Dietary patterns in patients with asthma and their relationship with asthma-related emergency room visits: NHANES 2005-2016.

RATIONALE: Extensive interdependencies exist between dietary intake, metabolic dysregulation, and asthma; however, the dietary pattern in adults with asthma remains unknown. OBJECTIVES: To evaluate the association between dietary patterns and asthma ER visits and explore the effect of the interaction between race and diet on asthma. METHODS: Using NHANES data, we compared dietary patterns between adults with asthma with and without asthma-related emergency room (ER) visits in the previous year, and between subjects of different races. The 2015 Healthy Eating Index (HEI-2015) was used to assess alignment between dietary patterns and the 2015-2020 Dietary Guideline for Americans. RESULTS: Among 1681 individuals included in the study, 193 reported asthma-related ER visit. Patients with asthma had low fruit and vegetable intake, and a low mean (SE) HEI-2015 score [52.6 (0.53)]. Individuals with asthma-related ER visits had lower vegetable consumption compared to those without (median 0.61 vs. 0.85 cup equivalents). Furthermore, non-Hispanic Blacks (NHB) reported lower amount of vegetable (median cup equivalent 0.58 vs. 0.89) and fruit intake (0.17 vs. 0.39) and had a lower HEI-2015 score (49.9 vs. 52.9) comparing to non-Hispanic Whites. No association was discovered between dietary patterns and ER visits in multivariable analysis, or significant interactions between diet and race in predicting the need for ER visits. CONCLUSIONS: Dietary patterns in adult with current asthma are frequently misaligned with current dietary guidelines. Patients with asthma-related ER visits and of NHB race had lower vegetable consumption; however, the associations disappeared in multivariable analysis. The impact of diet on asthma is not straightforward and deserves further investigation.Supplemental data for this article is available online at at www.tandfonline.com/ijas.

Correlation of New Criteria for Malnutrition Assessment in Hospitalized Patients: AND-ASPEN Versus SGA.

Objectives: Identifying malnutrition in the hospitalized patient is important as it correlates with increased morbidity. The Subjective Global Assessment (SGA) is recognized in the literature as a standardized and validated method for diagnosing malnutrition. The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) developed a comprehensive method (AND-ASPEN criteria) for diagnosing malnutrition that has yet to be validated. In effort to validate the AND-ASPEN criteria for identifying malnutrition, this study investigated whether AND-ASPEN criteria would correlate with SGA in hospitalized patients.Methods: A cohort of patients >18 years old admitted to a tertiary hospital and assessed for malnutrition using AND-ASPEN criteria were randomly selected, and a retrospective review was completed. Criteria needed to perform SGA were extracted from the electronic medical record and SGA data were calculated and compared to AND-ASPEN malnutrition scoring. Spearman's correlation coefficient was used to assess correlation between the SGA and AND-ASPEN malnutrition score. Data are presented as mean ± standard deviation, median or frequency.Results: A total of 409 patients were reviewed and 225 (55%) met inclusion criteria. SGA malnutrition scores classified 47.1% (n = 106) of subjects as well-nourished, 32% (n = 72) moderately malnourished, and 20.9% (n = 47) severely malnourished. The AND-ASPEN malnutrition scores classified 43.8% (n = 179) of the subjects as well-nourished, 26.2% (n = 107) as moderately malnourished, and 30.1% (n = 123) severely malnourished. The SGA score and AND-ASPEN malnutrition diagnosis were found to be correlated (p < 0.001). There was no association between age or length of stay with either assessment tool.Conclusions: The AND-ASPEN criteria for diagnosing malnutrition correlated with SGA in identifying nutritional status in hospitalized adult patients. Future prospective studies capturing the impact of malnutrition diagnosis, medical and nutrition interventions with patient outcomes are warranted to confirm the impact of early and accurate identification of malnutrition of patient outcomes.

The breath print represents a novel biomarker of malnutrition in pulmonary arterial hypertension: A proof of concept study.

BACKGROUND: The breath print is a quantitative measurement of molecules in exhaled breath and represents a new frontier for biomarker identification. It is unknown whether this state-of-the-art, noninvasive method can detect malnutrition. We hypothesize that individuals with malnutrition will present with a distinguishable breath print. METHODS: We conducted a retrospective chart review on patients with previously analyzed breath samples to identify malnutrition. Breath was analyzed by selected-ion flow-tube mass spectrometry. Registered dietitians conducted a retrospective chart review to collect malnutrition diagnoses and nutrition status indicators. Patients were categorized into one of four groups: pulmonary arterial hypertension (PAH), PAH with malnutrition (PAH-Mal), control, and control with malnutrition (Control-Mal), based on the malnutrition diagnosis present in the patient's chart. Principle component analysis was conducted to characterize the breath print. A logistic regression model with forward selection was used to detect the best breath predictor combination of malnutrition. RESULTS: A total of 74 patients met inclusion criteria (PAH: 52; PAH-Mal: 10; control: 10; Control-Mal: 2). Levels of 1-octene (PAH-Mal, 5.1 ± 1.2; PAH, 12.5 ± 11.2; P = 0.005) and ammonia (PAH-Mal, 14.6 ± 15.8; PAH, 56.2 ± 64.2; P = 0.013) were reduced in PAH-Mal compared with PAH. The combination of 1-octene (P = 0.010) and 3-methylhexane (P = 0.045) distinguished malnutrition in PAH (receiver operating characteristic area under the curve: 0.8549). CONCLUSIONS: This proof of concept study provides the first evidence that the breath print is altered in malnutrition. Larger prospective studies are needed to validate these results and establish whether breath analysis may be a useful tool to screen for malnutrition in the clinical setting.

What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19?

Several agents intended to supplement dietary intake or endogenous molecules may have a theoretical role in preventing or treating COVID-19. Because of their potential to influence immune response, ascorbic acid (vitamin C), zinc, vitamin D, and N-acetylcysteine have been hypothesized to be useful for prevention or treatment of COVID-19. The authors outline the biologic plausibility, applicable clinical data, and potential role of each of these agents.