Effects of Cuisine-Based Chinese Heart-Healthy Diet in Lowering Blood Pressure Among Adults in China: Multicenter, Single-Blind, Randomized, Parallel Controlled Feeding Trial.

BACKGROUND: More than one-fifth of the world's population consumes Chinese cuisines regularly, but no evidence-based healthy diets fitting the Chinese food culture are available for implementation. METHODS: A multicenter, patient- and outcome assessor-blind, randomized feeding trial was conducted among 265 participants with 130 to 159 mm Hg baseline systolic blood pressure (SBP) for 4 major Chinese cuisines (Shangdong, Huaiyang, Cantonese, Szechuan). After a 7-day run-in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine-based Chinese heart-healthy diet for another 28 days. The primary outcome was SBP, and secondary outcomes included diastolic blood pressure and food preference score. Linear regression models were used to estimate the intervention effects and adjustments for the center. The incremental cost per 1 mm Hg reduction in SBP was also calculated. RESULTS: A total of 265 participants were randomized (135 on the Chinese heart-healthy diet and 130 on the control diet), with 52% women, mean age of 56.5±9.8 years, and mean SBP and diastolic blood pressure of 139.4±8.3 and 88.1±8.0 mm Hg, respectively, at baseline. The change in SBP and diastolic blood pressure from baseline to the end of the study in the control group was -5.0 (95% CI, -6.5 to -3.5) mm Hg and -2.8 (95% CI, -3.7 to -1.9) mm Hg, respectively. The net difference of change between the 2 groups in SBP and diastolic blood pressure were -10.0 (95% CI, -12.1 to -7.9) mm Hg and -3.8 (95% CI, -5.0 to -2.5) mm Hg, respectively. The effect size did not differ among cuisines (P for interaction=0.173). The mean food preference score was 9.5 (with 10 the best preferred) at baseline, and the net change during intervention was 0.1 (95% CI, -0.1 to 0.2; P=0.558). The incremental cost-effectiveness ratio per 1 mm Hg SBP reduction was CNY 0.4 (USD 0.06) per day. No difference in the number of adverse events was found between the 2 groups (P=0.259), and none of the adverse events was associated with the intervention. CONCLUSIONS: The Chinese heart-healthy diet is effective, palatable, and cost-effective in reducing blood pressure in Chinese adults with high blood pressure, with a clinically significant effect applicable across major Chinese cuisine cultures. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03882645.

Effects of whey protein complex combined with low-intensity exercise in elderly inpatients with COPD at a stable stage.

BACKGROUND AND OBJECTIVES: Previous literature mostly has demonstrated the efficacy of pulmonary rehabilitation (PR) combined with whole nutrition powder in patients with chronic obstructive pulmonary disease (COPD). However, the benefits of whey protein as an oral nutritional supplement (ONS) during PR are not clear. METHODS AND STUDY DESIGN: It took 12 weeks to complete the trial, we divided 90 elderly patients with stable-stage COPD into a low-intensity exercise group (n= 30, PR group), PR plus whey proteins complex group (n= 30, PRWP group), and a control group (n= 30) randomly, and assessed index such as exercise capacity, mental health status, lung function, and body composition. Eventually, 84 people persisted until the end of the trial. RESULTS: Compared with the control group, hand grip strength (HGS)(1.4 ± 0.6 kg, and 1.0 ± 0.2 kg respectively, p< 0.05) in the PRWP and PR group, 6 minutes of walking distance (6MWD)(14.1 ± 3.8m, p< 0.05) in PRWP group improved. Furthermore, compared with the PR group, Medical Research Council Dyspnea Scale (MRC)(-0.2 ± 0.1, p< 0.01), anxiety score (-1.2 ± 0.4, p< 0.01), and body weight (2.0 ± 0.8kg, p< 0.05) improved in the PRWP group. There were no inter-group differences in a fat-free mass index or appendicular skeletal muscle mass index. CONCLUSIONS: Muscle strength could be enhanced in both intervention models. Adding whey protein complex was additionally successful in rectifying dyspnea, anxiety, and weight loss caused by exercise. This rehabilitation pattern might be valuable in elderly patients with COPD.

Possible sarcopenia and its risk factors in a home for seniors in Shanghai.

BACKGROUND AND OBJECTIVES: The Asian Working Group for Sarcopenia (AWGS) recommended various measures for identifying patients with possible sarcopenia in its 2019 consensus. The present survey aimed to assess older adults in a senior home to determine the prevalence and associated factors for possible sarcope-nia and to compare the differences between various assessment pathways based on AWGS 2019 criteria. METHODS AND STUDY DESIGN: This cross-sectional study examined 583 participants of a senior home. Patients with possible sarcopenia were determined through the following four pathways: [I] calf circumference (CC) + handgrip strength (HGS); [II] SARC-F+HGS; (III) SARC-CalF+HGS; and (IV) CC, SARC-F, and/or SARC-CalF+HGS. RESULTS: The four assessment pathways revealed a high prevalence of possible sarcopenia in the older adults in the senior home ([I]=50.6%; [II]=46.8%; [III]=48.2%; [IV]=65.9%). There is significant difference in prevalence between pathway IV and the other pathways (p<0.001). A multivariate analysis revealed that advanced age, risk of malnutrition, malnutrition, high level of care, an exercise frequency of <3 times per week, and osteoporosis were correlated with a higher risk of possible sarcopenia. By contrast, oral nutritional supplements (ONS) reduced the risk of possible sarcopenia. CONCLUSIONS: This survey reported a high prevalence of possible sarcopenia in the older adults of the senior home and determined the associated influencing factors. Furthermore, our findings suggested that pathway IV is the most suitable pathway for the examined older adults which enabled the detection and early intervention of more possible sarcopenia.

Malnutrition and its risk factors in a home for seniors in Shanghai.

BACKGROUND AND OBJECTIVES: Older adults residing in senior homes are at a high risk of malnutrition. In this study, we investigated the nutritional status of these individuals and factors associated with malnutrition in this population. METHODS AND STUDY DESIGN: This cross-sectional study (September 2020-January 2021) included a total of 583 older adults residing in a senior home in Shanghai (mean age, 85.0±6.6 years). The Mini Nutritional Assessment Short Form (MNA-SF) questionnaire was administered to assess the nutritional status of the participants. Patients with possible sarcopenia were identified according to the guidelines recommended by the Asian Working Group for Sarcopenia in its 2019 consensus (AWGS 2019). Moreover, the factors influencing malnutrition were determined through multivariate analyses. RESULTS: The likelihoods of having malnutrition and being at a risk of malnutrition were noted in 10.5% and 37.4% of the participants, respectively. In both male and female participants, handgrip strength (HGS) and calf circumference (CC) increased significantly with increasing scores on the aforementioned questionnaire (p<0.001). Among the participants, 44.6% had ≥3 chronic diseases and 48.2% used multiple medicines. Multivariate analyses revealed that dys-phagia (OR, 3.8; 95% CI, 1.7-8.5), possible sarcopenia (OR, 3.6; 95% CI, 2.2-5.6), and dementia (OR, 4.5; 95% CI, 2.8-7.0) were correlated with a relatively high prevalence of malnutrition/malnutrition risk. Exercise (at least thrice a week) reduced malnutrition risk. CONCLUSIONS: Malnutrition is common among older adults residing in senior homes; therefore, the associated factors must be identified, and appropriate interventions should be administered.

Acute effect of flaxseed-enriched snack bars on glycemic responses and satiety in healthy individuals.

BACKGROUND AND OBJECTIVES: The dietary glycemic index (GI) and glycemic load (GL) have garnered scholarly attention for their roles in weight management and glycemic control. Flaxseed is a good source of fiber, lignans, and omega-3 fatty acids. This study evaluated healthy individuals' acute glycemic response and satiety following the consumption of flaxseed-enriched snack bars. METHODS AND STUDY DESIGN: Nineteen healthy men and women consumed flaxseed bars or a glucose solution containing 50 g of available carbohydrates. Capillary blood glucose concentrations were obtained through the finger-prick test. The GI and GL values of the flaxseed bars were calculated using incremental area under the glucose response curve. Over 2 h, subjective satiety was examined at 0 (fasting), 15, 30, 45, 60, 90 and 120min following the consumption of flaxseed bars or saltine crackers containing 300 kcal by using a visual analogue scale (VAS). RESULTS: Compared with that of the glucose solution, the glucose concentrations of the flaxseed bars (15-90 min) were significantly lower (p<0.001). The GI and GL values of the flaxseed bars were 30.0±23.0 and 2.3±0.2, respectively. Compared with saltine cracker consumption, flaxseed bars consumption resulted in lower hunger and higher satiety. The satiety index score of the flaxseed bars was 1.6 times higher than that of the saltine crackers. CONCLUSIONS: Although further studies are warranted to evaluate the long-term effects of flaxseed-enriched snacks on glycemia and energy balance, our findings suggest that the incorporation of flaxseed into snack bars is a viable strategy for the management of obesity and diabetes.

Nutritional diet plan for patients with dysphagia.

BACKGROUND AND OBJECTIVES: To present a new method of text-modified food management for patients with dysphagia that integrates the idea of food exchange. In addition to prioritizing nutrition in each recipe, the diet plan emphasizes straightforward preparation methods that balance nutrition and palatability. METHODS AND STUDY DESIGN: On the basis of the recommended intake in the Expert Consensus, the design of the texture-modified food incorporates the concept of equivalent food exchange. The plan consists of a staple food, a meat, a vegetable, a snack, and a fruit as the base units, and the volume and nutrient density of each unit is modified to meet the needs of patients with dysphagia. RESULTS: Five categories of standard portions were established, the standard portion of staple foods, milk should be used instead of water during preparation, and carbohydrate components (dextrin) should be added so that each portion provides approximately 200 Kcal of energy. The standard portion of meat, protein components (90% whey) should be added to provide approximately 14 g of protein and 150 Kcal of energy per portion. Two types of standard snacks are recommended, each serving provides 250 Kcal of energy. Vegetables and fruits provide 70 Kcal and 90 Kcal of energy. We compiled 11 recipes representative of the food exchange system and our recipe design priorities (texture modification, sufficient nutrition, color, fragrance and taste). CONCLUSIONS: The method is combined theory and practice and can be applied to clinical nutrition work to promote the nutritional intake of patients with dysphagia.

Effects of flaxseed supplementation on functional constipation and quality of life in a Chinese population: A randomized trial.

BACKGROUND AND OBJECTIVES: This prospective, randomized, controlled study aimed to evaluate the effects of flaxseed supplementation on functional constipation and quality of life in adult men and women in China. METHODS AND STUDY DESIGN: 90 subjects with functional constipation diagnosed by the Rome IV criteria were enrolled. Subjects were randomly assigned to receive either 50 g/day flaxseed flour with meals (n=60) or 15 mL/day of a lactulose solution on an empty stomach (n=30) every morning for 4 weeks. Wexner constipation scores, stool consistency according to the Bristol Stool Form Scale, and bowel habits (frequency of bowel movements/week, the time spent on defecation) were the primary outcomes. The change in Patient Assessment of Constipation Quality of Life score was the secondary outcome. RESULTS: After 4 weeks, the bowel habits in both groups were significantly improved. The median Wexner constipation score decreased from 14 to 6.5 in the flaxseed group (p<0.001) and from 15 to 9 in the lactulose group (p<0.001). The median defecation frequency per week increased significantly (2 to 7 for flaxseed and 2 to 6 for lactulose, p<0.001 for both groups). The Patient Assessment of Constipation Quality of Life score decreased significantly (-1.34 and -0.66 for flaxseed and lactulose, respectively; p<0.001 for both groups). CONCLUSIONS: Flaxseed flour is somewhat more effective at increasing defecation frequency than lactulose, improving bowel movements and promoting life quality of subjects with chronic functional constipation in the Chinese population.

Clinical nutrition knowledge, attitude and practice of medical interns in Shanghai: Contributory factors.

BACKGROUND AND OBJECTIVES: To provide a questionnaire, with Shanghai medical interns as respondents, analyzing knowledge (K), attitude (A), and practice (P) in relation to clinical nutrition, and to explore factors that could affect KAP scores. METHODS AND STUDY DESIGN: The cross- sectional study used 330 interns from Shanghai medical universities responding to general material data questionnaires and KAP questionnaires on clinical nutrition. RESULTS: The mean KAP score was 210.26±25.9 (X±SD), and the score for each part of the KAP questionnaire was just within the threshold for qualified. Multivariate analysis showed that the factors influencing the proportion of excellent scores for K were preventive medicine major (OR=3.45, p<0.001), senior intern (OR=2.52, p=0.002), and tertiary intern hospital (OR=2.31, p=0.006). The only factor influencing the proportion of excellent scores for P was accessing nutritional information one to three times per week (OR=3.95, p=0.011). Nutrition course had no relation to any scores of K, A, P. CONCLUSIONS: The mean scores of overall KAP and the individual K, A, P were all categorized as qualified. The P score was the lowest and only influenced by how frequently information was accessed. In summary, nutrition knowledge and regular practical training gained from intern hospital could be a better way to enable senior interns to quickly and competently address patient nutrition problems at the commencement of their careers.

Response of serum LDL cholesterol to oatmeal consumption depends on CYP7A1_rs3808607 genotype in Chinese.

BACKGROUND AND OBJECTIVES: Notable inter-individual differences in cholesterol-lowering effects following oatmeal consumption have been previously reported. Genetic variations may among the reasons for the heterogeneous response to lipid modulations. And to determine whether SNP of cytochrome P450 family 7 subfamily A member 1 gene rs3808607 and isoforms of apolipoprotein E are associated with the inter-individual variations in cholesterol-lowering effects of oatmeal consumption, we did this study. METHODS AND STUDY DESIGN: Data in this study were extracted from a parallel, controlled trial, in which 62 medication-naive hypercholesterolemic patients provided with staple food substitute of either 80 g/d oatmeal (n=31) or 80 g/d refined white rice (n=31) for 45 days. Fasting blood samples were collected at baseline and endpoint of the study for lipid profiling, glycemic testing, and genotyping. RESULTS: Totally, 56 of 62 participants completed the study and were thus included. Genotype- diet interactions were observed between oatmeal consumption and SNP in the cytochrome P450 family 7 subfamily A member 1 gene rs3808607 in regulating LDL cholesterol (p=0.04); rs3808607-TT homozygotes exhibited significantly higher responsiveness to oatmeal (reduction in LDL cholesterol) than G allele carriers (GG/GT) (p=0.02). However, obvious genotype-diet interactions were not observed between oatmeal consumption and apolipoprotein E isoforms in cholesterol and glycemic modulation (p>0.05). CONCLUSIONS: SNP in cytochrome P450 family 7 subfamily A member 1 gene rs3808607 was associated with the extent of LDL cholesterol reduction following oatmeal consumption. Trials with larger sample sizes are required to confirm the findings.

Impact of a low-carbohydrate and high-fiber diet on nonalcoholic fatty liver disease.

BACKGROUND AND OBJECTIVES: To study the effects of a low-carbohydrate and high-fiber diet and education on patients with nonalcoholic fatty liver disease. METHODS AND STUDY DESIGN: We randomly divided 44 patients with nonalcoholic fatty liver disease into two groups: low-carbohydrate and high-fiber diet and education (intervention group), and education alone (control group). Liver and kidney function, fasting plasma glucose, insulin resistance index, body composition, and controlled attenuation parameter were detected before and after the intervention. RESULTS: After 2 months, the body fat, body weight, abdominal circumference, and visceral fat area, fasting plasma glucose, insulin resistance index, and levels of serum alanine aminotransferase, aspartate transaminase, uric acid, and insulin of the intervention group were significantly lower than before (p<0.05). In the female intervention group, the insulin resistance index and levels of serum alanine aminotransferase, uric acid, triglyceride, fasting plasma glucose, and C-peptide were lower and the level of serum high-density lipoprotein cholesterol was higher than in the female control group (p<0.05). In the male intervention group, the levels of serum alanine aminotransferase, triglyceride, and fasting plasma glucose were lower and the level of serum high-density lipoprotein cholesterol was higher compared with the male control group (p<0.05). CONCLUSIONS: A low-carbohydrate and high-fiber diet and education can effectively reduce the body weight and body fat of patients with nonalcoholic fatty liver disease and improve metabolic indicators such as liver enzymes, blood glucose, blood lipid, and uric acid. Our female patients showed significantly better improvement in the indicators than our male patients.