Effects of degree of milling on bran layer structure, physicochemical properties and cooking quality of brown rice.

Effects of varying degree of milling (DOM) (0-22%) on the bran layer structure, physicochemical properties, and cooking quality of brown rice were explored. As the DOM increased, bran degree, protein, lipid, dietary fiber, amylose, mineral elements, and color parameters (a* and b* values) of milled rice decreased while starch and L* value increased. Microscopic fluorescence images showed that the pericarp, combined seed coat-nucellus layer, and aleurone layer were removed in rice processed at DOM of 6.6%, 9.2%, and 15.4%, respectively. The pasting properties, thermal properties, and palatability of rice increased as the DOM increased. Principal component and correlation analysis indicated that excessive milling lead to a decline in nutritional value of rice with limited impact on enhancing palatability. Notably, when parts of aleurone cell wall were retained, rice samples exhibited high cooking and sensory properties. It serves as a potential guide to the production of moderately milled rice.

A population-based study of incidence, aetiology, treatment and outcome of enterocutaneous fistula.

AIM: The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10-year period and to describe aetiology, treatments, care consumption and outcome. METHOD: A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in-hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified. RESULTS: The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF-related in-hospital care until closure or end of follow-up was 4 (range 0-61) weeks. Eighty-eight patients (47%) received home-based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF-related death was 30.2%. CONCLUSION: This study defines the population-based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home-based healthcare.

Amino Acid Bitterness: Characterization and Suppression.

Amino acids are necessary for life, and many must be consumed because they cannot be endogenously synthesized. Typically, we eat them as proteins and peptides, which have little taste. However, we also directly ingest free amino acids, several of which are aversive because they elicit bitterness. This bitterness often prevents many patient populations from taking formulas and supplements containing free amino acids. Here, we characterize which amino acids are the most bitter, their concentration-intensity functions, and individual differences in bitterness perception, and we explore how sodium salts suppress the bitterness of amino acids. We found that the essential amino acids comprise the most bitter stimuli, with six of them conveying the most bitterness. Clustering and correlating amino acids by individual differences in bitterness perception show that there are approximately four groupings of amino acids and suggest that within these clusters, amino acids may be activating the same or overlapping TAS2Rs. We also show that bitterness can be largely suppressed by sodium salts for 5 of the 6 most bitter amino acids. These results hold promise for managing the bitter taste of nutritional supplements that contain amino acids and improving compliance.

Secondary Analysis Assesses Dietary Diversity Changes among Maya Guatemalan Women Post-Nutrition Interventions.

OBJECTIVES: This study aimed to evaluate the change in the Dietary Diversity (DD) Index of Maya women of reproductive age living in rural areas of the Western Highlands of Guatemala after nutrition, health, and agroecology interventions. METHODS: This is a secondary analysis study on DD from two matched groups from three villages in the Lake Atitlan area in the department of Sololá. The first cohort was recruited in 2017 (sample of n = 77). The second cohort was recruited in 2020 (sample of n = 61). Both were followed until 2021. The program provided various resources for assistance for food production and home improvements (sessions from 2018 to 2022). Agroecology sessions were conducted in the test farm. Due to the COVID-19, adjustments were made to continue the education and training sessions. RESULTS: Both cohort samples had a statistically significant increase in participants who consumed at least 15 g from five groups of foods (2017: p = .00002; 2020: p = .045). There was a statistically significant increase in mean food groups consumed daily (2017: p < .00001; 2020: p = .005). CONCLUSIONS FOR PRACTICE: Implementing interventions that include nutrition, health, and agroecology practices in the long term has demonstrated a statistically significant increase in the Dietary Diversity Index of Maya women in their reproductive years living in rural villages in the Western Highlands.

Response of broilers to supplementation of Salvia officinalis L. essential oil in hot ambient conditions.

Heat stress has various detrimental effects on poultry production. The aim of the study was to alleviate the effects of heat stress in broiler production. For this purpose, 288 one-day-old broiler chicks (Ross 308) were obtained from a commercial hatchery and randomly allocated to one of three treatment groups; CON: corn-soybean meal based commercial diet, SEO100: CON with 100 mg/kg Sage essential oil (SEO) and SEO200: CON with 200 mg/kg SEO with 96 birds in each group (4 replicates each) in a completely randomized design under hot ambient temperatures for 42 days. No differences were observed in the body weight, feed intake, and feed conversion ratio at 42 days of age among groups. However, there was a significant increase in 21-day body weight in SEO200 chicks compared to CON. Furthermore, the addition of SEO significantly decreased the mortality rate under heat stress conditions. The total oxidant status value was lower in broiler chickens in which SEO was added to their diets. While the total antioxidant status value was higher in SEO100 chicks, it did not show a linear increase. Additionally, the results demonstrated that the addition of SEO to broiler diets under heat stress did not have a significant effect on inspected meat quality traits, with the exception of the b*(yellowness) value of breast muscle. In conclusion, the results of this study indicate that 200 mg/kg SEO can be added to diets for the welfare of broiler chickens under heat stress conditions for struggling with oxidants and increasing viability. Further research is needed to investigate the antioxidant activity and meat quality of different levels of SEO in hot ambient conditions.

Peer-to-peer training among health care professionals working in dialysis clinics: an education approach from the GoodRENal project.

BACKGROUND: Lifestyle interventions aiming to improve dietary habits, increase physical activity level, and improve emotional well-being can positively impact clinical outcomes in patients with chronic kidney disease (CKD). Educational material for health care professionals working with CKD patients that focuses on why and how to promote lifestyle changes is lacking. The present study aims to depict the material and dissemination methods for the peer-to-peer training program developed for health care professionals working in the dialysis clinics of the four countries engaged in the GoodRENal project: Spain, Greece, Sweden, and Belgium. METHODS: This is an ERASMUS + project funded by the European Union (number 2020-1-ES01-KA2014-083141, http://goodrenal.eu/ ) named GoodRENal. The educational material was developed in English by a multidisciplinary team integrating the GoodRENal project (dietitian, physiotherapist, psychologist, and nephrologist). The material was then translated to Greek, Spanish, Swedish and Dutch and is available for download at the GoodRENal webpage ( https://goodrenal.es/results-3/ ). After training, the health care professionals filled in an anonymous questionnaire regarding their degree of satisfaction with the training. RESULTS: In total, 138 health care professionals in the four dialysis clinics joined the peer-to-peer training, representing 50% to 92% of the health care professionals in each clinic. From the total sample, 78 health care professionals responded to the satisfaction questionnaire. The answers showed that most participants were very satisfied or satisfied with the peer-to-peer training and that they found this approach useful in their clinical practice. CONCLUSION: The educational material developed for health care professionals working with patients on hemodialysis (HD) obtained good satisfaction scores from the participants.

Advanced lung cancer inflammation index is associated with mortality in critically ill patients with heart failure.

AIMS: Nutrition and inflammation status play a vital role in the prognosis of patients with heart failure (HF). This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a novel composite indicator of inflammation and nutrition, and short-term mortality among critically ill patients with HF. METHODS: This retrospective study included 548 critically ill patients with HF from the MIMIC-IV database. ALI was computed using body mass index, serum albumin and neutrophil-lymphocyte ratio. The primary endpoint was all-cause in-hospital mortality, and the secondary endpoint was 90 day mortality. Kaplan-Meier survival curve analysis with long-rank test and Cox proportional hazards regression models were employed to assess the relationship between baseline ALI and short-term mortality risk. The incremental predictive ability of ALI was evaluated by C-statistic, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS: The average age of 548 patients was 72.2 (61.9, 82.1) years, with 60% being male. Sixty-three patients (11.5%) died in the hospital, and 114 patients (20.8%) died within 90 days of intensive care unit admission. The Kaplan-Meier analysis revealed that the cumulative incidences of both in-hospital and 90 day mortality were significantly higher in patients with lower ALI (log-rank test, in-hospital mortality: P < 0.001; 90 day mortality: P < 0.001). The adjusted Cox proportional hazard model revealed that ALI was inversely associated with both in-hospital and 90 day mortality after adjusting for confounders [hazard ratio (HR) (95% confidence interval) (CI): 0.97 (0.94, 0.99), P = 0.035; HR (95% CI): 0.62 (0.39, 0.99), P = 0.046]. A linear relationship was observed between ALI and in-hospital mortality (P for non-linearity = 0.211). The addition of ALI significantly improved the prognostic ability of GWTG-HF score in the in-hospital mortality [C-statistic improved from 0.62 to 0.68, P = 0.001; continuous NRI (95% CI): 0.44 (0.20, 0.67), P < 0.001; IDI (95% CI): 0.03 (0.01, 0.04), P < 0.001] and 90 day mortality [C-statistic improved from 0.63 to 0.70, P < 0.001; continuous NRI (95% CI): 0.31 (0.11, 0.50), P = 0.002; IDI (95% CI): 0.01 (0.00, 0.02), P = 0.034]. Subgroup analysis revealed stronger correlations between ALI and in-hospital mortality in males and patients aged over 65 years (interaction P = 0.031 and 0.010, respectively). The C-statistic of in-hospital mortality in patients over 65 years was 0.66 (95% CI: 0.58, 0.74). CONCLUSIONS: ALI at baseline can independently predict the risk of short-term mortality in critically ill patients with HF, with lower ALI significantly associated with higher mortality. Further large prospective research with extended follow-up periods is necessary to validate the findings of this study.

Association of hemoglobin, albumin, lymphocyte, and platelet score with risk of all-cause and cause-specific mortality among cancer survivors: NHANES 1999-2018.

Background: The HALP score, comprising hemoglobin, albumin, lymphocyte, and platelet levels, serves as an indicator of both nutritional and inflammatory status. However, its correlation with all-cause and cause-specific mortality among cancer survivors remains unclear. Therefore, this study aims to investigate the relationship between HALP scores and mortality outcomes in this population. Method: We extracted cohort data spanning ten cycles (1999-2018) from the U.S. National Health and Nutrition Examination Survey (NHANES). Mortality rates, determined using the National Death Index (NDI) as of December 31, 2019, were assessed. Weighted multivariate logistic regression analyzed the association between HALP scores and cancer prevalence. Kaplan-Meier analyses and weighted multivariate-adjusted Cox analyses investigated the link between HALP scores and all-cause and cause-specific mortality in cancer survivors. Restricted cubic spline (RCS) analysis was employed to assess nonlinear relationships. Furthermore, multi-parametric subgroup analyses were conducted to ensure the robustness of the results. Results: Our study included 41,231 participants, of whom 3,786 were cancer survivors (prevalence: 9.5%). Over a median follow-up of 91 months (range: 51-136), we observed 1,339 deaths, including 397 from cancer, 368 from cardio-cerebrovascular disease, and 105 from respiratory disease. Elevated HALP scores showed a consistent association with reduced cancer incidence (P for trend <0.001). In multivariable-adjusted Cox regression analyses, HALP scores were significantly inversely associated with all-cause mortality, cancer mortality, cardio-cerebrovascular disease mortality, and respiratory disease mortality in cancer survivors (P for trend < 0.05). Nonlinear relationships between HALP scores and all-cause and cause-specific mortality in cancer survivors were evident through RCS regression modeling (P for nonlinearity < 0.01). Kaplan-Meier analyses demonstrated that higher HALP scores were indicative of a poorer prognosis. Conclusion: Our findings indicate a notable inverse correlation between HALP scores and both all-cause and cause-specific mortality among cancer survivors.

Association between systemic immune-inflammation index and cataract among outpatient US adults.

Background: While several studies have noted a higher SII correlates with multiple diseases, research on the association between SII and cataract remains limited. Our cross-sectional study seeks to examine the association between SII and cataract among outpatient US adults. Methods: This compensatory cross-sectional study utilized NHANES data from 1999 to 2008 cycles, conducting sample-weighted multivariate logistic regression and stratified analysis of subgroups. Results: Among 11,205 adults included in this study (5,571 [46.2%] male; 5,634 [53.8%] female), 2,131 (15.2%) had cataract and 9,074 (84.8%) did not have cataract. A fully adjusted model showed that SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts among women (OR, 1.27; 95% CI, 1.02-1.59) (p = 0.036). However, no difference was found in the men subgroup, and there was no significant interaction between SII and sex. Conclusion: Our results indicated that a SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts in women. This study is the first to specifically investigate the impact of a high SII on cataract risk in outpatient adults in the United States. By effectively addressing inflammation, it is possible to mitigate cataract progression and significantly enhance patient outcomes.

Role of Peripheral Parenteral Nutrition Composition on Clinical Outcomes in Patients Undergoing Gastrectomy or Colectomy: A Phase III Indian Clinical Trial.

Aims and background: Various types of parenteral nutritional products exist, each with specific formulations designed to meet the diverse nutritional needs of patient's post-abdominal surgery. Here, two different parenteral nutrition (PN) solutions BFLUID and NUTRIFLEX PERI are compared in terms of therapeutic efficacy and safety profile. Materials and methods: A prospective, multi-center, randomized, parallel-group, non-inferiority Phase III clinical trial compared two PN solutions namely BFLUID (N = 78) and NUTRIFLEX PERI (N = 72) in 150 patients undergoing gastrectomy or colectomy. Primary endpoints included length of hospital stay while secondary endpoints included assessment and comparison of length of ICU/HDU stay, assessment of incidents of infections and mortality, change in blood levels of vitamin B1, change in nutritional parameters, thrombophlebitis, pain at the injection site, and recording of adverse events (AEs). Results: There was no significant difference in terms of length of hospital stay, length of ICU/HDU stay as well as changes in nutritional parameters from baseline and change in blood levels of vitamin B1 from baseline. Both study groups exhibited comparability in terms of AEs, pain at the injection site, and the incidence of phlebitis. There was no significant difference in the number and severity of adverse events reported in both groups. Additionally, no signs of infection were observed in patients from either group. Conclusion: The trial successfully demonstrated the non-inferiority of BFLUID to NUTRIFLEX PERI. Moreover, the results indicated that PN enriched with high levels of branched-chain amino acids (BCAAs), essential amino acids (EAAs), and thiamine is both safe and efficacious for adult patients undergoing gastrectomy or colectomy. How to cite this article: Goyal A, Pathak A, BS Madhu, Soni H, Bhatt K, Raju KVVN, et al. Role of Peripheral Parenteral Nutrition Composition on Clinical Outcomes in Patients Undergoing Gastrectomy or Colectomy: A Phase III Indian Clinical Trial. Indian J Crit Care Med 2024;28(9):871-878.

A machine learning-based online web calculator to aid in the diagnosis of sarcopenia in the US community.

Background: Sarcopenia places a heavy healthcare burden on individuals and society. Recognizing sarcopenia and intervening at an early stage is critical. However, there is no simple and easy-to-use prediction tool for diagnosing sarcopenia. The aim of this study was to construct a well-performing online web calculator based on a machine learning approach to predict the risk of low lean body mass (LBM) to assist in the diagnosis of sarcopenia. Methods: Data from the National Health and Nutritional Examination Surveys 1999-2004 were selected for model construction, and the included data were randomly divided into training and validation sets in the ratio of 75:25. Six machine learning methods- Classification and Regression Trees, Logistic Regression, Neural Network, Random Forest, Support Vector Machine, and Extreme Gradient Boosting (XGBoost)-were used to develop the model. They are screened for features and evaluated for performance. The best-performing models were further developed as an online web calculator for clinical applications. Results: There were 3046 participants enrolled in the study and 815 (26.8%) participants with LBM. Through feature screening, height, waist circumference, race, and age were used as machine learning features to construct the model. After performance evaluation and sensitivity analysis, the XGBoost-based model was determined to be the best model with better discriminative performance, clinical utility, and robustness. Conclusion: The XGBoost-based model in this study has excellent performance, and the online web calculator based on it can easily and quickly predict the risk of LBM to aid in the diagnosis of sarcopenia in adults over the age of 60.

A tree-based approach to identify indispensable foods in minimum-cost food baskets.

Introduction: Optimization techniques, such as linear programming, can be used to estimate the minimum cost of a nutrient-adequate food basket, to determine if individuals or households can afford nutritious diets. These cost estimates typically account for seasonal fluctuations but often overlook significant disruptions in the availability of affordable nutritious food that can severely impact food and nutrition security. Methods: This paper proposes a tree-based method, the binary search tree, to assess the resilience of the cost estimate of the minimum-cost food basket. In particular, this method aims to identify indispensable foods in these baskets - those whose unavailability would lead to a substantial cost increase. The binary search tree operates by iteratively excluding essential food items while ensuring the construction of minimum-cost nutritious baskets. It considers all relevant combinations of foods up to a specified size and avoids unnecessary optimizations, thereby saving computation time. We describe how the resulting tree can be evaluated and condensed to capture only the necessary information for decision makers. The construction and evaluation of the binary search tree are independent of the (dietary) restrictions or type of optimization model (i.e., linear, non-linear or integer) included. Results: In general, the binary search tree can identify all (combinations of) foods whose exclusion leads to a significant cost increase of a nutritious food basket. Furthermore, it can detect possible substitute effects between foods and identify key limiting nutrients. A case study is presented in which the binary search tree is applied to data from Ebonyi, Nigeria, modeled using linear programming. We report all combinations of up to five foods that, when unavailable, can impact food and nutrition security in Ebonyi. Conclusion: The BST can provide insights into local food and nutrition security when facing drastic disruptions in access to nutritious foods by identifying indispensable foods. Its results can be used to inform and design interventions in the context of humanitarian operations.

Bibliometric analysis of nutrition in gastric cancer from 2013 to 2023.

Background: Increasing evidence suggests that nutrition plays an important role in the treatment of gastric cancer. However, no bibliometrics analysis has been conducted in this field. Our study aimed to conduct a bibliometric study to explore the latest publishing trends and areas of intense activity within the sphere of nutrition in gastric cancer. Method: Publications were extracted from the Web of Science Core Collection. CiteSpace (Version 6.2.4) and VOSviewer (Version 1.6.18) were used for visual analysis. Results: In total, there were 441 publications authored by 2,941 authors from 809 organizations and 47 countries, published in 182 journals from 2013 to 2023. The most prolific country was China, and the most productive institution was the Chinese Academy of Medical Sciences. The leading core journal was Nutrients. P Daisuke Kobayashi and Yasuhiro Kodera were the most influential authors. The first highly cited document was published in Gastric Cancer by Kamarajah et al. The hotspots in this field were nutrition treatment and nutritional status. Moreover, research on nutritional status and nutrition-related prognosis in gastric cancer might be a potential trend. Conclusion: Nutrition in gastric cancer is a burgeoning research field garnering increasing attention. Further investigation is necessary to better understand the impact of nutritional status on the prognosis of gastric cancer.

Contextualizing toxic elements in the diet: a case for integration of toxic element data into food databases.

Food composition data plays a key role in the practice of nutrition. However, nutrition professionals may currently lack the resources they need to integrate information about toxic elements - such as arsenic, cadmium, and lead - in food into the advice they give consumers. Geographic, sociocultural, and individual factors may impact not only the toxic element content of food, but also how the balance between potentially toxic and health-promoting components of food must be weighed. Better integration and contextualization of toxic element data into key food databases could allow for more nuanced, comprehensive nutrition guidance.

Undernutrition and associated factors among school-age children in Wolaita Zone, South Ethiopia: a comparative cross-sectional study.

Background: Nutritional deficiencies in school-age children are a public health concern, especially in resource-limited countries. A school feeding program involves the provision of food on-site or taken home to reduce hunger. It is implemented in several developing nations; however, little is known about the association of school feeding programs with the nutritional status of school-age children in the study area. Objectives: The study aimed to determine the magnitudes and associated factors of undernutrition among school-age children with school feeding programs (SFPs) and non-school feeding programs (N-SFPs) in Kindo Didaye woreda, South Ethiopia. Methods: A school-based comparative cross-sectional study was conducted in Kindo Didaye district from May to June 2023. A total of 612 participants were included in the study. The data were collected from each selected student's parents by using a structured interviewer-administered questionnaire. The weight and height of the children were measured, and a household dietary diversity assessment was conducted. The data were analyzed using SPSS version 25. A binary logistic regression analysis was carried out. A p-value of <0.05 and 95% confidence interval (CI) were used to establish a statistically significant association. Results: The magnitude of undernutrition among the school-age children was 38.9%: 43.3% in the children from the SFP schools and 34.5% in the children from the N-SFP schools. Stunting was 24.1% among the children in the schools with SFPs and 16% among the children in the N-SFP schools, whereas thinness was 33.8% among the children in the SFP schools and 25.6% among the children in the N-SFP schools. The children who were in the older age group [adjusted odds ratio (AOR) = 4.4, 95%CI; 2.22-8.85], consumed less than three meals per day at home (AOR = 6.03; 95%CI 3.9-9.3), and did not eat breakfast at all before going to school (AOR = 3.5; 95%CI 1.15-10.76) were more likely to become undernourished. The children whose fathers received secondary and above education (AOR = 0.52; 95% CI (0.27-0.971) had lower odds of becoming underweight. Conclusion: The magnitude of undernutrition was high in the current study. Existing interventions that work to improve the nutritional status of school-age children should be strengthened. Children should consume any type of food as breakfast at home before going to school regardless of the presence of school feeding programs and at least three times a day.

A nutrition-focused review of the interventions in US-living Latino communities with type II diabetes.

Type 2 diabetes (T2D) is a chronic, debilitating disease that disproportionally affects the Hispanic/Latino community residing in the United States. Optimal nutrition therapy is fundamental to the proper management of T2D and must be culturally adapted to facilitate permanent behavior change in this population. This review selected and assessed the nutrition components of interventions aimed to improve T2D outcomes in US-based Latinos/Hispanics, published from 2002 to 2023. An overview of the participant characteristics, nutrition intervention, and dietary assessment and outcomes is included. Nutrition interventions in this community benefit from the inclusion of bicultural registered dietitian nutritionist (RDNs) to assure the counseling team promotes culturally tailored nutrition recommendations based on current dietary guidelines. Nutrition assessment and outcomes should be captured with the use of validated dietary assessment tools and dietary quality indices appropriate to their target population. Standardizing these practices will facilitate intervention comparability and replicability and ultimately better target the needs of this community.

Cystine urolithiasis-free duration after first occurrence and treatment is longer for castrated dogs than for sexually intact male dogs.

OBJECTIVE: To evaluate outcome in 60 dogs with cystine urolithiasis treated with surgical removal with and without castration and postoperative therapeutic diet to determine frequency of recurrence and urolith-free duration. METHODS: Patient records were reviewed for dogs with documented cystine urolithiasis from September 2010 to December 2020. Medical records, client interviews, and referring veterinarians were contacted to document the absence of clinical signs associated with subsequent urolith formation and to evaluate risk factors for urolith reoccurrence. RESULTS: 80 patients were identified with cystine uroliths, with 60 qualifying for inclusion in the study. Seven dogs were neutered prior to surgery, and 25 dogs were neutered at the time of the first surgery. Recurrence occurred in 20 dogs; 17 of those patients were intact (85%) at the time of recurrent urinary signs. Of the 20 dogs with recurrence, 50% (10 of 20) were being treated with dietary modifications. CONCLUSIONS: The risk of recurrence among neutered pets was 23% versus 47% for intact pets, but this difference was not statistically significant; however, neutered pets had a longer urolithiasis-free duration. There was no statistically significant difference in risk of recurrence and urolith-free duration between pets with and without therapeutic diet management, (30% vs 32.5%) respectively. Multivariant analysis showed no significant interaction between surgical intervention with therapeutic diet, with nonsignificant hazard ratios (HRs) for neuter status (HR = 0.503), diet (HR = 1.056), and their interaction (HR = 4.32 to 9). CLINICAL RELEVANCE: Sexually intact (vs castrated) male dogs should be monitored more closely for recurrence of surgical cystine urolithiasis.

Food is Medicine National Summit: Transforming Health Care.

Food Is Medicine (FIM) interventions reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery. They comprise programs that provide nutritionally-tailored food, free of charge or at a discount, to support disease management, disease prevention, or optimal health, linked to the health care system as part of a patient's treatment plan. Such programs often prioritize health equity. On April 26-27, 2023, Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and Food & Nutrition Innovation Institute held a two-day National Food is Medicine Summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector to identify challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale. This report of a meeting describes key themes of the Summit, based on presentations and discussions on momentum around FIM, incorporating FIM in health care, tradeoffs and unintended consequences of various FIM models, scaling of programs, financing and payment mechanisms, educating and engaging the health care workforce, and federal and state government actions and opportunities on FIM. Speakers highlighted examples of recent public and private sector actions on FIM and innovative cross-sector partnerships, including state Medicaid waivers, academic and philanthropic research initiatives, health care system screenings and interventions, and collaborations including community-based organizations and/or entities outside of the food and health care sectors. Challenges and opportunities to broader implementation and scaling of FIM programs identified include incorporating FIM into health care business models, educating the health care workforce, and sustainably scaling FIM programs while leveraging the local connections of community-based organizations. This meeting report highlights recent advances, best practices, challenges, and opportunities discussed at the National Summit to inform future actions on FIM.