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OBJECTIVE: The Subjective Global Assessment (SGA) is a validated tool for identifying nutritional status in patients receiving maintenance dialysis (MHD), but it is not without limitations. Current research identifies additional clinical characteristics such as phase angle (PhA) associated with SGA. This study aimed to assess the overall correlation between PhA and SGA; associations between PhA and SGA by body mass index (BMI), and to identify clinical characteristics associated with SGA. DESIGN AND METHODS: This is a secondary analysis of the Rutgers Nutrition & Kidney Database, which enrolled participants from four primary studies that included adults diagnosed with chronic kidney disease who were receiving MHD. Multivariable binary logistic regression analyses were conducted to estimate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: The study sample included 60.0% males with 81.1% of the sample identifying as African American. Additionally, 38.9% were obese according to the BMI classification, and 57.0% were moderately malnourished. Patients with obesity had 44% lower odds of being moderately malnourished (OR=0.56, 95% CI= 0.37, 0.85). In the model adjusted for age and ethnicity and other clinical characteristics, increasing PhA values by one unit was associated with 28% lower odds (OR= 0.72, 95% CI= 0.53, 0.97) of being moderately malnourished while increasing waist circumference (WC) values by one unit was associated with 12% higher odds (OR= 1.12; 95% CI= 1.06, 1.19) of being moderately malnourished than well-nourished. In this fully adjusted model, increasing FFM (OR= 0.95, 95% CI=0.91, 0.99) and FM (OR = 0.92, 95% CI= 0.87, 0.97) by 1 kg was also associated with a 5% and 8% lower odds of being moderately malnourished, respectively. CONCLUSION: PhA and SGA were significantly associated only among patients classified as obese. PhA, WC, FM, and FFM were identified as potential clinical determinants of SGA. Patients receiving MHD and who have obesity may benefit from utilizing SGA along with WC, PhA, FM, and FFM to assess nutritional status.
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BACKGROUND/OBJECTIVE: Tooth loss is common among older adults and can affect dietary intake and weight status. This study investigated associations between dentition status and body mass index (BMI) in older adults. MATERIALS AND METHODS: This was a cross-sectional study of data from a convenience sample of older adults (65-89 years) treated at an urban U.S. dental school clinic. Clinical and demographic data were obtained from electronic health records. Dentition status was determined based on data from odontograms. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of having a non-normal weight status for each measure of dentition status, after adjusting for covariates. RESULTS: Patients (n = 1765) were 54.1% female, 51.5% White, 41.6% African American and 22.5% Hispanic/Latino. The median (interquartile range [IQR]) age was 71 (67.0-75.0) years; the mean (±SD) BMI was 28.5 (±5.7) kg/m2 ; 72.5% were overweight or obese. The median (IQR) number of remaining teeth was 20.0 (13.0-24.0); the median numbers of anterior and posterior occluding pairs of teeth were 5.0 (2.0-6.0) and 2.0 (0.0-5.0), respectively; and 44.9% had a functional dentition (≥21 teeth). Having a higher number of remaining teeth and more posterior occluding pairs were associated with lower odds of obesity (OR = 0.980, 95% CI = 0.964, 0.997, p = .022 and OR = 0.931, 95% CI = 0.885, 0.980, p = .006, respectively). Lack of a functional dentition was associated with higher odds of obesity (OR = 1.400, 95% CI = 1.078, 1.818, p = .012), after controlling for covariates. CONCLUSION: Older adults with tooth loss - especially loss of posterior occlusion and lack of a functional dentition - were more likely to be obese than of normal weight.
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OBJECTIVE: Health care professionals who hold a specialist certification typically have a high perceived value of their credential. However, the perceived value of the board-certified specialist in renal nutrition (CSR) credential has not been studied. This study evaluated the perceived value of the CSR credential among registered dietitian nutritionists (RDNs) using the Perceived Value of Certification Tool (PVCT©) and explored differences in perceived values among those who did and did not receive reimbursement for taking the credentialing examination. METHODS: A cross-sectional internet-based survey was sent to 553 RDNs who held the CSR credential. The survey included the 18-item PVCT© including 12 intrinsic and 6 extrinsic value statements. Total, intrinsic, and extrinsic value scores and percent agreement were calculated. Value scores were compared using the Mann-Whitney U test to assess differences between those who received reimbursement and those who did not. RESULTS: The response rate was 33.3% (n = 184). Twelve of 18 value statements had >80% agreement. The median PVCT© scores were 61.0 of 72.0 for total, 43.5 of 48.0 for intrinsic, and 18.0 of 24.0 for extrinsic values. Those who received reimbursement had significantly higher perceived extrinsic value scores than those who did not (P = .041). Intrinsic and total value scores were higher but not significantly different in those who received reimbursement. The statements with the highest percent agreement were "validates specialized knowledge" and "provides evidence of professional commitment", and the lowest value statement was "increases salary". CONCLUSIONS: RDNs have a high perceived value of the CSR credential. Those who received reimbursement for their credential examination had higher extrinsic value. Future research should explore the value of the CSR credential among RDNs without the CSR credential and among stakeholders.
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Dietética , Nutricionistas , Certificación , Habilitación Profesional , Estudios Transversales , Humanos , Encuestas y CuestionariosRESUMEN
Telomeres play a key role in chromosomal maintenance and stability. To date, few studies have investigated the association of leukocyte telomere length with risk of cancer incidence and all-cause mortality in a large prospective cohort, particularly of the Asian population. Relative telomere lengths in genomic DNA from peripheral blood samples were quantified using a validated quantitative real-time PCR among 26 540 middle-aged or older Chinese adults. Hazard ratios (HRs) and 95% confidence intervals (CIs) of cancer and deaths by quintiles of telomere length were calculated using the Cox proportional hazards regression method with adjustment for age, sex and other potential confounders. After baseline blood collection, 4353 persons developed cancer and 7609 died. Participants with the longest decile of telomeres had a 26% (95% CI: 11%-44%) higher risk of total cancer incidence compared to the shortest decile after controlling for age, sex and other potential founders (Ptrend < .0001). In contrast, longer telomeres were associated with lower risk of all-cause mortality (HR = 0.93; 95% CI: 0.84-1.03), noncancer death (HR = 0.81; 95% CI: 0.71-0.92), specifically, death from chronic obstructive pulmonary disease and pneumonia (HR = 0.79, 95% CI: 0.70-0.89) and digestive diseases (HR = 0.60, 95% CI: 0.42-0.88). Our findings demonstrated that longer telomeres are associated with increased risk of cancer development overall and several common cancer types including breast, rectal, prostate, pancreatic cancer and lung adenocarcinoma. Our study also confirmed that longer telomeres are associated with a reduced risk of noncancer related death.
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Leucocitos/ultraestructura , Neoplasias/mortalidad , Telómero/genética , Anciano , Pueblo Asiatico , China/etnología , Estudios de Cohortes , ADN/sangre , ADN/genética , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/epidemiología , Neoplasias/genética , Estudios Prospectivos , Singapur/epidemiologíaRESUMEN
BACKGROUND: Telomeres and telomerase play key roles in the chromosomal maintenance and stability. Recent epidemiological studies have shown that longer telomeres are associated with increased risk of several cancer types. However, epidemiological data for telomere length and risk of breast cancer are sparse. METHODS: We prospectively studied the association between telomere length and risk of breast cancer in 14,305 middle-aged or older Chinese women of the Singapore Chinese Health Study including 442 incident breast cancer cases after 12.3 years of follow-up. Relative telomere length in peripheral blood leukocytes was quantified using a validated monochrome multiple quantitative polymerase chain reaction method. The Cox proportional hazard regression method was used to estimate hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) for breast cancer associated with longer telomeres after adjustment for potential confounders. RESULTS: Longer telomeres were significantly associated with higher risk of breast cancer in a dose-dependent manner (Ptrend = 0.006); the highest quartile of telomere length was associated with a statistically significant 47% higher risk of breast cancer compared with the lowest quartile of telomere length after the adjustment for age and other known risk factors for breast cancer (HRQ4 vs Q1 = 1.47, 95% CI = 1.11, 1.94). CONCLUSIONS: The findings of the present study support the hypothesis that longer telomeres may be a risk factor for breast cancer. Telomere length in peripheral blood leukocytes may be developed as a biomarker for breast cancer risk prediction.
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Neoplasias de la Mama/genética , Neoplasias de la Mama/mortalidad , Leucocitos/metabolismo , Telómero/genética , Anciano , Biomarcadores , Biomarcadores de Tumor , Neoplasias de la Mama/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Singapur/epidemiología , Singapur/etnologíaRESUMEN
BACKGROUND: Consumption of green tea has been associated with reduced risk of breast cancer. Hormonal modulation has been suggested as one of the potential underlying mechanisms; however, it has yet to be fully elucidated in large, long-term human clinical trials. OBJECTIVE: We investigated the effects of decaffeinated green tea extract (GTE) on circulating sex hormones and insulin-like growth factor (IGF) proteins. METHODS: We conducted a placebo-controlled double-blind randomized clinical trial recruiting from 8 clinical centers in Minnesota. Participants were 538 healthy postmenopausal women randomly assigned to the GTE group (463 completed the study; mean age = 60.0 y) and 537 to the placebo group (474 completed; mean age = 59.7 y). Women in the GTE group orally took 4 decaffeinated capsules containing 1315 mg total catechins including 843 mg epigallocatechin-3-gallate daily for 1 y, whereas women in the placebo group took similar capsules containing no tea catechins. Blood sex hormones (estrone, estradiol, androstenedione, testosterone, and sex hormone-binding globulin) and IGF proteins (IGF-1 and IGF binding protein-3) were quantified at baseline and months 6 (for IGF proteins only) and 12, and were assessed as secondary outcomes of the study using a mixed-effect repeated-measures ANOVA model. RESULTS: Women in the GTE group had significantly higher blood total estradiol (16%; P = 0.02) and bioavailable estradiol (21%; P = 0.03) than in the placebo group at month 12. There was a statistically significant interaction between GTE supplementation and duration of treatment on estradiol and bioavailable estradiol (both Ps for interaction = 0.001). The catechol-O-methyltransferase genotype did not influence blood sex hormones before or after GTE supplementation. The circulating concentrations of IGF proteins were comparable between GTE and placebo groups at all 3 time points. CONCLUSION: These results suggest that a 12-mo GTE supplementation significantly increases circulating estradiol concentrations in healthy postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00917735.
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Neoplasias de la Mama , Catequina/farmacología , Hormonas Esteroides Gonadales/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Extractos Vegetales/farmacología , Té/química , Anciano , Catequina/química , Suplementos Dietéticos , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Extractos Vegetales/química , PosmenopausiaRESUMEN
Background: Dietary factors, such as antioxidant nutrients, contribute significantly to the maintenance of an appropriate balance between antioxidant defense and free radical production in the body.Objective: The objective of this study was to examine the relation between oxidative stress as assessed by plasma F2-isoprostane (IsoP) concentration, glycemic load (GL), glycemic index (GI), intake of antioxidant nutrients, dietary fiber, and polyunsaturated fatty acids (PUFAs).Methods: This study was a cross-sectional secondary analysis of baseline data collected from a random sample of 269 postmenopausal women participating in the Minnesota Green Tea Trial. GL, GI, and dietary variables were calculated from the diet history questionnaire. Subjects filled out surveys about the use of anti-inflammatory drugs and physical activity. Plasma IsoP concentration was assessed by GC-mass spectrometry. IsoP concentrations were compared across quartiles of GL, GI, insoluble fiber, PUFAs, and antioxidant nutrients with the use of linear regression.Results: Antioxidant supplement intake, including zinc, copper, vitamin C and vitamin E, was reported by >60% of the participants. Mean intake of PUFAs was 12.5 g. Mean plasma IsoP concentrations increased from 34 to 36.7 pg/mL in the lowest quartiles of GL and GI, respectively, to 45.2 and 41.6 pg/mL, respectively, in the highest quartiles (P-trend = 0.0014 for GL and P-trend = 0.0379 for GI), whereas mean IsoP concentrations decreased from 41.8 pg/mL in the lowest quartile of PUFAs to 34.9 pg/mL in the highest quartile (P-trend = 0.0416). Similarly, mean IsoP concentrations decreased from 44.4 pg/mL in the lowest quartile of insoluble fiber to 36 pg/mL in the highest quartile (P-trend = 0.0243) after adjustment for potential confounders.Conclusions: We concluded that dietary PUFAs and insoluble fiber are inversely associated with oxidative stress whereas GL and GI are positively associated with oxidative stress in postmenopausal women. This trial was registered at clinicaltrials.gov as NCT00917735.
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Dieta , Fibras de la Dieta/farmacología , F2-Isoprostanos/sangre , Ácidos Grasos Insaturados/farmacología , Índice Glucémico , Carga Glucémica , Estrés Oxidativo , Antioxidantes/administración & dosificación , Estudios Transversales , Grasas Insaturadas en la Dieta/farmacología , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , Encuestas y CuestionariosRESUMEN
BACKGROUND: Green tea consumption has been associated with favorable changes in body weight and obesity-related hormones, although it is not known whether these changes result from green tea polyphenols or caffeine. OBJECTIVE: We examined the impact of decaffeinated green tea extract (GTE) containing 843 mg of (-)-epigallocatechin-3-gallate on anthropometric variables, obesity-associated hormones, and glucose homeostasis. METHODS: The Minnesota Green Tea Trial was a 12-mo randomized, double-blind, placebo-controlled clinical trial of 937 healthy postmenopausal women assigned to either decaffeinated GTE (1315 mg total catechins/d) or a placebo, stratified by catechol-O-methyltransferase (COMT) genotype. This study was conducted in a subset of 237 overweight and obese participants [body mass index (BMI) ≥25 kg/m(2)]. RESULTS: No changes in energy intake, body weight, BMI, or waist circumference (WC) were observed over 12 mo in women taking GTE (n = 117) or placebo (n = 120). No differences were seen in circulating leptin, ghrelin, adiponectin, or glucose concentrations at month 12. Participants randomly assigned to GTE with baseline insulin ≥10 µIU/mL (n = 23) had a decrease in fasting serum insulin from baseline to month 12 (-1.43 ± 0.59 µIU/mL), whereas those randomly assigned to placebo with baseline insulin ≥10 µIU/mL (n = 19) had an increase in insulin over 12 mo (0.55 ± 0.64 µIU/mL, P < 0.01). Participants with the homozygous high-activity (G/G) form of COMT had significantly lower adiponectin (5.97 ± 0.50 compared with 7.58 ± 0.53 µg/mL, P = 0.03) and greater insulin concentrations (7.63 ± 0.53 compared with 6.18 ± 0.36 µIU/mL, P = 0.02) at month 12 compared with those with the low-activity (A/A) genotype, regardless of treatment group. CONCLUSIONS: Decaffeinated GTE was not associated with reductions in body weight, BMI, or WC and did not alter energy intake or mean hormone concentrations in healthy postmenopausal women over 12 mo. GTE decreased fasting insulin concentrations in those with elevated baseline fasting concentrations. The high-activity form of the COMT enzyme may be associated with elevations in insulin and a reduction in adiponectin concentrations over time. This trial was registered at http://www.clinicaltrials.gov as NCT00917735.
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Adiponectina/sangre , Catecol O-Metiltransferasa/genética , Insulina/sangre , Obesidad/sangre , Sobrepeso/sangre , Té/química , Administración Oral , Anciano , Glucemia/metabolismo , Índice de Masa Corporal , Peso Corporal , Cafeína/administración & dosificación , Cafeína/análisis , Catequina/administración & dosificación , Catequina/análogos & derivados , Método Doble Ciego , Ingestión de Energía , Ayuno , Femenino , Genotipo , Ghrelina/sangre , Humanos , Leptina/sangre , Persona de Mediana Edad , Actividad Motora , Evaluación Nutricional , Extractos Vegetales/administración & dosificación , Polifenoles/administración & dosificación , Posmenopausia , Circunferencia de la CinturaRESUMEN
PURPOSE: The Minnesota Green Tea Trial (MGTT) was a randomized, placebo-controlled, double-blinded trial investigating the effect of daily green tea extract consumption for 12 months on biomarkers of breast cancer risk. METHODS: Participants were healthy postmenopausal women at high risk of breast cancer due to dense breast tissue with differing catechol-O-methyltransferase (COMT) genotypes. The intervention was a green tea catechin extract containing 843.0 ± 44.0 mg/day epigallocatechin gallate or placebo capsules for 1 year. Annual digital screening mammograms were obtained at baseline and month 12, and fasting blood and 24-h urine samples were provided at baseline and at months 6 and 12. Primary endpoints included changes in percent mammographic density, circulating endogenous sex hormones, and insulin-like growth factor axis proteins; secondary endpoints were changes in urinary estrogens and estrogen metabolites and circulating F2-isoprostanes, a biomarker of oxidative stress. RESULTS: The MGTT screened more than 100,000 mammograms and randomized 1,075 participants based on treatment (green tea extract vs. placebo), stratified by COMT genotype activity (high COMT vs. low/intermediate COMT genotype activity). A total of 937 women successfully completed the study and 138 dropped out (overall dropout rate = 12.8 %). CONCLUSIONS: In this paper we report the rationale, design, recruitment, participant characteristics, and methods for biomarker and statistical analyses.
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Biomarcadores/metabolismo , Neoplasias de la Mama/prevención & control , Mama/anatomía & histología , Mamografía , Té , Antioxidantes/administración & dosificación , Catequina/administración & dosificación , Catequina/análogos & derivados , Catecol O-Metiltransferasa/genética , Método Doble Ciego , Estrógenos/orina , F2-Isoprostanos/sangre , Femenino , Genotipo , Hormonas Esteroides Gonadales/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Persona de Mediana Edad , Minnesota , Estrés Oxidativo , Factores de RiesgoRESUMEN
High-dose vitamin B12 is a potential treatment for patients with vasodilatory shock that is refractory to other therapies. Vasodilatory shock is characterized by low blood pressure and low systemic vascular resistance. Nitric oxide and hydrogen sulfide, two potential targets of high-dose vitamin B12 given as hydroxocobalamin, facilitate this syndrome. This review explores the relationship between high-dose vitamin B12 and hemodynamic outcomes in adults with vasodilatory shock and provides an update on the literature since a 2019 review on this topic. A literature search of studies published in the past 5 years was conducted in the CINAHL, PubMed, Cochrane, and EMBASE databases in May 2023. After assessing for eligibility, eight studies met this review's inclusion criteria. Seven of the eight studies reported decreased vasopressor requirements for part or all of the study samples after receiving a hydroxocobalamin infusion. However, not all patients responded to hydroxocobalamin. These findings are limited by patient selection and differences in the timing of vasopressor requirement and blood pressure outcome assessments. The current evidence is promising as to whether vitamin B12 , given as a hydroxocobalamin infusion, may improve hemodynamic outcomes in vasodilatory shock, but the evidence is of low quality. The use of hydroxocobalamin to treat refractory, vasodilatory shock remains investigative. Larger randomized controlled trials are required to elucidate the role of vitamin B12 in treating refractory, vasodilatory shock, including in conjunction with other alternative therapies such as methylene blue and corticosteroids.
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Choque , Vitamina B 12 , Adulto , Humanos , Vitamina B 12/uso terapéutico , Hidroxocobalamina/uso terapéutico , Choque/tratamiento farmacológico , Vasoconstrictores/uso terapéutico , Vitaminas/uso terapéuticoRESUMEN
BACKGROUND: Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. METHODS: A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. RESULTS: The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). CONCLUSION: Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.
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Nutrición Enteral , Nutricionistas , Humanos , Femenino , Masculino , Adulto , Nutrición Enteral/métodos , Persona de Mediana Edad , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Modelos Logísticos , Estados Unidos , Competencia ClínicaRESUMEN
The predominant catechin in green tea, epigallocatechin gallate (EGCG), may be hepatotoxic in high doses. Our objective was to investigate the influence of catechol-O-methyltransferase (COMT) and uridine 5'-diphospho-glucuronosyltransferase 1A4 (UGT1A4) genotypes on changes in liver injury biomarkers in response to long-term, high-dose green tea extract (GTE) supplementation among postmenopausal women. A secondary analysis was conducted using data from the Minnesota Green Tea Trial (N = 1,075), in which participants were randomized to consume high-dose GTE (843 mg/day EGCG) or placebo capsules for 12 months. Analysis of covariance adjusting for potential confounders was performed to examine changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST: ALT ratio, and alkaline phosphatase from baseline to months 3, 6, 9, and 12 across COMT and UGT1A4 genotypes. Mean age and BMI within the GTE group (n = 400) were 59.8 yrs and 25.1 kg/m2, respectively, and 98% of subjects were white. From baseline to month 3, mean AST: ALT ratio change was +1.0% in the COMT (rs4680) A/G genotype versus -4.8% in the A/A genotype (p = 0.03). From baseline to months 6 and 9, respectively, mean ALT change was +78.1% and +82.1% in the UGT1A4 (rs6755571) A/C genotype versus +28.0% and +30.1% in the C/C genotype (p < 0.001 and p = 0.004, respectively). The UGT1A4 (rs6755571) A/C genotype may be an important risk factor for clinically-relevant serum transaminase elevations with 6-9 months of high-dose GTE supplementation among postmenopausal women. Understanding the genetic underpinnings of GTE-related hepatotoxicity may allow for a genetically-informed paradigm for therapeutic use of GTE.
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Catequina , Enfermedad Hepática Inducida por Sustancias y Drogas , Extractos Vegetales , Femenino , Humanos , Antioxidantes , Catecol O-Metiltransferasa/genética , Enfermedad Hepática Inducida por Sustancias y Drogas/genética , Suplementos Dietéticos , Genotipo , Glucuronosiltransferasa/genética , Extractos Vegetales/toxicidad , Té/toxicidadRESUMEN
Research suggests that adiponectin, leptin, and genetic polymorphisms such as catechol-O-methyltransferase (COMT) genotype may play an integral role in blood pressure status and thereby cardiovascular health. This is an area especially important for women who are post-menopause; however, the current literature investigating these associations is limited. This study was a cross-sectional secondary analysis of baseline data (N 237) from the Minnesota Green Tea Trial (MGTT). The current study explored the relationships between plasma adiponectin, leptin, and COMT genotype on blood pressure measures. Plasma adiponectin and leptin were obtained after an overnight fast of at least 10 h and were measured by the radioimmunoassay method. The relationships were analysed using multiple linear regression after adjusting for potential confounders. Effect modifications by age, body mass index (BMI) category, blood pressure category, antihypertensive medication use, and COMT genotype were also investigated. The majority of participants were non-Hispanic (97â 9 %) and Caucasian (94â 9 %). Mean (sd) age and BMI were 60â 7 (5â 0) years and 28â 2 (2â 9) kg/m2, respectively. After adjustment for confounding variables, neither plasma adiponectin, plasma leptin nor COMT genotype was associated with systolic or diastolic blood pressure measures. The results of stratified analyses also did not reveal any significant interactions or associations. Based on the findings of this study, which utilised more rigorous statistical methods than previous research, neither adiponectin, leptin nor COMT genotype play a role in blood pressure measures in women who are post-menopause.
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BACKGROUND: The Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change. METHODS: We retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in-patient care units. RESULTS: There was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05-1.15]; postprotocol = 0.36 [95% CI, 0.30-0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5-year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001). CONCLUSION: Our findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.
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Nutrición Enteral , Intubación Gastrointestinal , Adulto , Humanos , Nutrición Enteral/métodos , Estudios Retrospectivos , Intubación Gastrointestinal/métodos , Fenómenos Electromagnéticos , Intestino DelgadoRESUMEN
Green tea extract (GTE) is a potential mitigator of oxidative stress, and F2-isoprostanes are a reliable biomarker of oxidative stress. Genetic polymorphisms in the catechol-o-methyltransferase (COMT) gene may modify tea catechin metabolism, prolonging exposure. We hypothesized that GTE supplementation would decrease plasma F2-isoprostanes concentrations compared with placebo and that participants with the COMT genotype polymorphisms would experience a more significant expression of this outcome. This study was a secondary analysis of the Minnesota Green Tea Trial, a randomized placebo-controlled, double-blinded trial investigating the effects of GTE in women who were generally healthy and postmenopausal. The treatment group consumed 843 mg of epigallocatechin gallate daily for 12 months versus placebo. Participants in this study had a mean age of 60 years, were predominantly White, and most had a healthy body mass index. GTE supplementation did not significantly change plasma F2-isoprostanes concentrations compared with placebo after 12 months (P for overall treatment = .07). There were no significant interactions between treatment and age, or body mass index, physical activity, smoking history, and alcohol intake. COMT genotype did not modify the effect of GTE supplementation on F2-isoprostanes concentrations in the treatment group (P = .85). Among participants in the Minnesota Green Tea Trial, consuming GTE supplements daily for 1 year did not result in a significant decrease in plasma F2-isoprostanes concentrations. Likewise, the COMT genotype did not modify the effect of GTE supplementation on F2-isoprostanes concentrations.
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Catequina , F2-Isoprostanos , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , Catecol O-Metiltransferasa/genética , Isoprostanos , Antioxidantes , Té , Suplementos Dietéticos , Extractos Vegetales/uso terapéutico , Catequina/farmacologíaRESUMEN
Due to documented adverse events, understanding the prevalence of nutritional supplements commonly used by athletes is essential. This cross-sectional study used data from a web-based survey conducted in February-March 2022. Participants were Division I (DI) and Division III (DIII) student-athletes of the National Collegiate Athletic Association (NCAA). Chi-square tests were conducted to identify the differences in the prevalence of demographic and athletic characteristics between the divisions. Multivariable odds ratios and 95% confidence intervals were calculated using logistic regression adjusting for potential confounders to determine the predictors of supplement usage. A total of 247 NCAA student-athletes (72.5% Division I, 27.5% Division III) completed the survey, yielding a 24.5% response rate. There were no significant differences between nutritional supplementation and NCAA divisions. Instead, all student-athletes used supplements regardless of division. There were significant differences in race, ethnicity, sports dietitian access, name, image, and likeness (NIL), advisement to consume NS, and knowledge of NS between the divisions (all P-values < 0.01). Unadjusted regression models showed that being in an upper-level academic standing was associated with higher odds of using sports food and ergogenic supplements than student-athletes with a lower-level academic standing. However, multivariable logistic regression analysis revealed that none of the demographic and athletic characteristics significantly affected supplement usage. Allocating resources for access to sports dietitians and supplement education for all divisions may benefit student-athletes knowledge and safety.
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Deportes , Humanos , Estudios Transversales , Atletas , Suplementos Dietéticos , EstudiantesRESUMEN
OBJECTIVE: To explore the feasibility of screening for type 2 diabetes (T2DM) and the prevalence of adult patients seen in a dental clinic at risk for T2DM based on American Diabetes Association (ADA) diabetes risk test (DRT) scores and point of care hemoglobin A1C (A1C) values. METHOD AND MATERIALS: This was a cross-sectional analysis of data from adults 18 to 89 years old seen in an academic dental clinic between November 2019 and April 2022 without prior history of diabetes. Clinical and demographic data were obtained from electronic health records and odontograms. Frequency distributions, chi-square, and Mann-Whitney U tests were used for data analysis. RESULTS: Of the 13,519 patients whose data were included, 54.7% (n = 7,389) were women. Of those with race and ethnicity data, 53.6% (n = 2,871) were white, 40.2% (n = 2,153) were African American, and 29.5% (n = 1,559) were Hispanic/Latino. Mean ± SD age was 47.0 + 17.0 years; mean ± SD body mass index was 28.0 ± 6.1 kg/m2. Thirty-five percent (n = 4,774) had diabetes risk test scores reflecting T2DM risk. Those at risk were more likely to be older, male, and overweight/obese than those not at risk (P < .001). Of those at risk who consented to a point of care A1C (9.8%, n = 470), 40.2% (n = 189) had values consistent with dysglycemia (A1C ≥ 5.7%); 34.9% (n = 164) reflecting prediabetes (A1C = 5.7% to 6.4%) and 5.3% (n = 25) diabetes (A1C ≥ 6.5%). CONCLUSIONS: Diabetes screening in a dental clinic identified that over one-third of adults without T2DM were at risk based on diabetes risk test scores. Of those who had point of care A1Cs conducted; 40% had dysglycemia. Diabetes screening in an academic dental clinic can help identify patients at risk for T2DM.
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Diabetes Mellitus Tipo 2 , Humanos , Adulto , Masculino , Femenino , Persona de Mediana Edad , Adolescente , Adulto Joven , Anciano , Anciano de 80 o más Años , Hemoglobina Glucada , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Sistemas de Atención de Punto , Estudios Transversales , Clínicas OdontológicasRESUMEN
Medical stabilization, nutrition rehabilitation, and weight restoration, while minimizing risk for the potentially fatal complication of refeeding syndrome, are the primary goals for the treatment of hospitalized individuals with anorexia nervosa and other restrictive-type eating disorders. The purpose of this review was to examine the literature exploring the prophylactic supplementation of phosphate, magnesium, and potassium, in addition to routine thiamin and multivitamin supplementation, for the prevention of refeeding syndrome in adolescents and adults with anorexia nervosa. Through evaluation of outcomes (including serum electrolyte levels and clinical signs and symptoms such as respiratory failure, cardiac failure, peripheral edema, rhabdomyolysis, and encephalopathy), three studies found that prophylactic supplementation of potassium, magnesium, and/or phosphate were effective in preventing refeeding syndrome or refeeding hypophosphatemia (a characteristic of refeeding syndrome). Although all studies found that prophylactic supplementation was effective in preventing refeeding syndrome, refeeding approaches (including the method, amount, and duration of nutrient delivery) as well as the populations studied varied considerably, making it difficult to arrive at specific recommendations for practice. Randomized controlled trials are needed to further examine the safety and effectiveness of prophylactic supplementation of phosphate, magnesium, and potassium on the prevention of refeeding syndrome, utilizing similar feeding and supplementation protocols.
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Anorexia Nerviosa , Hipofosfatemia , Síndrome de Realimentación , Adolescente , Adulto , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/terapia , Suplementos Dietéticos , Humanos , Hipofosfatemia/etiología , Hipofosfatemia/prevención & control , Magnesio/uso terapéutico , Fosfatos , Potasio , Síndrome de Realimentación/etiología , Síndrome de Realimentación/prevención & controlRESUMEN
BACKGROUND: Preoperative malnutrition adversely impacts perioperative outcomes among patients with gastrointestinal (GI) cancer. The attributable risk (AR) that nutrition status contributes towards negative outcomes is poorly understood. METHODS: Adults undergoing GI cancer surgeries were identified within the American College of Surgeons National Surgical Quality Improvement Program database (2005-2017). Emergency surgeries, outpatients, and cases with an American Society of Anesthesiologists status above III were excluded. Adjusted multivariable models were constructed to determine the associations between markers of nutrition status (body mass index, >10% weight loss in last 6 months, functional status, and serum albumin level) and adverse perioperative outcomes (presence and number of complications, death, 30-day readmission, and length of stay). Predictive accuracy statistics and population AR (PAR) were determined. RESULTS: The final sample included 78,662 cases. Patients with >10% weight loss 6 months preceding surgery (compared with those who did not), had a significantly increased risk of complications (Relative Risk = 1.28; 95% CI, 1.20-1.37) and odds of death (odds ratio [OR] = 1.37; 95% CI, 1.18-1.59). A totally dependent functional status (compared with independent status) was associated with a 3.3-times higher odds of death (OR = 3.30; 95% CI, 1.53-7.15). Multivariable models were not predictive of adverse outcomes; PAR from the markers ranged 1%-2%. CONCLUSION: Ten percent weight loss in preceding 6 months was associated with increased risk of adverse perioperative outcomes among adults undergoing GI cancer surgery. The contribution of nutrition status markers to surgical outcomes as assessed by PAR was small (1%-2%), a finding not previously reported. Future intervention studies should include validated nutrition risk markers, control for effects of perioperative variables, and evaluate PAR within the immediate/long-term postoperative periods.
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Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Gastrointestinales , Desnutrición , Adulto , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/cirugía , Humanos , Desnutrición/complicaciones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: The purpose of this cross-sectional study was to examine whether single nucleotide polymorphisms (SNPs) in enzymes that metabolize sex steroid hormones were associated with the blood levels of these hormones in postmenopausal women and if the use of menopausal hormone therapy (MHT) could modify this association. METHODS: Baseline data were collected from 932 postmenopausal women enrolled in the Minnesota Green Tea Trial. Participants filled out a questionnaire about their demographics, lifestyle factors, and medical and reproductive history. Free, bioavailable, and total serum levels of reproductive hormones were measured through liquid chromatography/tandem mass spectrometry. For genotyping of UGT1A1 (rs10928303), UGT1A4 (rs10929301, rs11673726), UGT1A6 (rs1105879, rs2070959, rs6759892), UGT1A8 (rs10167119), UGT2B7 (rs7439366), and SULT1A1 (rs9282861, rs1968752), mass spectrometry based on multiplex methods and TaqMan assays were performed. Adjusted linear models were fit to assess the associations between SNPs and blood hormones using age, body mass index (BMI), and MHT as covariates. RESULTS: The mean age was 59.8 years, and the mean BMI was 25.1 kg/m². Past or recent use of MHT was reported by 41.2% of the participants. SNPs in SULT1A1 (rs1968752 and rs9282861) and UGT1A4 (rs11673726) genes were significantly associated with estrone levels, whereas SNPs in UGT1A6 (rs6759892) and UGT1A8 (rs10167119) genes were significantly associated with bioavailable estradiol levels. CONCLUSIONS: There was no evidence that MHT use modified the association between SNPs and sex-steroid hormone levels; however, further studies are needed to establish the potential clinical significance of UGT1A4 (rs11673726), UGT1A6 (rs6759892), and UGT1A8 (rs10167119) SNPs and the modulation of hormone levels in postmenopausal women.