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1.  Can serum isotope levels accurately measure intestinal calcium absorption compared to gold-standard methods? 
Nutrition Journal  2015;14:73.
Background
Low fractional calcium absorption (FCA) contributes to osteoporosis but is not measured clinically, as the gold-standard method requires administration of two calcium tracers and a subsequent 24-h urine collection. We evaluated alternate methods to measure FCA, compared to the gold standard method.
Methods
We administered two stable calcium isotope tracers (~8 mg oral 44Ca and ~3 mg intravenous 42Ca) with breakfast to 20 fasting post-menopausal women (Cohort 1) 59 ± 7 years old with vitamin D insufficiency. We measured subsequent calcium isotope concentrations in 24-h urine samples and serum collected 1, 3 and 5 h post tracer administration during an inpatient research stay. We assessed the candidate serum estimates in a second cohort of 9 women with similar characteristics. Methods of measuring FCA were compared using correlation coefficients and Bland-Altman tests.
Results
FCA estimated from a 3-h serum sample correlated highest with the levels from the 24-h urine collection (ρ 0.78, p < 0.001), but explained only 58 % of the variance in FCA. The total variance explained by 3-h estimates improved to 61 % with incorporation of glomerular filtration rate (GFR). FCA estimates from the 3-h serum measurement were assessed in a second group of nine women (Cohort 2) 60 ± 7 years old. In this cohort, however, FCA estimated by 3-h serum isotope levels did not correlate with gold-standard FCA measurements, whether determined with (ρ 0.02, p = 0.97) or without GFR values (ρ 0.03, p = 0.93). By contrast, FCA in Cohort 2 correlated best with 5-h serum isotope levels (ρ 0.75, p = 0.02).
Conclusions
We conclude that serum isotope levels correlate with true fractional calcium absorption, but do not reliably estimate FCA when analyzed using Bland-Altman tests, compared to gold-standard methods.
Trial registration
ClinicalTrials.gov.Identifier: NCT00933244
doi:10.1186/s12937-015-0065-5
PMCID: PMC4520086
Accuracy; Methods; Calcium absorption; Postmenopausal women; Stable calcium isotopes
2.  Extraction Kinetics of phytochemicals and antioxidant activity during black tea (Camellia sinensis L.) brewing 
Nutrition Journal  2015;14:74.
Background
Tea is the most consumed beverage in the world which is second only to water. Tea contains a broad spectrum of active ingredients which are responsible for its health benefits. The composition of constituents extracted to the tea brew depends on the method of preparation for its consumption. The objective of this study was to investigate the extraction kinetics of phenolic compounds, gallic acid, caffeine and catechins and the variation of antioxidant activity with time after tea brew is made.
Methods
CTC (Crush, Tear, Curl) tea manufactured in Sri Lanka was used in this study. Tea brew was prepared according to the traditional method by adding boiling water to tea leaves. The samples were collected at different time intervals. Total phenolic and flavonoid contents were determined using Folin ciocalteu and aluminium chloride methods respectively. Gallic acid, caffeine, epicatechin, epigallocatechin gallate were quantified by HPLC/UV method. Antioxidant activity was evaluated by DPPH radical scavenging and Ferric Reducing Antioxidant Power (FRAP) assays.
Results
Gallic acid, caffeine and catechins were extracted within a very short period. The maximum extractable polyphenols and flavanoids were achieved at 6–8 min after the tea brew is prepared. Polyphenols, flavanoids and epigallocatechin gallate showed a significant correlation (p < 0.001) with the antioxidant activity of tea.
Conclusion
The optimum time needed to release tea constituents from CTC tea leaves is 2–8 min after tea is made.
doi:10.1186/s12937-015-0060-x
PMCID: PMC4520228
Camellia sinensis L; Black tea; Brewing time; Extraction kinetics
3.  Potential protective properties of flax lignan secoisolariciresinol diglucoside 
Nutrition Journal  2015;14:71.
Lignans are a group of phytonutrients which are widely distributed in the plant kingdom. Flaxseed is the richest source of providing lignan precursor such as secoisolariciresinol diglucoside (SDG). This article reviews the studies relevant to experimental models in animals and humans demonstrating the possible nutraceutical actions of SDG to prevent and alleviate lifestyle-related diseases. A local and international web-based literature review for this project was carried out to provide information relating to the study. The major key word “SDG” was selected to gather information using the electronic databases pertaining to the current state of flaxseed lignans composition, bioactive compounds, metabolism and to find out their role in terms of chemopreventive action. The extraction methods vary from simple to complex depending on separation, fractionation, identification and detection of the analytes. The majority of studies demonstrate that SDG interferes with the development of different types of diseases like cardiovascular, diabetic, lupus nephritis, bone, kidney, menopause, reproduction, mental stress, immunity, atherosclerosis, hemopoietic, liver necrosis and urinary disorders due to its various biological properties including anti-inflammatory, antioxidant, antimutagenic, antimicrobial, antiobesity, antihypolipidemic and neuroprotective effects. Moreover, SDG has a defending mediator against various cancers by modulating multiple cell signaling pathways. As discussed in this review, SDG has shown therapeutic potential against a number of human diseases and can be recommended for discerning consumers.
doi:10.1186/s12937-015-0059-3
PMCID: PMC4517353  PMID: 26215288
Flaxseed; Processing; Lignan; Precursors; Diet; Therapy; Maladies
4.  The effect of short-term high versus normal protein intake on whole-body protein synthesis and balance in children following cardiac surgery: a randomized double-blind controlled clinical trial 
Nutrition Journal  2015;14:72.
Background
Infants undergoing cardiac surgery are at risk of a negative protein balance, due to increased proteolysis in response to surgery and the cardiopulmonary bypass circuit, and limited intake. The aim of the study was to quantify the effect on protein kinetics of a short-term high-protein (HP) diet in infants following cardiac surgery.
Methods
In a prospective, double-blinded, randomized trial we compared the effects of a HP (5 g · kg−1 · d−1) versus normal protein (NP, 2 g · kg−1 · d−1) enteral diet on protein kinetics in children <24 months, on day 2 following surgical repair of congenital heart disease. Valine kinetics and fractional albumin synthesis rate (FSRalb) were measured with mass spectrometry using [1-13C]valine infusion. The Mann–Whitney U test was used to investigate differences between group medians. Additionally, the Hodges-Lehmann procedure was used to create a confidence interval with a point estimate of median differences between groups.
Results
Twenty-eight children (median age 9 months, median weight 7 kg) participated in the study, of whom in only 20 subjects isotopic data could be used for final calculations. Due to underpowering of our study, we could not draw conclusions on the primary outcome parameters. We observed valine synthesis rate of 2.73 (range: 0.94 to 3.36) and 2.26 (1.85 to 2.73) μmol · kg−1 · min−1 in the HP and NP diet, respectively. The net valine balance was 0.54 (−0.73 to 1.75) and 0.24 (−0.20 to 0.63) μmol · kg−1 · min−1 in the HP and NP group. Between groups, there was no difference in FSRalb. We observed increased oxidation and BUN in the HP diet, compared to the NP diet, as a plausible explanation of the metabolic fate of surplus protein.
Conclusions
It is plausible that the surplus protein in the HP group has caused the increase of valine oxidation and ureagenesis, compared to the NP group. Because too few patients had completed the study, we were unable to draw conclusions on the effect of a HP diet on protein synthesis and balance. We present our results as new hypothesis generating data.
Trial registration
Dutch Trial Register NTR2334.
doi:10.1186/s12937-015-0061-9
PMCID: PMC4517637  PMID: 26215396
Proteins; Isotopes; Child; Congenital heart defect; Intensive care
5.  Impact of daily supplementation of Spirulina platensis on the immune system of naïve HIV-1 patients in Cameroon: a 12-months single blind, randomized, multicenter trial 
Nutrition Journal  2015;14:70.
Background
Micronutrient deficiencies occur early in Human Immunodeficiency Virus (HIV) infections they have reverse effects on the nutritional status. The diet supplementation with a natural nutraceutical rich in proteins and micronutrient like Spirulina platensis, may be effective and efficient in delaying HIV disease progression by frequently reported improvement in immune response.
Methods
A prospective single-blind, randomized, multicenter study conducted on 320 HIV-1 ARV-naïve participants for 12 months. Participants received either S. platensis supplementation and standard care or standard care and local balanced diet without S. platenis. Selected hematological and biochemical as well as CD4 count cells, viral load copies were assessed at three separate times.
Results
Among the 169 ART-naïve participants enrolled in the study, the female was mostly represented (67.1 %). The significant increase of CD4 count cells (596.32–614.92 cells count) and significant decrease of viral load levels (74.7 × 103–30.87 × 103 copies/mL) of the patients who received a supplementation of S. platensis was found after 6 months of treatment. Haemoglobin level was also significantly higher in the same group while the fasting blood glucose concentration decreased after 12 months compared to control.
Conclusion
A daily supplementation with S. platensis to diet combined with a reasonable balanced diet has significantly increased the CD4 cells and reduced the viral load after 6 months. Further studies are recommended among a large specific group of people infected by the HIV in order to investigate the mechanisms involved on the effect of S. platensis on immune system.
doi:10.1186/s12937-015-0058-4
PMCID: PMC4508814  PMID: 26195001
Spirulina platensis; HIV-naive; CD4 cells; Balance diet; Viral load; Clinical trial
6.  Melamine contamination in nutritional supplements - Is it an alarm bell for the general consumer, athletes, and ‘Weekend Warriors’? 
Nutrition Journal  2015;14:69.
Background
Nutritional supplements are used or experimented with by consumers, notably these are; competitive and recreational athletes of all ages, and ‘weekend warriors’. As a consequence the supplement industry has grown to meet the increasing demand. A Global Industry Analysts Inc. report indicates that the herbal supplement market has not declined during the worldwide recession, but in fact exhibited steady growth over the period 2008 to 2009. It is anticipated that the market will reach US$93.15 billion by the year 2015. These supplements may contain adulterated substances that may potentially have harmful short - and long-term health consequences to the consumer. “Scrap Melamine” is such an example, which has been implicated in the kidney failure and death of several cats, dogs and pigs. In China in 2008, reports described very severe health effects in infants and young children. At the time over 294 000 infants were screened and diagnosed with urinary tract stones and sand-like calculi associated with melamine in milk products, of which 50 000 infants were hospitalised, and at least six associated deaths, recorded. The extent that melamine contamination occurs in nutritional supplements is not known. Therefore, the aim of this study was to determine whether commercially available nutritional and traditional supplement products contain melamine, even though they are not declared by the manufacturer on the product label.
Methods
A total of 138 nutritional supplements products were obtained from (i) direct purchases from shops, pharmacies and outlets, (ii) directly from consumers, and (iii) from suppliers, manufacturers and distributors. The products were laboratory analysed for melamine, using Tandem Liquid Chromatography Mass Spectrometry.
Results
Forty-seven % of all the products (n = 138) tested positive for melamine. Eight-two % of the South African produced products (n = 27) tested positive and 58 % of the products imported into South Africa (n = 50) tested positive. The median concentration estimate for melamine in the products tested were, 6.0 μg/g for the 138 supplements tested, 8.9 μg/g for South African produced products, and 6.9 μg/g for products imported into South Africa.
Conclusion
The melamine (undeclared on product label) levels detected in the nutritional supplements products investigated were within the Tolerable Daily intake (TDI) limit guidelines of 200 μg/g as set by WHO and others. Melamine over exposure within the context of the nutritional supplements consumption in the products investigated should not be of concern to the consumer provided the recommended guidelines of daily product use are adhered to. Further investigation is warranted to determine, (i) the link of melamine as (part) substitute for the perceived total declared protein content on the product label, (ii) cyanuric and uric acid presence in the supplement products that could form chemical-complex formation with melamine and/or analogues that could cause adverse health effects.
doi:10.1186/s12937-015-0055-7
PMCID: PMC4504043  PMID: 26182916
Nutritional supplements; Information labels and warnings; Uric acid; Cyanuric acid; Pesticides; Protein; Laboratory screen testing
7.  Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China 
Nutrition Journal  2015;14:68.
Background & Objective
Nutrition assessment enables early identification of malnourished patients and those at risk of malnutrition. To determine the prevalence of malnutrition, to analyze the correlation between short-form Mini Nutritional Assessment (MNA-SF) and Nutritional Risk Screening 2002 (NRS2002) with classical nutritional markers among elderly hospitalized patients in surgery departments, with a view to improving nutrition advice for these patients.
Methods
A total of 142 elderly patients admitted for surgery were enrolled in the study. Within 48 hours of admission, MNA-SF and NRS2002 scale, anthropometric measures and biochemical tests were carried out to assess the nutritional status of each patient.
Results
The prevalence of malnutrition classified by MNA-SF, NRS2002, BMI, serum albumin, hemoglobin, total lymphocyte count, handgrip strength, calf circumference and mid-arm circumference were 45 %, 38 %, 17 %, 22 %, 24 %, 71 %, 36 %, 12 % and 15 %, respectively. As the nutritional status classified by both MNA-SF and NRS2002 deteriorated, BMI, serum albumin, hemoglobin, handgrip strength, mid-arm circumference and calf circumference of patients with malnutrition were lower (P < 0.05). MNA-SF and NRS2002 had a unanimous correlation with classical nutritional markers (P < 0.05) except total lymphocyte count (P > 0.05). MNA-SF results showed a moderate agreement (P < 0.001) with NRS2002. Malnourished patients were older than well-nourished patients with NRS2002 (P < 0.05). Digestive disease patients tend to suffer from malnutrition, evaluated by MNA-SF (P < 0.05).
Conclusions
The results show a relatively high prevalence of malnutrition among elderly patients in our general surgery department, especially in patients with digestive disease. NRS2002 and MNA-SF on elderly patients showed great consistency but significant difference in elderly patients with digestive disease. Both MNA-SF and NRS2002 correlated with each other and with BMI, serum albumin, hemoglobin, handgrip strength, calf circumference and mid-arm circumference. MNA-SF may be a more suitable tool for the nutrition assessment of surgical elderly inpatients.
doi:10.1186/s12937-015-0054-8
PMCID: PMC4499876  PMID: 26170020
Malnutrition; Nutritional assessment; Short-form mini-nutritional assessment; NRS2002
8.  Efficacy and safety of oral branched-chain amino acid supplementation in patients undergoing interventions for hepatocellular carcinoma: a meta-analysis 
Nutrition Journal  2015;14:67.
Most hepatocellular carcinoma (HCC) patients have complications, including cirrhosis and malnutrition. The efficacy of dietary supplementation with oral branched-chain amino acids (BCAAs) in HCC patients undergoing interventions has not been confirmed. Relevant publications on the efficacy and safety of oral BCAA supplementation for HCC patients undergoing anti-HCC interventions through September, 2014 were searched for identification in the PubMed, Embase, Web of Science, and the Cochrane Library databases. The pooled risk ratio (RR) and standardized mean difference (SMD) were used to assess the supplementation effects. A total of 11 eligible studies (974 patients in total) were evaluated and included in our analysis. Oral BCAA supplementation helped to maintain liver reserve with higher serum albumin (SMD = 0.234, 95 % CI: 0.033–0.435, P = 0.022), and lower rates of ascites (RR = 0.545, 95 % CI: 0.316–0.938, P = 0.029) and edema (RR = 0.494, 95 % CI: 0.257–0.952, P = 0.035) than in the control group. BCAA supplementation seemed to be effective in improving mortality, especially in Child-Pugh class B patients, but the efficacy was not confirmed. Apparent effects were not found in improving HCC recurrence, total bilirubin, ALT, or AST. BCAA supplementation was relatively safe without serious adverse events. BCAA supplementation may be clinically applied in improving liver functional reserve for HCC patients and further improving the quality of life.
Electronic supplementary material
The online version of this article (doi:10.1186/s12937-015-0056-6) contains supplementary material, which is available to authorized users.
doi:10.1186/s12937-015-0056-6
PMCID: PMC4496824  PMID: 26155840
Branched-chain amino acids; Hepatocellular carcinoma; Meta-analysis
9.  The relationship between the parenteral dose of fish oil supplementation and the variation of liver function tests in hospitalized adult patients 
Nutrition Journal  2015;14:65.
Background
Hepatic dysfunction is a complication associated with parenteral nutrition (PN). Our primary objective was to study the relationship between doses of intravenous fish oil (FO) emulsion in PN and the variation in the main liver function tests (LFTs) in hospitalized PN-treated adults. As a secondary objective, we studied the safety of FO administration.
Methods
We conducted a retrospective study in adult patients receiving FO supplementation in PN. Demographic, nutritional and safety variables were collected. Variation of LFTs was defined as the difference between values just before the first administration of FO and values at the end of PN. A multiple linear regression was performed to study the association between PN-lipids (FO or vegetable) and the variation of each LFT; the following variables were used to adjust the effect of lipids: sepsis, length of stay in the intensive care unit and lipids dose. Student t-test was used to study safety variables. Data were analyzed using SPSS 19.0.
Results
Patients (53, median age 68 years (24–90); 62 % men) with the principal diagnosis of digestive neoplasm (42 %) received PN for a median of 19 (7–75) days. In the multivariate analysis, the amount of FO was related to a decrease in gamma-glutamyl transferase (GGT) (B = −2.23;CI95 % = −4.41/-0.05), a decrease in alkaline phosphatase (AP) (B = −1.23;CI95 % = −2.07/-0.37), and a decrease in alanine aminotransferase (ALT) (B = −0.82; CI95 % = −1.19/-0.44). No differences were found in safety variables.
Conclusions
GGT, AP and ALT improved with FO PN-supplementation. Moreover, the improvement was greater when the doses of FO were higher. FO administration in PN is safe.
doi:10.1186/s12937-015-0048-6
PMCID: PMC4489029  PMID: 26133968
Liver function tests; Fish oil emulsion; Fatty acids; Omega-3 fatty acids; Parenteral nutrition
10.  Consumer attitudes about the role of multivitamins and other dietary supplements: report of a survey 
Nutrition Journal  2015;14:66.
Background
U.S. nutrition surveys find that intakes of many nutrients fall short of recommendations. The majority of U.S. adults use multivitamins and other dietary supplements as one means of improving nutrient intakes. Some policy makers and health professionals appear reluctant to recommend routine use of dietary supplements to fill nutrient gaps in the diet, in part because they are concerned that people will view the supplements as a substitute for dietary improvement and that the use of supplements may lead to overconsumption of micronutrients. Surveys find that in fact users of dietary supplements tend to have better diets and adopt other healthy habits, suggesting that the supplements are viewed as one aspect of an overall effort to improve wellness. Furthermore, evidence demonstrates that the incidence of excess micronutrient intake is low. We report the results of a survey probing consumer attitudes about the role of dietary supplements.
Methods
The Council for Responsible Nutrition funded a survey to measure consumer attitudes about the role of multivitamins, calcium and/or vitamin D supplements, and other supplements in improving dietary intakes. The research was designed and analyzed by FoodMinds and was fielded using Toluna’s On-line Omnibus. The weighted sample of 2159 respondents is representative of U.S. adults.
Results
Nearly 90 % of the survey respondents agreed that multivitamins and supplements of calcium and/or vitamin D can help meet nutrient needs when desirable intakes are not achieved through food alone. At the same time, 80 % agreed that dietary supplements should not be used to replace healthy dietary or lifestyle habits, and 82 % agreed that people considering taking a high dose, single nutrient supplement should talk with their physician.
Conclusions
These results provide additional support for the conclusion that the vast majority of consumers recognize that multivitamins and other supplements can help fill nutrient gaps but should not be viewed as replacements for a healthy diet. This suggests that policy makers and health professionals could feel comfortable recommending rational dietary supplementation as one means of improving nutrient intakes, without being unduly concerned that such a recommendation would lead consumers to discount the importance of good dietary habits.
doi:10.1186/s12937-015-0053-9
PMCID: PMC4489202  PMID: 26134111
Dietary supplements; Multivitamins; Calcium supplements; Vitamin D supplements; Surveys of dietary supplements; Consumer attitudes; Surveys of consumer attitudes
11.  Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005–2010 
Nutrition Journal  2015;14:64.
Introduction
Previous research has shown inconsistencies in the association of tree nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS).
Objective
To determine the association of tree nut consumption with risk factors for CVD and for MetS in adults.
Methods
NHANES 2005–2010 data were used to examine the associations of tree nut consumption with health risks in adults 19+ years (n = 14,386; 51 % males). Tree nuts were: almonds, Brazil nuts, cashews, filberts [hazelnuts], macadamias, pecans, pine nuts, pistachios, and walnuts. Group definitions were non-consumers < ¼ ounce/day and consumers of ≥ ¼ ounce/day tree nuts using data from 24-h dietary recalls. Means and ANOVA (covariate adjusted) were determined using appropriate sample weights. Using logistic regression, odds ratios of being overweight (OW)/obese (OB) (body mass index [BMI] >25/<30 and ≥30, respectively) and having CVRF or MetS, were determined.
Results
Tree nut consumption was associated with lower BMI (p = 0.004), waist circumference (WC) (p = 0.008), systolic blood pressure (BP) (p = 0.001), Homeostatic Model Assessment—Insulin Resistance (p = 0.043), and higher high density lipoprotein-cholesterol (p = 0.022), compared with no consumption, and a lower likelihood of OB (−25 %), OW/OB (−23 %), and elevated WC (−21 %).
Conclusions
Tree nut consumption was associated with better weight status and some CVRF and MetS components.
doi:10.1186/s12937-015-0052-x
PMCID: PMC4484644  PMID: 26123047
Tree Nuts; NHANES; Adults; Metabolic Syndrome; Cardiovascular Risk Factors
12.  Effects of a grape-supplemented diet on proliferation and Wnt signaling in the colonic mucosa are greatest for those over age 50 and with high arginine consumption 
Nutrition Journal  2015;14:62.
A diet rich in fruits and vegetables, and a grape-derived compound, resveratrol, have been linked to a reduced incidence of colon cancer. In vitro and in vivo, resveratrol suppresses Wnt signaling, a pathway constitutively activated in over 85 % of colon cancers.
Thirty participants were placed on a low resveratrol diet and subsequently allocated to one of three groups ingesting 1/3-to-1 lb (0.15–0.45 kg) of grapes per day for 2 weeks. Dietary information was collected via 24-h recall. Colon biopsies for biomarker analysis were obtained pre- and post-grape and evaluated for the expression of Wnt pathway target genes and for markers of proliferation by RT-PCR and immunohistochemistry.
Participants lost an average of 2 · 6 lb (1.2 kg, p = 0 · 0018) during the period of grape ingestion. The expression of CyclinD1 (p < 0 · 01), AXIN2, CD133 (p = 0 · 02) and Ki67 (p = 0 · 002) were all reduced after grape ingestion. Individuals over 50 years of age and those with high dietary arginine consumption had increased basal expression of CyclinD1, AXIN2, cMYC and CD133 (p value range 0 · 04 to <0 · 001) that, following grape ingestion, were reduced to levels seen in younger participants.
The reduction in Wnt signaling and mucosal proliferation seen following short-term ingestion of 1/3–1 lb (0.15–0.45 kg) of grapes per day may reduce the risk of mutational events that can facilitate colon carcinogenesis. The potential benefit is most marked for high-risk older individuals and individuals whose diet is high in arginine intake. Dietary grape supplementation may play a role in colon cancer prevention for high-risk individuals.
doi:10.1186/s12937-015-0050-z
PMCID: PMC4472174  PMID: 26085034
Diet; Cancer prevention; Resveratrol; Colon cancer; Aging; Arginine
13.  The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi 
Nutrition Journal  2015;14:63.
Background
Malnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation.
Methods
A modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel.
Results
80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators.
Conclusions
This evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.
doi:10.1186/s12937-015-0051-y
PMCID: PMC4473836  PMID: 26089037
Malnutrition; Nutrition screening; SGA; Acute care; Evidence; Care pathway; Delphi survey
14.  Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial 
Nutrition Journal  2015;14:61.
Objective
Almonds reduce cardiovascular disease risk via cholesterol reduction, anti-inflammation, glucoregulation, and antioxidation. The objective of this randomized, controlled, cross-over trial was to determine whether the addition of 85 g almonds daily to a National Cholesterol Education Program (NCEP) Step 1 diet (ALM) for 6 weeks would improve vascular function and inflammation in patients with coronary artery disease (CAD).
Research design and methods
A randomized, controlled, crossover trial was conducted in Boston, MA to test whether as compared to a control NCEP Step 1 diet absent nuts (CON), incorporation of almonds (85 g/day) into the CON diet (ALM) would improve vascular function and inflammation. The study duration was 22 weeks including a 6-weeks run-in period, two 6-weeks intervention phases, and a 4-weeks washout period between the intervention phases. A total of 45 CAD patients (27 F/18 M, 45–77 y, BMI = 20-41 kg/m2) completed the study. Drug therapies used by patients were stable throughout the duration of the trial.
Results
The addition of almonds to the CON diet increased plasma α-tocopherol status by a mean of 5.8 %, reflecting patient compliance (P ≤0.05). However, the ALM diet did not alter vascular function assessed by measures of flow-mediated dilation, peripheral arterial tonometry, and pulse wave velocity. Further, the ALM diet did not significantly modify the serum lipid profile, blood pressure, C-reactive protein, tumor necrosis factor-α or E-selectin. The ALM diet tended to decrease vascular cell adhesion molecule-1 by 5.3 % (P = 0.064) and increase urinary nitric oxide by 17.5 % (P = 0.112). The ALM intervention improved the overall quality of the diet by increasing calcium, magnesium, choline, and fiber intakes above the Estimated Average Requirement (EAR) or Recommended Dietary Allowance (RDA).
Conclusions
Thus, the addition of almonds to a NECP Step 1 diet did not significantly impact vascular function, lipid profile or systematic inflammation in CAD patients receiving good medical care and polypharmacy therapies but did improve diet quality without any untoward effect.
Trial registration
The trial was registered with the ClinicalTrials.Gov with the identifier: NCT00782015.
doi:10.1186/s12937-015-0049-5
PMCID: PMC4469426  PMID: 26080804
Almonds; Coronary arterial disease; Dietary quality; Endothelial function; Inflammation; Oxidative stress
15.  Youth peers put the “invent” into NutriBee’s online intervention 
Nutrition Journal  2015;14:60.
Background
Early adolescents perceive peers as credible and relatable. Peers therefore have a unique conduit to engage early adolescents in positive health behaviors through nutrition learning such as that recommended by the U.S. Institute of Medicine (IOM).
Purpose
We developed an online, peer leader component to an existing in-person preventive nutrition intervention called NutriBee. We reasoned that youth ages 13–18 could create intervention materials that could remain engaging, credible and relatable to younger peers ages 10–12 online. Peer leaders could potentially derive health benefits from their service-learning experience.
Methods
From 2013–2014 youth could apply online to relate a personal interest to nutrition, an opportunity promoted at NutriBee pilot sites and through social media. The peer leaders with diverse backgrounds honed original ideas into tangible projects with the support of adult subject-matter experts chosen by the youth. Nutrition expertise was provided by NutriBee staff who then also converted the youth-invented projects from various media into an online curriculum.
Results
19 of 27 (70%) of selected youth from 12 states and diverse backgrounds, created an online curriculum comprising 10% of NutriBee’s 20-hour intervention. All 19 online projects modeled 1 or more of NutriBee’s 10 positive health behaviors; 8 evoked the chemosenses; 6 conveyed food texture; and 13 provided social context. Peer leaders perceived career advancement and service learning benefits. The dose, pedagogic approach, and project content align with the IOM recommendation.
Conclusions
Youth created intervention materials which communicate positive health behaviors online in ways peers can adopt. In a customarily sight-sound digital platform, youth leveraged the senses of smell, taste and touch and social context important for food selection. Peer leaders derived health benefit, as indirectly assessed by IOM criteria.
doi:10.1186/s12937-015-0031-2
PMCID: PMC4470038  PMID: 26077664
Peer group; Adolescents; Attitude to health; Food preferences; Nutrition; Service-learning; Chemosensory perception; Institute of Medicine; Diffusion of Innovations
16.  Intake of partially defatted Brazil nut flour reduces serum cholesterol in hypercholesterolemic patients- a randomized controlled trial 
Nutrition Journal  2015;14:59.
Objective
Thyroid hormones can lower levels of atherogenic lipoproteins, and selenium is important in thyroid hormone homeostasis. We aimed to investigate the effects of a healthy diet associated with the Brazil nut (Bertholletia excelsa) in dyslipidemic and hypertensive patients.
Methods
This study was a randomized, placebo-controlled, double-blind trial. Seventy-seven dyslipidemic and hypertensive patients already receiving lipid-lowering drugs received either a dietary treatment associated with partially defatted Brazil nut flour (13 g/day providing 227,5 μg of selenium/day),or with dyed cassava flour as a placebo. All patients received a personalized dietary guideline with nutritional recommendations for dyslipidemia and hypertension and were followed for 90 days.
Results
The Brazil nut group showed reductions in total cholesterol (−20.5 ± 61.2 mg/dL, P = 0.02), non HDL-cholesterol (−19.5 ± 61.2 mg/dL, P = 0.02) and Apo A-1 (−10.2 ± 26.7 mg/dL, P = 0.03) without significant alterations in the Apo B/Apo A-1 ratio. The placebo group showed a reduction in FT3 levels (−0.1 ± 0.4, P = 0.03) and increased Lp(a) levels (5.9 ± 18.0 mg/dL, P = 0.02). There were no statistical differences in blood pressure and serum lipids between Brazil nut and placebo group.
Conclusions
Supplementation with Brazil nuts seems to favor the maintenance of FT3 levels and contributes to lipemia reduction in hypercholesterolemic and euthyroid patients.
Trial registration
ClinicalTrials.gov Identifier NCT01990391
doi:10.1186/s12937-015-0036-x
PMCID: PMC4488974  PMID: 26077768
Brazil nut; Selenium; Serum lipids; Thyroid hormones; Dyslipidemia
17.  Association of dietary patterns with serum adipokines among Japanese: a cross-sectional study 
Nutrition Journal  2015;14:58.
Background
Diet may influence disease risk by modulating adipokines. Although some foods and nutrients have been linked to circulating adipokine levels, little is known about the role of dietary patterns on adipokines. We investigated the association between major dietary patterns and circulating levels of adiponectin, leptin, resistin, visfatin, and plasminogen activator inhibitor-1 (PAI-1) in a working population.
Methods
The subjects were 509 employees (296 men and 213 women), aged 20 to 65 years, of two municipal offices. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Dietary patterns were derived by using principal component analysis of the consumption of 52 food and beverage items, which were ascertained by a validated diet history questionnaire. Multiple regression analysis was performed to assess the association between dietary pattern scores and adipokine concentrations, with adjustment for potential confounders.
Results
Three major dietary patterns were extracted: a Japanese, a Westernized breakfast, and a meat food patterns. Of these, we found significant, inverse associations of the Westernized breakfast pattern, which was characterized by higher intake of confectioneries, bread, and milk and yogurt but lower intake of alcoholic beverages and rice, with serum leptin and PAI-1 concentrations in a fully adjusted model (P for trend = 0.04 for both leptin and PAI-1). The other adipokines were not significantly associated with any dietary pattern.
Conclusion
The Westernized breakfast dietary pattern may be associated with lower circulating levels of leptin and PAI-1.
doi:10.1186/s12937-015-0046-8
PMCID: PMC4469003  PMID: 26058488
Cross-sectional study; Dietary pattern; Adipokines; Adiponectin; Leptin; PAI-1; Japanese; Epidemiology
18.  Designing optimal food intake patterns to achieve nutritional goals for Japanese adults through the use of linear programming optimization models 
Nutrition Journal  2015;14:57.
Background
Simultaneous dietary achievement of a full set of nutritional recommendations is difficult. Diet optimization model using linear programming is a useful mathematical means of translating nutrient-based recommendations into realistic nutritionally-optimal food combinations incorporating local and culture-specific foods. We used this approach to explore optimal food intake patterns that meet the nutrient recommendations of the Dietary Reference Intakes (DRIs) while incorporating typical Japanese food selections.
Methods
As observed intake values, we used the food and nutrient intake data of 92 women aged 31–69 years and 82 men aged 32–69 years living in three regions of Japan. Dietary data were collected with semi-weighed dietary record on four non-consecutive days in each season of the year (16 days total). The linear programming models were constructed to minimize the differences between observed and optimized food intake patterns while also meeting the DRIs for a set of 28 nutrients, setting energy equal to estimated requirements, and not exceeding typical quantities of each food consumed by each age (30–49 or 50–69 years) and gender group.
Results
We successfully developed mathematically optimized food intake patterns that met the DRIs for all 28 nutrients studied in each sex and age group. Achieving nutritional goals required minor modifications of existing diets in older groups, particularly women, while major modifications were required to increase intake of fruit and vegetables in younger groups of both sexes. Across all sex and age groups, optimized food intake patterns demanded greatly increased intake of whole grains and reduced-fat dairy products in place of intake of refined grains and full-fat dairy products. Salt intake goals were the most difficult to achieve, requiring marked reduction of salt-containing seasoning (65–80 %) in all sex and age groups.
Conclusion
Using a linear programming model, we identified optimal food intake patterns providing practical food choices and meeting nutritional recommendations for Japanese populations. Dietary modifications from current eating habits required to fulfil nutritional goals differed by age: more marked increases in food volume were required in younger groups.
doi:10.1186/s12937-015-0047-7
PMCID: PMC4470056  PMID: 26048405
Food intake pattern; Optimization; Linear programming; Japanese adults
19.  Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for Chinese pregnant women 
Nutrition Journal  2015;14:56.
Background
Food frequency questionnaire (FFQ) is a reliable tool to estimate dietary intake in large nutritional epidemiological studies, but there is lack of a current and validated FFQ for use in urban Chinese pregnant women. This study aimed to evaluate the reproducibility and validity of a semi-quantitative FFQ designed to estimate dietary intake among urban pregnant women in a cohort study conducted in central China.
Methods
In the reproducibility study, a sample of 123 healthy pregnant women completed the first FFQ at 12–13 weeks gestation and the second FFQ 3–4 weeks later. To validate the FFQ, the pregnant women completed three 24-h recalls (24HRs) between the intervals of two FFQs.
Results
The intraclass correlation coefficients of two administrations of FFQ for foods ranged from 0.23 (nuts) to 0.49 (fruits) and for nutrients from 0.24 (iodine) to 0.58 (selenium) and coefficients were all statistically significant. The unadjusted Pearson correlation coefficients between two methods ranged from 0.28 (beans) to 0.53 (fruits) for foods and from 0.15 (iodine) to 0.59 (protein) for nutrients. Energy-adjusted and de-attenuated correlation coefficients for foods ranged from 0.35 (beans) to 0.56 (fruits) and for nutrients from 0.11 (iodine) to 0.63 (protein), and all correlations being statistically significant except for iodine, sodium and riboflavin. On average, 67.0 % (51.2 %-80.5 %) of women were classified by both methods into the same or adjacent quintiles based on their food intakes, while 68.5 % (56.1 %-77.2 %) of women were classified as such based on nutrient intakes. Extreme misclassifications were very low for both foods (average of 2.0 %) and nutrients (average of 2.2 %). Bland-Altman Plots also showed reasonably acceptable agreement between two methods.
Conclusion
This FFQ is a reasonably reliable and valid tool for assessing most food and nutrient intakes of urban pregnant women in central China.
doi:10.1186/s12937-015-0044-x
PMCID: PMC4457005  PMID: 26040544
Food frequency questionnaire; Validity; Reproducibility; Pregnant women
20.  Association between dietary patterns and metabolic syndrome in individuals with normal weight: a cross-sectional study 
Nutrition Journal  2015;14:55.
Background
The results of several papers have confirmed the existence of correlations between an unhealthy diet and the presence of metabolic syndrome. However, relationships between eating habits and metabolic obesity with normal weight have not yet been sufficiently studied. The aim of the study is to determine which dietary patterns are present in individuals with a normal BMI and to find out whether those patterns were connected with the risk of metabolic syndrome and its features.
Methods
A cross-sectional study was carried out in a group of 2479 subjects with a normal weight (BMI = 18.5–24.9 kg/m2), aged between 37–66. The study included the evaluation of eating habits, anthropometric measurements, blood pressure tests and the analysis of the collected fasting-blood samples, on the basis of which cholesterol, triglycerides and glucose levels were determined. Dietary patterns were determined by means of factor analysis.
Results
In the group of individuals with a normal BMI, four dietary patterns were distinguished: “healthy”, “fat, meat and alcohol”, “prudent” and “coca cola, hard cheese and French fries”. After controlling for potential confounders, subjects in the highest tertile of prudent dietary pattern scores had a lower odds ratio for the metabolic obesity normal weight) (odds ratio: 0.69; 95 % CI: 0.53-0.89; p < 0.01) and low HDL cholesterol (odds ratio: 0.77; 95 % CI: 0.59-0.99; p < 0.05), in comparison to those from the lowest tertile, whereas the individuals in the second tertile had a higher odds ratio for the increased blood glucose concentration than those in the lowest tertile (odds ratio: 0.74; 95 % CI: 0.57-0.96; p < 0.05).
Conclusion
A dietary pattern characterized by a high consumption of fish and whole grains, and a low consumption of refined grains, sugar, sweets and cold cured meat, is connected with lower risk of metabolic obesity normal weight as well as with the lower risk of low HDL cholesterol concentration and increased glucose concentration.
doi:10.1186/s12937-015-0045-9
PMCID: PMC4455325  PMID: 26025375
Dietary patterns; Metabolic syndrome; Body mass index
21.  Improvement of antioxidant status after Brazil nut intake in hypertensive and dyslipidemic subjects 
Nutrition Journal  2015;14:54.
Objectives
To investigate the effect of partially defatted Granulated Brazil nut (GBN) on biomarkers of oxidative stress and antioxidant status of hypertensive and dyslipidemic patients on nutrition and drug approaches.
Methods
Ninety one hypertensive and dyslipidemic subjects of both genders (51.6 % men), mean age 62.1 ± 9.3 years, performed a randomized crossover trial, double-blind, placebo controlled. Subjects received a diet and partially defatted GBN 13 g per day (≈227.5 μg/day of selenium) or placebo for twelve weeks with four-week washout interval. Anthropometric, laboratory and clinic characteristics were investigated at baseline. Plasma selenium (Se), plasma glutathione peroxidase (GPx3) activity, total antioxidant capacity (TAC), 8-epi PGF2α and oxidized LDL were evaluated at the beginning and in the end of each intervention.
Results
GBN intake significantly increased plasma Se from 87.0 ± 16.8 to 180.6 ± 67.1 μg/L, increased GPx3 activity in 24,8 % (from 112.66 ± 40.09 to 128.32 ± 38.31 nmol/min/mL, p < 0,05), and reduced 3.25 % of oxidized-LDL levels (from 66.31 ± 23.59 to 60.68 ± 20.88 U/L, p < 0.05). An inverse association between GPx3 and oxidized LDL levels was observed after supplementation with GBN by simple model (β -0.232, p = 0.032) and after adjustment for gender, age, diabetes and BMI (β -0.298, p = 0.008). There wasn’t association between GPx3 and 8-epi PGF2α (β -0.209, p = 0.052) by simple model.
Conclusion
The partially defatted GBN intake has a potential benefit to increase plasma selenium, increase enzymatic antioxidant activity of GPx3 and to reduction oxidation in LDL in hypertensive and dyslipidemic patients.
Trial registration
ClinicalTrials.gov Identifier NCT01990391; November 20, 2013.
doi:10.1186/s12937-015-0043-y
PMCID: PMC4477321  PMID: 26022214
Brazil nut; Selenium; Serum lipids; Dyslipidemia
22.  A randomised controlled trial investigating the effects of Mediterranean diet and aerobic exercise on cognition in cognitively healthy older people living independently within aged care facilities: the Lifestyle Intervention in Independent Living Aged Care (LIILAC) study protocol [ACTRN12614001133628] 
Nutrition Journal  2015;14:53.
Background
The rapid ageing of the population is becoming an area of great concern, both globally and in Australia. On a societal level, the cost of supporting an ageing demographic, particularly with their associated medical requirements, is becoming an ever increasing burden that is only predicted to rise in the foreseeable future. The progressive decline in individuals’ cognitive ability as they age, particularly with respect to the ever increasing incidence of Alzheimer’s Disease (AD) and other cognitive complications, is in many respects one of the foundation stones of these concerns. There have been numerous observational studies reporting on the positive effects that aerobic exercise and the Mediterranean diet appear to have on improving cognitive ability. However, the ability of such interventions to improve cognitive ability, or even reduce the rate of cognitive ageing, has not been fully examined by substantial interventional studies within an ageing population.
Methods
The LIILAC trial will investigate the potential for cognitive change in a cohort of cognitively healthy individuals, between the ages of 60 and 90 years, living in independent accommodation within Australian aged care facilities. This four-arm trial will investigate the cognitive changes which may occur as a result of the introduction of aerobic exercise and/or Mediterranean diet into individuals’ lifestyles, as well as the mechanisms by which these changes may be occurring. Participants will be tested at baseline and 6 months on a battery of computer based cognitive assessments, together with cardiovascular and blood biomarker assessments. The cardiovascular measures will assess changes in arterial stiffness and central pulse pressures, while the blood measures will examine changes in metabolic profiles, including brain derived neurotrophic factor (BDNF), inflammatory factors and insulin sensitivity.
Conclusion
It is hypothesised that exercise and Mediterranean diet interventions, both individually and in combination, will result in improvements in cognitive performance compared with controls. Positive findings in this research will have potential implications for the management of aged care, particularly in respect to reducing the rate of cognitive decline and the associated impacts both on the individual and the broader community.
Trial registration
Australia New Zealand Clinical Trial Registry-ACTRN12614001133628
doi:10.1186/s12937-015-0042-z
PMCID: PMC4449609  PMID: 26003546
Exercise; Diet; Mediterranean; Cognitive; Cognition; Ageing; Aged Care
23.  Predicting body composition using foot-to-foot bioelectrical impedance analysis in healthy Asian individuals 
Nutrition Journal  2015;14:52.
Background
The objectives of this study were to develop a regression model for predicting fat-free mass (FFM) in a population of healthy Taiwanese individuals using standing foot-to-foot bioelectrical impedance analysis (BIA) and to test the model’s performance in predicting FFM with different body fat percentages (BF%).
Methods
We used dual-energy X-ray absorptiometry (DXA) to measure the FFM of 554 healthy Asian subjects (age, 16–75 y; body mass index, 15.8–43.1 kg/m2). We also evaluated the validity of the developed multivariate model using a double cross-validation technique and assessed the accuracy of the model in an all-subjects sample and subgroup samples with different body fat levels.
Results
Predictors in the all-subjects multivariate model included height2/impedance, weight, year, and sex (FFM = 13.055 + 0.204 weight + 0.394 height2/Impedance – 0.136 age + 8.125 sex (sex: Female = 0, Male = 1), r2 = 0.92, standard error of the estimate = 3.17 kg). The correlation coefficients between predictive FFM by BIA (FFMBIA) and DXA-measured FFM (FFMDXA) in female subjects with a total-subjects BF%DXA of <20 %, 20 %–30 %, 30 %–40 % and >40 % were r = 0.87, 0.90, 0.91, 0.89, and 0.94, respectively, with bias ± 2SD of 0.0 ± 3.0 kg, −2.6 ± 1.7 kg, −1.5 ± 2.8 kg, 0.5 ± 2.7 kg, and 2.0 ± 2.9 kg, respectively. The correlation coefficients between FFMBIA and FFMDXA in male subjects with a total-subjects BF%DXA of <10 %, 10 %–20 %, 20 %–30 %, and >30 % were r = 0.89, 0.89, 0.90, 0.93, and 0.91, respectively, with bias ± 2SD of 0.0 ± 3.2 kg, −2.3 ± 2.5 kg, −0.5 ± 3.2 kg, 0.4 ± 3.1 kg, and 2.1 ± 3.2 kg, respectively.
Conclusions
The standing foot-to-foot BIA method developed in this study can accurately predict FFM in healthy Asian individuals with different levels of body fat.
doi:10.1186/s12937-015-0041-0
PMCID: PMC4489024  PMID: 25986468
Dual-energy X-ray absorptiometry; Foot-to-foot; Cross-validation; Fat-free mass
24.  Shoshin Beriberi in Critically-Ill patients: case series 
Nutrition Journal  2015;14:51.
Thiamine plays a fundamental role in cellular metabolism. The classical syndrome caused by thiamine deficiency is beriberi, and its fulminant variant, once considered an uncommon finding, is now encountered among the critically ill.
We present a case series of four critically ill non-septic non-alcoholic patients with severe lactic acidosis and refractory cardio-circulatory collapse caused by acute fulminant beriberi, which drastically responded to thiamine administration.
In critical care settings, increased awareness of this life-threatening but reversible condition is a requirement, especially among patients receiving parenteral nutrition and those with unexplained recalcitrant lactic acidosis.
doi:10.1186/s12937-015-0039-7
PMCID: PMC4443551  PMID: 25982313
Fulminant beriberi; Lactic acidosis; Circulatory collapse; Critically ill
25.  Zingiberaceae extracts for pain: a systematic review and meta-analysis 
Nutrition Journal  2015;14:50.
Background
Members of the family Zingiberaceae including turmeric, ginger, Javanese ginger, and galangal have been used for centuries in traditional medicine. Preclinical studies of Zingiberaceae extracts have shown analgesic properties. This study aims to systematically review and meta-analyze whether extracts from Zingiberaceae are clinically effective hypoalgesic agents.
Methods
Literature was screened from electronic databases using the key words Zingiberaceae AND pain OR visual analogue score (VAS) to identify randomized trials. From this search, 18 studies were identified, and of these, 8 randomized, double-blinded, placebo-controlled trials were found that measured pain by VAS for inclusion in the meta-analysis.
Results
Findings indicated significant efficacy of Zingiberaceae extracts in reducing subjective chronic pain (SMD − 0.67; 95 % CI − 1.13 to − 0.21; P = 0.004). A linear dose-effect relationship was apparent between studies (R2 = 0.71). All studies included in the systematic review reported a good safety profile for extracts, without the renal risks associated with non-steroidal anti-inflammatory drugs, and with similar effectiveness.
Conclusion
Our findings indicated that Zingiberaceae extracts are clinically effective hypoalgesic agents and the available data show a better safety profile than non-steroidal anti-inflammatory drugs. However, both non-steroidal anti-inflammatory drugs and Zingiberaceae have been associated with a heightened bleeding risk, and there have been no comparator trials of this risk. Further clinical studies are recommended to identify the most effective type of Zingiberaceae extract and rigorously compare safety, including bleeding risk.
doi:10.1186/s12937-015-0038-8
PMCID: PMC4436156  PMID: 25972154
VAS; Ginger; Turmeric; Galangal; Curcumin; Curcuma

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