP6 and interleukin (IL)-18 expression but lower IL-1ß and Caspase-1 (cysteinyl aspartate-specific protease-1) expression than the SBS group (P < .05). CONCLUSION: Supplementation of MFGM modulates gut microbiota composition in SBS, possibly through strengthening the colonic mucus barrier and regulation of NLRP6 inflammasome.

Current Status of Sarcopenia in the Disabled Elderly of Chinese Communities in Shanghai: Based on the Updated EWGSOP Consensus for Sarcopenia.

Our study aimed to investigate the prevalence and associated factors of sarcopenia in the disabled elderly in communities in Shanghai, China. A cross-sectional study was conducted in 2018. Five hundred and seventy two participants (≥60 years) were recruited through cluster sampling from Putuo District of Shanghai. Sarcopenia was defined according to the updated consensus of the European Sarcoma Working Group in 2019. The sarcopenia, depression, and nutrition status were assessed by using SARC-F, the Short Version of the Center for Epidemiological Studies Depression Scale (CES-D-10), and the Mini Nutritional Assessment-Short form (MNA-SF), respectively Physical activity was also assessed. Our results showed the prevalence of sarcopenia was 0.5%, but the prevalence of low handgrip strength was 37.2% (male, 5.5%; female, 39.1%). The modified Poisson regression model was used to evaluate the relationship among related variables and low handgrip strength. The risk for low handgrip strength was higher in the physically disabled subjects than in the visually disabled ones (aPR: 1.69, 95% CI: 1.88-2.42). Depressive symptoms (aPR: 1.31, 95% CI: 1.04-1.62) and PASE score (aPR: 0.99, 95% CI: 0.99-1.00) were independently associated with low handgrip strength. In summary, the prevalence of EWGSOP2-defined sarcopenia is low and the prevalence of declined muscle strength is high in the disabled elderly. The elderly participants with a physical disability had a higher prevalence of low hand handgrip strength than those with a visual disability. More studies with a larger sample size and longitudinal follow-up are needed to confirm our findings.

Healthy adult vegetarians have better renal function than matched omnivores: a cross-sectional study in China.

BACKGROUND: An appropriate diet is an important determinant of kidney health. However, the association between vegetarian diets and renal function is unclear. We aimed to study the association between vegetarian diets and renal function in healthy adults. METHODS: A total of 269 vegetarians and 269 sex- and age-matched nonvegetarian omnivores were enrolled in this cross-sectional study. Basic characteristics and daily dietary intakes were assessed by face-to-face interviews. Blood samples were collected, and renal function was assessed by measuring blood urea nitrogen (BUN), serum creatinine (SCr), uric acid (UA) and the estimated glomerular filtration rate (eGFR). Blood pressure, fasting blood glucose and blood lipid profiles were also assessed. RESULTS: The average age of the vegetarians was 35.4 ± 8.6 years, 82.2% of whom were female. We evaluated the association between vegetarian diets and renal function using multivariate analysis. Compared with omnivores, vegetarians had lower BUN [ß = - 0.63, 95% confidence interval (CI): (- 0.88, - 0.38)], SCr [ß = - 2.04, 95% CI:(- 4.10, 0.02)], and UA levels [ß = - 15.15, 95% CI: (- 27.81, - 2.50)] and higher eGFRs [ß = 4.04, 95% CI: (0.30, 7.78)] after adjusting for sex, age, body mass index (BMI), physical activity, alcohol consumption, smoking status, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), systolic pressure and fasting blood glucose. Further analysis of food composition and renal function showed that dietary fiber intake was significantly negatively associated with BUN [ß = - 0.02, 95% CI: (- 0.03, 0.00)], SCr [ß = - 0.14, 95% CI: (- 0.25, 0.04)], and UA levels [ß = - 0.72, 95% CI: (- 1.36, 0.07)] and positively associated with the eGFR [ß = 0.20, 95% CI: (0.00, 0.40)]. CONCLUSIONS: Healthy adult vegetarians have better renal function than omnivores, and the higher dietary fiber intake associated with vegetarian diets may contribute to the protective effect on renal function.

Dietary Choline Intake during Pregnancy and PEMT rs7946 Polymorphism on Risk of Preterm Birth: A Case-Control Study.

INTRODUCTION AND AIMS: Choline-metabolizing genetic variation may interact with choline intake on fetal programming and pregnancy outcome. This case-control study aims to explore the association of maternal choline consumption and phosphatidylethanolamine N-methyltransferase (PEMT) gene polymorphism rs7946 with preterm birth risk. METHODS: 145 Han Chinese women with preterm delivery and 157 Han Chinese women with term delivery were recruited in Shanghai. Dietary choline intake during pregnancy was assessed using a validated food frequency questionnaire. Additionally, DNA samples were genotyped for PEMT rs7946 (G5465A) with plasma homocysteine (Hcy) levels measured. RESULTS: Compared with the lowest quartile of choline intake, women within the highest consumption quartile had adjusted odds ratio (aOR) for preterm birth of 0.48 (95% confidence interval, CI [0.24, 0.95]). There was a significant interaction between maternal choline intake and PEMT rs7946 (p for interaction = 0.04), where the AA genotype carriers who consumed the energy-adjusted choline <255.01 mg/day had aOR for preterm birth of 3.75 (95% CI [1.24, 11.35]), compared to those with GG genotype and choline intake >255.01 mg/day during pregnancy. Additionally, the greatest elevated plasma Hcy was found in the cases with AA genotype and choline consumption <255.01 mg/day (p < 0.001). CONCLUSION: The AA genotype of PEMT rs7946 may be associated with increased preterm birth in these Han Chinese women with low choline intake during pregnancy.

Soluble Mediators From Lactobacillus rhamnosus Gorbach-Goldin Support Intestinal Barrier Function in Rats After Massive Small-Bowel Resection.

BACKGROUND: Intestinal barrier plays an essential role in maintaining gastrointestinal health. This study aimed to explore the effects of a soluble mediator preparation derived from Lactobacillus rhamnosus Gorbach-Goldin (LGG) on intestinal barrier function in a rat model of short bowel syndrome (SBS). METHODS: Six-week-old male Sprague-Dawley rats underwent 80% small-bowel resection (SBR) and then were supplemented with water (SBS), 5 × 108 colony-forming unit viable LGG (SBS+LGG), or the LGG soluble mediators (SBS+LSM) in an equivalent dose to LGG by intragastric gavage daily from day 2 throughout day 14 after operation. Rats that underwent bowel transection and reanastomosis were used as the sham group. Body weight, ileum histology, intestinal permeability and bacterial translocation, inflammatory cytokines, and tight junction protein expressions of ileum were evaluated. RESULTS: Animals undergoing SBR showed higher intestinal permeability and decreased expression of tight junction proteins in the ileum than sham group. Both SBS+LGG and SBS+LSM groups had reduced bacterial translocation and intestinal permeability as compared with the SBS group, with lower levels of serum endotoxin and tumor necrotizing factor alpha in ileum tissues. Moreover, the SBS+LSM group showed better body weight gain, lower endotoxin and FD-40 levels, and higher expressions of claudin-1 and claudin-4 in ileum than the SBS+LGG group. CONCLUSION: Enteral supplementation of LSMs or viable LGG can ameliorate intestinal barrier disruption in a rat model of SBS. The LSM preparation not only mimicked biological effects of viable LGG but also was revealed to be more effective in reducing inflammation and supporting intestinal barrier function.

Development and validation of a pediatric nutritional screening score (PNSS) for hospitalized children.

BACKGROUND AND OBJECTIVES: There is no evidence on the most effective nutritional screening tool for hospitalized children. The objective of this study was to develop and validate a pediatric nutritional screening tool to assess undernutrition risk upon hospital admission. METHODS AND STUDY DESIGN: The study had a two-phase prospective observational design. A novel pediatric nutritional screening score (PNSS) was developed and sensitivity, specificity, and reliability were evaluated by comparing with a complete dietetic assessment. Length of hospital stay, weight loss, disease complications, and nutritional support were recorded. RESULTS: PNSS consisted of three elements: disease with malnutrition risks, changes in food intake, and anthropometric measurements, with a score of 0-2 for each element. The optimal cut-off score to identify patients (n=96) at risk of undernutrition was two. The agreement between PNSS and the complete dietetic assessment was moderate (κ=0.435, 95% CI=0.373-0.498). Sensitivity and specificity values of PNSS were 82% (95% CI=76%-87%) and 71% (95% CI=67%-74%), respectively. Inter-rater agreement had a κ value of 0.596 (95% CI=0.529-0.664, p<0.001). The percentage of children with undernutrition risk was 44.9%. Children with oncologic, gastrointestinal, and cardiac diseases were most likely to be at risk of undernutrition. The at-risk group was associated significantly with longer length of hospital stay and higher percentage of weight loss compared with the not-at-risk group. CONCLUSION: PNSS is the first nutritional screening tool developed for hospitalized children and validated in a large population of patients in China.

Effects of early parenteral iron combined erythropoietin in preterm infants: A randomized controlled trial.

BACKGROUD: The aim of the study was to evaluate the effect of early parenteral iron supplementation combined erythropoietin for prevention of anemia in preterm infants. METHODS: In total, 96 preterm infants were randomly assigned to 3 groups: a control group receiving standard parenteral nutrition (group 1: n = 31), an iron-supplemented group (group 2: IS, n = 33), and an iron-supplemented combined erythropoietin group (group 3: IS+EPO, n = 32). The primary objective was to assess hemoglobin (Hb) levels. The secondary objectives included assessment of red blood cell counts (RBC), mean cell volume (MCV), serum iron, ferritin, percentages of reticulocyte (RET), total iron binding capacity (TIBC) and oxidative stress, which was assessed by measuring plasma levels of malondialdehyde and superoxide dismutase at baseline and at 2 weeks. The blood routine indices including Hb, RBC, MCV, and percentages of RET were measured at corrected age of 1 and 3 months. RESULTS: At 2 weeks of life, the percentages of reticulocyte in group 2 and group 3 were significantly higher than those in group 1 (2.1±0.4, 2.5±0.3, and 1.7±0.3, respectively, P < 0.001, P<0.001), whereas TIBC were significantly lower than those in group 1 (36.7±4.6, 36.0±4.7, and 41.6 ±â€Š5.2 respectively, P = 0.011, P = 0.006). There were no significant differences in RBC counts, the levels of hemoglobin, ferritin, malondialdehyde, and superoxide dismutase among the 3 groups at 2weeks of life. RBC, Hb, MCV, body weight, body length, and head circumference at a corrected age of 1 month did not differ among 3 groups. At corrected age of 3months, more infants in the control group had abnormal Hb and MCV levels (Hb levels: 114.3 ±â€Š21.3, 123.7 ±â€Š31.6, and 125.1 ±â€Š21.2, P = 0.021, P = 0.034, respectively; MCV: 74.1 ±â€Š3.5, 78.3 ±â€Š4.7 and 79.1 ±â€Š5.2, P = 0.017, P = 0.012, respectively), whereas cases of oral iron, cases of breastfeeding, RBC, body weight, body length, and head circumference were not different among 3 groups. CONCLUSION: Early parenteral iron supplementation combined erythropoietin in preterm infants improved the percentages of reticulocyte, decreased total iron binding capacity, and improved the Hb and MCV levels at 3 months of age. Early parenteral iron supplementations with EPO were beneficial for the preterm infants.

Retrospective Dual-Center Study of Parenteral Nutrition-Associated Cholestasis in Premature Neonates: 15 Years' Experience.

BACKGROUND: The pathogenesis of parenteral nutrition-associated cholestasis (PNAC) has not been clarified. The objective of this study was to explore the incidence of PNAC in premature infants without surgery and to identify associated risk factors. MATERIALS AND METHODS: Premature neonates who received parenteral nutrition (PN) at least 14 days were included in a retrospective, dual-center study. Cholestasis was diagnosed as conjugated bilirubin ≥2 mg/dL. Infants with metabolic liver disease, cyanotic congenital heart disease, congenital syphilis, hepadnaviridae infection, and those who underwent surgery were excluded. Infants were divided into 3 groups chronologically: group A (2000-2004, n = 50), group B (2005-2009, n = 283), and group C (2010-2014, n = 741). A case-controlled study was conducted by comparing infants with PNAC to those without PNAC. RESULTS: Of 1074 premature neonates, PNAC was confirmed in 53 infants (4.93%). There were 6.8% very low birth weight (BW) infants and 20.0% extremely low BW infants who developed PNAC. The incidence of PNAC decreased slightly during 2000-2014 (8.0%, 6.4%, and 4.2% in groups A, B, and C, respectively). Compared with those without PNAC, infants with PNAC (n = 53) had significantly younger gestational age, lower BW, longer PN duration, and higher rate of sepsis. Logistic regression showed male sex, PN duration ≥43 days, and sepsis were statistically correlated with PNAC. CONCLUSIONS: Prolonged duration (≥43 days), male sex, and sepsis are probably independent risk factors for developing PNAC in premature neonates.

Parenteral nutrition combined with rice soup can be a safe and effective intervention for congenital chylous ascites.

Congenital chylous ascites in the neonatal period is a rare entity. Total parenteral nutrition (TPN), medium chain triglyceride (MCT)-based diet, octreotide and repeated paracentesis are regarded as appropriate medical treatment for congenital chylous ascites, and surgery is recommended when conservative therapy has failed. We present two cases in which ascites were confirmed via an abdominal sonogram and diagnostic paracentesis. In our clinical experience, rice soup combined with PN can be a safe and effective intervention.

Effect of an Olive Oil-Based Lipid Emulsion Compared With a Soybean Oil-Based Lipid Emulsion on Liver Chemistry and Bile Acid Composition in Preterm Infants Receiving Parenteral Nutrition: A Double-Blind, Randomized Trial.

BACKGROUND: The pathogenesis of parenteral nutrition (PN)-associated liver dysfunction is multifactorial. Lipid emulsions may be one of the putative mechanisms. Our aim was to comparatively assess the effect of parenteral olive oil- and soybean oil-based lipid emulsions on liver chemistry and bile acid composition in preterm infants. METHODS: We performed a double-blind, randomized clinical study in which 103 preterm infants were randomly assigned to PN using either soybean oil-based lipid emulsion (SO; n = 51) or olive oil (OO)-based lipid emulsion (OO; n = 52). The primary end point was liver chemistry. The secondary end point was the plasma bile acid composition. RESULTS: One hundred infants completed this study. In the SO group, the serum direct bilirubin was significantly higher after PN for 7 days compared with the OO group. Bile acids increased over time in both treatment groups. However, specific differences in the change in bile acid composition over time were noted between groups. CONCLUSIONS: Differences in direct bilirubin and bile acid composition were observed over time between the 2 groups. Considering the long-term use of lipid emulsions in higher risk babies, these findings might be useful for understanding the pathogenesis of PN-associated liver dysfunction.

The effects of different lipid emulsions on the lipid profile, fatty acid composition, and antioxidant capacity of preterm infants: A double-blind, randomized clinical trial.

BACKGROUND & AIMS: Olive oil (OO), medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) mixture and soybean oil (SO) lipid emulsions are currently used for preterm infants in China. The aim of our study was to compare the lipid profile, fatty acid composition, and antioxidant capacity of preterm infants administered OO, MCT/LCT, or SO lipid emulsions. METHODS: In this study, 156 preterm infants (birth weight < 2000 g and gestational age < 37 weeks) received parenteral nutrition (PN) containing OO, MCT/LCT, or SO lipid emulsions for a minimum of 14 d. On days 0, 7, and 14, the lipid profile, fatty acid composition and antioxidant capacity were analyzed. RESULTS: On day 7, HDL levels in the MCT/LCT group were significantly lower than in the OO (1.06 ± 0.40 mmol/L) or SO groups. LDL levels were higher in the OO group than in the MCT/LCT or SO groups on day 7. A-I/B was higher in MCT/LCT than in OO or SO groups. Myristic acid (C14:0) levels on days 7 and 14 increased in MCT/LCT compared to the OO and SO groups. The OO group had higher oleic acid (C18:1n9) levels than the two other groups. Linoleic acid (C18:2n6), linolenic acid (C18:3n3), and eicosapentaenoic acid (20:5n3) were significantly lower in the OO group than in MCT/LCT or SO groups. Monounsaturated fatty acid levels decreased, and ω-6 polyunsaturated fatty acid and essential fatty acids levels increased in MCT/LCT and SO groups. No significant differences were obtained in SOD, MDA, GSH-Px, and T-AOC among the groups. CONCLUSION: The three lipid emulsions were safe and well tolerated in preterm infants. Oleic acid (C18:1n9) levels increased and LA (C18:2n6), ALA (C18:3n3), and EPA (C20:5n23) levels decreased in OO compared to MCT/LCT or SO. CLINICAL TRIAL REGISTRATION NUMBER: NCT01683162, https://register.clinicaltrials.gov/.

Choline Alleviates Parenteral Nutrition-Associated Duodenal Motility Disorder in Infant Rats.

BACKGROUND: Parenteral nutrition (PN) has been found to influence duodenal motility in animals. Choline is an essential nutrient, and its deficiency is related to PN-associated organ diseases. Therefore, this study was aimed to investigate the role of choline supplementation in an infant rat model of PN-associated duodenal motility disorder. MATERIALS AND METHODS: Three-week-old Sprague-Dawley male rats were fed chow and water (controls), PN solution (PN), or PN plus intravenous choline (600 mg/kg) (PN + choline). Rats underwent jugular vein cannulation for infusion of PN solution or 0.9% saline (controls) for 7 days. Duodenal oxidative stress status, concentrations of plasma choline, phosphocholine, and betaine and serum tumor necrosis factor (TNF)-α were assayed. The messenger RNA (mRNA) and protein expression of c-Kit proto-oncogene protein (c-Kit) and membrane-bound stem cell factor (mSCF) together with the electrophysiological features of slow waves in the duodenum were also evaluated. RESULTS: Rats on PN showed increased reactive oxygen species; decreased total antioxidant capacity in the duodenum; reduced plasma choline, phosphocholine, and betaine; and enhanced serum TNF-α concentrations, which were reversed by choline intervention. In addition, PN reduced mRNA and protein expression of mSCF and c-Kit, which were inversed under choline administration. Moreover, choline attenuated depolarized resting membrane potential and declined the frequency and amplitude of slow waves in duodenal smooth muscles of infant rats induced by PN, respectively. CONCLUSION: The addition of choline to PN may alleviate the progression of duodenal motor disorder through protecting smooth muscle cells from injury, promoting mSCF/c-Kit signaling, and attenuating impairment of interstitial cells of Cajal in the duodenum during PN feeding.

[Prevalence of vegetarians and vegetarian's health dietary behavior survey in Shanghai].

OBJECTIVE: To assess the prevalence of vegetarians in the whole Shanghai population, and to know the vegetarians' brief and behavior on diet, nutrition and health. METHODS: First, a multi-staged, stratified, clustered random sampling design was used. A total representative sample of 4 004 Shanghai resident subjects were asked if they were vegetarians and what type of vegetarian they were by a well-designed questionnaire. Second, from ten vegetarian restaurants located in Shanghai. 473 adult vegetarians completed a questionnaire about vegetarian status, among whom 274 vegetarians completed a detailed questionnaire about their brief and behaviors on diet, nutrition and health status. RESULTS: Of 4 004 subjects, 0.77% were vegetarians (0.45% were lacto-vegetarians and 0. 12% were vegans). The average age was 65. 0 years. 74. 2% of the vegetarians were female. Of 473 vegetarians, 70. 2% of the vegetarians had college or higher education. Compared to vegans, lacto-ovo-vegetarians were significantly younger and had higher educational level. The main reasons for choosing a vegetarian lifestyle were religion (49. 3%) and health (31. 3%). Furthermore, more vegan tend to be Buddhist. Vegetarians were more concerned about their health (209/274, 76. 5%) , the consumption of balance diets (183/274, 66. 8%). Comparing with lacto-ovo-vegetarians (58. 3%) more vegans (70. 4%) believed in that vegetarian diet is a kind of healthy dietary pattern and will not have any nutrients deficiency (P = 0. 037). Vegetarians consumed more healthy foods (e. g.,whole grains, vegetables, soy products, and nuts) than the general population (P < 0. 01). Only 5. 8% of the vegetarians took dietary supplements. CONCLUSION: 0. 77% of population in Shanghai was vegetarian. The two main reasons for adopting a vegetarian lifestyle were religion and health. The vegetarians tend to have more nutrition knowledge, better attitude and behavior on health. However, most of the vegetarians had not realized the nutrient deficiency risk of vegetarian diets.