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Compher CW. Diagnosing malnutrition-do we really need 6 variables? Am J Clin Nutr 2024; 119:597-598. [PMID: 38350819 DOI: 10.1016/j.ajcnut.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Charlene W Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
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Compher CW, Quinn R, Haslam R, Bader E, Weaver J, Dudek S, Ritchie MD, Lewis JD, Wu GD. Penn Healthy Diet survey: pilot validation and scoring. Br J Nutr 2024; 131:156-162. [PMID: 37519237 DOI: 10.1017/s0007114523001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017-2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.
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Affiliation(s)
- Charlene W Compher
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Science, Philadelphia, PA, USA
| | - Ryan Quinn
- University of Pennsylvania School of Nursing, Department of Biostatistics, Philadelphia, PA, USA
| | - Richard Haslam
- University of Dublin, School of Medicine, Dublin, Republic of Ireland
| | | | - Joellen Weaver
- University of Pennsylvania Health System, Penn Medicine Biobank, Philadelphia, PA, USA
| | - Scott Dudek
- Department of Genetics and Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marylyn D Ritchie
- Department of Genetics and Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James D Lewis
- University of Pennsylvania Perelman School of Medicine, Division of Gastroenterology and Hepatology, Philadelphia, PA, USA
| | - Gary D Wu
- University of Pennsylvania Perelman School of Medicine, Division of Gastroenterology and Hepatology, Philadelphia, PA, USA
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Compher CW, Quinn R, Burke F, Piccinin D, Sartor L, Lewis JD, Wu GD. Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey. Nutr J 2022; 21:70. [PMID: 36384552 PMCID: PMC9670424 DOI: 10.1186/s12937-022-00821-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a need for a feasible, user-friendly tool that can be employed to assess the overall quality of the diet in U.S. CLINICAL SETTINGS Our objectives were to develop the Penn Healthy Diet (PHD) screener, evaluate screener item correlations with Healthy Eating Index (HEI)-2015 components, and develop a simple scoring algorithm. METHODS National Health and Nutrition Examination Survey (NHANES) 2017-18 dietary recall data in adults were used to define food examples in screener food groups based on components of the HEI-2015, Diet Approach to Stop Hypertension, and Alternative Mediterranean diet approaches. Instrument Content Validity Index (I-CVI) was used to evaluate the clarity and relevance of the screener. Patient acceptability was evaluated by completion time and response rates. NHANES 2017-18 food recall data were used to simulate responses to the screener items, which were evaluated for association with HEI-2015 components. A scoring algorithm was developed based on screener items moderately or strongly associated with HEI-2015 components. Reproducibility was tested using NHANES 2015-16 data. RESULTS The screener had strong clarity (I-CVI = 0.971) and relevance for nutrition counseling (I-CVI = 0.971). Median (IQR) completion time was 4 (3-5) minutes on paper and 4 (4-8) minutes online, and 73% of patients invited online completed the survey. Based on simulated NHANES participant screener responses, 15 of the 29 screener items were moderately or strongly associated with HEI-2015 components, forming the basis of the scoring algorithm with a range of 0-63 points, where higher score indicates a healthier diet. The median (IQR) screener and HEI-2015 scores were 14.96 (11.99-18.36) and 48.96 (39.51-59.48), respectively. The simulated PHD score was highly correlated with the HEI-2015 score (Spearman rho 0.75) in NHANES 2017-18 and confirmed in NHANES 2015-16 data (Spearman rho 0.75). CONCLUSIONS The Penn Healthy Diet screener may be a useful tool for assessing diet quality due to its acceptable content validity, ease of administration, and ability to distinguish between servings of key food groups associated with a healthy versus unhealthy diet according to the HEI-2015. Additional research is needed to further establish the instrument's validity, and to refine a scoring algorithm.
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Affiliation(s)
- Charlene W. Compher
- grid.25879.310000 0004 1936 8972University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Ryan Quinn
- grid.25879.310000 0004 1936 8972University of Pennsylvania School of Nursing, Philadelphia, PA USA
| | - Frances Burke
- grid.25879.310000 0004 1936 8972Department of Cardiology, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Doris Piccinin
- grid.25879.310000 0004 1936 8972Abramson Cancer Center, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Linda Sartor
- grid.25879.310000 0004 1936 8972Bariatric Surgery Program, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - James D. Lewis
- grid.25879.310000 0004 1936 8972Department of Gastroenterology, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Gary D. Wu
- grid.25879.310000 0004 1936 8972Department of Gastroenterology, Perelman University of Pennsylvania School of Medicine, Philadelphia, PA USA
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Trout KK, Compher CW, Dolin C, Burns C, Quinn R, Durnwald C. Increased Protein with Decreased Carbohydrate Intake Reduces Postprandial Blood Glucose Levels in Women with Gestational Diabetes: The iPRO Study. Womens Health Rep (New Rochelle) 2022; 3:728-739. [PMID: 36147835 PMCID: PMC9436385 DOI: 10.1089/whr.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Introduction There is an urgent need to establish an evidence base for recommendations regarding proportions of macronutrients for optimized nutritional management of gestational diabetes mellitus (GDM). Our study compared isocaloric diets in women with GDM that differed in protein and carbohydrate content with fats held constant. We hypothesized that the glucose area under the curve (AUC) would be lower with the higher protein/lower carbohydrate diet. Research Design and Methods This study used a random order crossover design within a controlled research unit environment. Nineteen women were randomized to treatment, with 12 participants completing both arms of the study. Blood sampling occurred preprandially and at t = 30, 60, 120, and 180" relative to meals. Inclusion criteria were confirmed diet-controlled GDMA1, singleton gestation, and with no pre-existing medical comorbidities. Mean gestational age at entrance to study = 32 (±1.76) weeks. Mean prepregnant body mass index of participants = 28.7 (±5.3) kg/m2 Participants were randomly assigned initially to either an increased protein/low carbohydrate (iPRO30%/CHO35%) diet or a lower protein/higher carbohydrate (LPRO15%/CHO50%) diet for a 36 hour inpatient stay on the research unit. All meals and snacks were prepared in a metabolic kitchen. After a 3-7 day washout period, participants were randomized to the opposite treatment. Results On day 2 (with confirmed overnight fasting), the average 3-hour pre- through postprandial glucose AUC was lower in iPRO30%/CHO35% treatment arm (17395.20 ± 2493.47 vs. 19172.47 ± 3484.31, p = 0.01). Conclusion This study is the first to demonstrate that a higher protein, lower carbohydrate meal, especially at breakfast, can result in lower postprandial blood glucose values in women with gestational diabetes. A lack of statistically significant differences at other collection time points could have been due to several factors, but most likely due to small sample size. Longer term outcomes of a higher protein diet, including maternal glycemic control, nitrogen balance, and impact on fetal growth outcomes, are needed.
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Affiliation(s)
- Kimberly K. Trout
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charlene W. Compher
- Departments of Biobehavioral Health Sciences, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cara Dolin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carrie Burns
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Quinn
- Departments of Biobehavioral Health Sciences, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Celeste Durnwald
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
OBJECTIVE To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents. DESIGN In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations. SETTING Jintan, China. PARTICIPANTS In total, 226 adolescents (106 females) from the Jintan Child Cohort study. RESULTS Adolescents with low Fe (<75 μg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 μg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: β = -1353·71, P = 0·002, Zn: β = -2262·01, P = 0·02) but less-accurate (Fe: β = -0·97, P = 0·04; Zn: β = -1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (β = 276·94, P = 0·04), and low Zn was associated with fast (β = -1781·83, P = 0·03), but error-prone performance (β = -1·79, P = 0·04) on spatial processing ability and slower reaction speed (β = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 μg/dl for low serum Zn, except for the association with attention task speed (P > 0·05). CONCLUSION Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.
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Affiliation(s)
- Xiaopeng Ji
- College of Health Sciences, School of Nursing, University of Delaware, Newark, DE 19713, USA
| | | | - Sharon Y Irving
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jinyoung Kim
- School of Nursing, University of Nevada, Las Vegas, USA
| | - David F Dinges
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA, USA
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Lewis JD, Sandler R, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson J, Suskind D, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen B, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease. Gastroenterology 2021; 161:837-852.e9. [PMID: 34052278 PMCID: PMC8396394 DOI: 10.1053/j.gastro.2021.05.047] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean diet (MD) as treatment for Crohn's disease (CD) with mild to moderate symptoms. METHODS Adult patients with CD and with mild-to-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6 weeks, participants received prepared meals and snacks according to their assigned diet. After 6 weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at week 6 included fecal calprotectin (FC) response (FC <250 μg/g and reduction by >50% among those with baseline FC >250 μg/g) and C-reactive protein (CRP) response (high-sensitivity CRP <5 mg/L and >50% reduction from baseline among those with high-sensitivity CRP >5 mg/L). RESULTS The study randomized 194 patients, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with the SCD (SCD, 46.5%; MD, 43.5%; P = .77). FC response was achieved in 8 of 23 participants (34.8%) with the SCD and in 4 of 13 participants (30.8%) with the MD (P = .83). CRP response was achieved in 2 of 37 participants (5.4%) with the SCD and in 1 of 28 participants (3.6%) with the MD (P = .68). CONCLUSIONS The SCD was not superior to the MD to achieve symptomatic remission, FC response, and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD and other health benefits associated with the MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms. ClinicalTrials.gov Identifier: NCT03058679.
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Affiliation(s)
- James D. Lewis
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania,Crohn’s & Colitis Foundation Clinical Research Alliance
| | - Robert Sandler
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology and Hepatology, University of North Carolina
| | | | - Colleen Brensinger
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Hongzhe Li
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | | | - Scott G. Daniel
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia
| | - Kyle Bittinger
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia
| | - Lindsey Albenberg
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia
| | - John F. Valentine
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology, Hepatology and Nutrition, University of Utah Health
| | - John Hanson
- Crohn’s & Colitis Foundation Clinical Research Alliance,Atrium Health, Charlotte, NC, United States
| | - David Suskind
- Seattle Children’s Hospital,University of Washington
| | | | - Charlene W. Compher
- Department of Biobehavioral Health Science, University of Pennsylvania, School of Nursing, University of Pennsylvania
| | - Meenakshi Bewtra
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania,Crohn’s & Colitis Foundation Clinical Research Alliance
| | - Akriti Saxena
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania,Crohn’s & Colitis Foundation Clinical Research Alliance
| | | | - Benjamin Cohen
- Crohn’s & Colitis Foundation Clinical Research Alliance,Mount Sinai School of Medicine,Cleveland Clinic
| | - Ann D. Flynn
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology, Hepatology and Nutrition, University of Utah Health
| | - Monika Fischer
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN
| | - Sumona Saha
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health
| | - Arun Swaminath
- Crohn’s & Colitis Foundation Clinical Research Alliance,Lenox Hill Hospital
| | - Bruce Yacyshyn
- Crohn’s & Colitis Foundation Clinical Research Alliance,University of Cincinnati
| | - Ellen Scherl
- Crohn’s & Colitis Foundation Clinical Research Alliance,Cornell University
| | - Sara Horst
- Crohn’s & Colitis Foundation Clinical Research Alliance,Vanderbilt University
| | | | - Kimberly Braly
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Lisa Nessel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Maureen McCauley
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Liam McKeever
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Hans Herfarth
- Crohn’s & Colitis Foundation Clinical Research Alliance,Division of Gastroenterology and Hepatology, University of North Carolina
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Gershuni V, Li Y, Elovitz M, Li H, Wu GD, Compher CW. Maternal gut microbiota reflecting poor diet quality is associated with spontaneous preterm birth in a prospective cohort study. Am J Clin Nutr 2021; 113:602-611. [PMID: 33515003 PMCID: PMC7948858 DOI: 10.1093/ajcn/nqaa361] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A processed diet, high in fat and low in fiber, is associated with differences in the gut microbiota and adverse health outcomes in humans; however, little is known about the diet-microbiota relation and its impact on pregnancy. Spontaneous preterm birth (SPTB), a pregnancy outcome with serious short- and long-term consequences, occurs more frequently in black and in obese women in the United States. OBJECTIVES In a prospective, case-control sample matched for race and obesity (cases = 16, controls = 32), we compared the fecal gut microbiota, fecal and plasma metabolites, and diet in the late second trimester. We hypothesized that a Western diet would be associated with reduced microbiota richness and a metabolic signature predicting incidence of SPTB. METHODS The fecal microbiota was characterized by 16S-tagged sequencing and untargeted metabolomics was used to analyze both plasma and fecal metabolites. Wilcoxon's rank-sum test was used for the comparison of microbiota genera, α-diversity, fecal and plasma metabolites, and dietary variables between term and SPTB. β-Diversity was analyzed using permutational multivariate ANOVA, and metabolite associations were assessed by module analysis. RESULTS A decrease in α-diversity was strongly associated with the development of SPTB, especially in the taxonomic class of Betaproteobacteria. Of 824 fecal metabolites, 22 metabolites (mostly lipids) differed between cases and controls (P < 0.01), with greater DHA (22:6n-3) and EPA (20:5n-3) in cases [false discovery rate (FDR) < 0.2]. The most significant fecal metabolite module (FDR-adjusted P = 0.008) was dominated by DHA and EPA. Dietary saturated fat (primarily palmitate) intake was greater in cases (31.38 ± 7.37 compared with 26.08 ± 8.62 g, P = 0.045) and was positively correlated with fecal DHA and EPA (P < 0.05). CONCLUSIONS Reduced α-diversity of the gut microbiota and higher excretion of omega-3 (n-3) fatty acids in stool may provide a novel biomarker signature predicting SPTB in women with a low-fiber, high-fat diet. Further investigation of these markers in a larger sample is needed for validation.
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Affiliation(s)
- Victoria Gershuni
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yun Li
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michal Elovitz
- Department of Maternal and Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hongzhe Li
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary D Wu
- Department of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Pironi L, Steiger E, Joly F, Wanten GJA, Chambrier C, Aimasso U, Sasdelli AS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie MJ, Cooper SC, Poullenot F, Rasmussen HH, Compher CW, Crivelli A, Hughes SJ, Santarpia L, Guglielmi FW, Rotovnik Kozjek N, Ellegard L, Schneider SM, Matras P, Forbes A, Wyer N, Zmarzly A, Taus M, O'Callaghan M, Osland E, Thibault R, Cuerda C, Jones L, Chapman B, Sahin P, Virgili NM, Lee ADW, Orlandoni P, Matysiak K, Di Caro S, Doitchinova-Simeonova M, Masconale L, Spaggiari C, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Petrina Jáuregui E, Zugasti Murillo A, Suárez-Llanos JP, Nardi E, Van Gossum A, Lal S. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure. Gut 2020; 69:1787-1795. [PMID: 31964752 DOI: 10.1136/gutjnl-2018-318172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
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Affiliation(s)
- Loris Pironi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ezra Steiger
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisca Joly
- Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cecile Chambrier
- Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Umberto Aimasso
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | | | - Amelia Jukes
- University Hospital of Wales, Cardiff, Cardiff, UK
| | - Miriam Theilla
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
| | - Marek Kunecki
- Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
| | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mireille J Serlie
- Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Florian Poullenot
- Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene W Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriana Crivelli
- Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | | | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | | | - Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Nicola Wyer
- University Hospital Coventry, Coventry, Coventry, UK
| | | | - Marina Taus
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ronan Thibault
- Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brooke Chapman
- Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | | | - Núria M Virgili
- Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
| | - Andre Dong Won Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Konrad Matysiak
- Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
| | | | | | - Luisa Masconale
- Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
| | - Corrado Spaggiari
- Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
| | - Carmen Garde
- Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | | | - Gabriel Olveira
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | | | | | - José P Suárez-Llanos
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Elena Nardi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - André Van Gossum
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lal
- Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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10
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Affiliation(s)
- Charlene W Compher
- Penn Nursing and Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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11
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Kumpf VJ, de Aguilar-Nascimento JE, Diaz-Pizarro Graf JI, Hall AM, McKeever L, Steiger E, Winkler MF, Compher CW. ASPEN-FELANPE Clinical Guidelines. JPEN J Parenter Enteral Nutr 2016; 41:104-112. [PMID: 27913762 DOI: 10.1177/0148607116680792] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined. The purpose of this clinical guideline is to develop recommendations for the nutrition care of adult patients with ECF. METHODS A systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. An anonymous consensus process was used to develop the clinical guideline recommendations prior to peer review and approval by the ASPEN Board of Directors and by FELANPE. QUESTIONS In adult patients with enterocutaneous fistula: (1) What factors best describe nutrition status? (2) What is the preferred route of nutrition therapy (oral diet, enteral nutrition, or parenteral nutrition)? (3) What protein and energy intake provide best clinical outcomes? (4) Is fistuloclysis associated with better outcomes than standard care? (5) Are immune-enhancing formulas associated with better outcomes than standard formulas? (6) Does the use of somatostatin or somatostatin analogue provide better outcomes than standard medical therapy? (7) When is home parenteral nutrition support indicated?
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Affiliation(s)
- Vanessa J Kumpf
- 1 Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Amber M Hall
- 4 Boston Children's Hospital, Boston, Massachusetts, USA
| | - Liam McKeever
- 5 University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ezra Steiger
- 6 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Cleveland Clinic, Cleveland, Ohio, USA
| | - Marion F Winkler
- 7 Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
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12
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Beckman LM, Boullata JI, Fisher PL, Compher CW, Earthman CP. Evaluation of Lean Body Weight Equation by Dual-Energy X-Ray Absorptiometry Measures. JPEN J Parenter Enteral Nutr 2016. [DOI: 10.1177/0148607115595223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren M. Beckman
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
- Swedish Medical Center—Food and Nutrition Services, Englewood, Colorado, USA
| | - Joseph I. Boullata
- Department of Biobehavioral & Health Sciences, University of Pennsylvania, Philadelphia, USA
| | - Paige L. Fisher
- Department of Biobehavioral & Health Sciences, University of Pennsylvania, Philadelphia, USA
| | - Charlene W. Compher
- Department of Biobehavioral & Health Sciences, University of Pennsylvania, Philadelphia, USA
| | - Carrie P. Earthman
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
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13
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Al Sawah S, Compher CW, Hanlon AL, Lipman TH. 25-Hydroxyvitamin D and glycemic control: A cross-sectional study of children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2016; 115:54-9. [PMID: 27242123 DOI: 10.1016/j.diabres.2016.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/22/2016] [Accepted: 03/01/2016] [Indexed: 12/25/2022]
Abstract
AIM The objective of this study was to describe the vitamin D status of children and adolescents with type 1 diabetes and to evaluate whether levels of 25-hydroxyvitamin D are significantly associated with HbA1c in this population. METHODS 197 children and adolescents from a diabetes center in a children's hospital were recruited during regular follow up visit. Non-fasting blood samples were collected to measure 25-hydroxyvitamin D and blood glucose levels. HbA1c and other key variables were abstracted from patients' medical records. RESULTS Of the 197 children and adolescents, more than half were adolescents, males, and Caucasian. 23% were overweight, while 13% were obese. Mean HbA1c was 8.6±1.4% (70±15.3mmol/mol). 40.6% of patients had 25-hydroxyvitamin D levels ≤50nmol/L; 49.2% had 25-hydroxyvitamin D levels between 51 and 75nmol/L and 10.2% had 25-hydroxyvitamin D levels >75nmol/L. The bivariate relationship between 25-hydroxyvitamin D and HbA1c almost reached statistical significance (P=0.057), while no significance was established in the multivariate model. CONCLUSIONS To the best of our knowledge this is the first study that has been adequately-powered to examine the association between 25-hydroxyvitamin D and HbA1c in children and adolescents with T1DM. This study demonstrated the high prevalence of patients with low levels of 25-hydroxyvitamin D specifically in healthy weight and Caucasian children and adolescents with T1DM. These data suggest the need for monitoring of 25-hydroxyvitamin D in all youth with T1DM.
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Abstract
OBJECTIVE This study examined concern about child weight in mothers of weight-discordant siblings and determined the accuracy of maternal self-report versus measured child height, weight, and corresponding body mass index (BMI; kg/m(2) ) z-score. DESIGN AND SAMPLE Discordant sibling design. Forty-seven mothers of 5- to 12-year-old, weight-discordant siblings. MEASURES Mothers self-reported their concern about child weight for each child separately and for a subset of children, self-reported their heights and weights. Siblings' height, weight, waist circumference, and adiposity were measured. RESULTS The majority (83%) of mothers expressed concern about their overweight/obese child's weight and 20% of mothers expressed concern about their normal-weight child's weight (p < .001). Difference scores in maternal concern about child weight were positively associated with difference scores in sibling BMI z-score (r = 0.42; p = .01) and percent body fat (r = 0.56; p < .001). For overweight/obese children only, maternal-reported child heights and weights were significantly lower compared to the measured values (p < .03). CONCLUSIONS One fifth of mothers of weight-discordant siblings were unconcerned about their overweight/obese child's weight and for overweight/obese children only, mothers tended to underreport children's height and weight. Mothers' concern for their overweight/obese child's weight was greater for sibling pairs who were more discordant in their weight.
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Affiliation(s)
- Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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15
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Nicolo M, Compher CW, Still C, Huseini M, Dayton S, Jensen GL. Feasibility of Accessing Data in Hospitalized Patients to Support Diagnosis of Malnutrition by the Academy-A.S.P.E.N. Malnutrition Consensus Recommended Clinical Characteristics. JPEN J Parenter Enteral Nutr 2013; 38:954-9. [DOI: 10.1177/0148607113514613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Michele Nicolo
- Hospital of the University of Pennsylvania, Philadelphia
| | - Charlene W. Compher
- Hospital of the University of Pennsylvania, Philadelphia
- University of Pennsylvania, Philadelphia
| | | | | | - Sarah Dayton
- Geisinger Medical Center, Danville, Pennsylvania
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16
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Beckman LM, Earthman CP, Thomas W, Compher CW, Muniz J, Horst RL, Ikramuddin S, Kellogg TA, Sibley SD. Serum 25(OH) vitamin D concentration changes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 2013; 21:E599-606. [PMID: 23526677 PMCID: PMC3731401 DOI: 10.1002/oby.20464] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/09/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe serum 25(OH)D changes after Roux-en-Y gastric bypass (RYGB) and to determine if fat mass (FM) loss and vitamin D intake are associated with changes in serum levels. DESIGN AND METHODS The relationship between serum 25(OH)D and 1) FM, 2) weight, 3) % excess weight loss (EWL), and 4) BMI was investigated after controlling for potential confounders using a mixed effects linear model in 20 women before and up to 1-year post-RYGB. Subcutaneous (SAT) and visceral adipose tissue (VAT) vitamin D concentrations at time of RYGB were also evaluated. RESULTS Weight and FM decreased 1-year after surgery by 45 ± 1 kg and 37 ± 1 kg, respectively while 25(OH)D increased by 10 ± 2 ng mL(-1) . Weight, FM, BMI, and %EWL changes were associated with 25(OH)D change. VAT had an average 21% more vitamin D per gram than SAT and concentrations were highly correlated. CONCLUSIONS Although weight loss may lead to increased serum 25(OH)D after RYGB, low levels remain a concern in some patients 1-year postsurgery. Additional research is needed to clarify the relationship between adipose storage of vitamin D and serum 25(OH)D in obesity, and how that relationship might change after surgery. This could lead to improved clinical management of vitamin D in this ever-growing clinical population.
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Affiliation(s)
- Lauren M Beckman
- Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Avenue, Saint Paul, Minnesota, USA
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17
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Irving SY, Medoff-Cooper B, Stouffer NO, Schall JI, Ravishankar C, Compher CW, Marino BS, Stallings VA. Resting energy expenditure at 3 months of age following neonatal surgery for congenital heart disease. CONGENIT HEART DIS 2013; 8:343-51. [PMID: 23360096 DOI: 10.1111/chd.12035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Infants with Congenital Heart Disease (CHD) often exhibit growth failure. This can affect anthropometric and neurodevelopmental outcomes well into childhood. To determine the resting energy expenditure (REE), body composition, and growth in infants with CHD at 3 months of age, with the secondary aim to identify predictors of REE as compared with healthy infants. DESIGN AND METHODS This descriptive study is a subanalysis of a prospective study investigating predictors of growth in postoperative infants with CHD compared with healthy infants. Growth measurements, REE, and body composition were obtained in all infants. Analysis included chi-square for association between categorical variables, t-tests, ANOVA and ANCOVA. Outcome measures included the REE as determined by indirect calorimetry, anthropometric z-scores and body composition at 3 months of age. SETTING Participants were recruited from the Cardiac Intensive Care Unit of a large, urban, pediatric cardiac center and pediatric primary care practices. RESULTS The analysis included 93 infants, 44 (47%) with CHD. Of the infants with CHD, 39% had single ventricle (SV) physiology. There was no difference in REE related to cardiac physiology between infants with CHD and healthy infants or between infants with SV and biventricular (BV) physiology. Anthropometric z-scores for weight (-1.1 ± 1.1, P < 0.001), length (-0.7 ± 1.1, P < 0.05), and head circumference (-0.6 ± 1.2, P < 0.001) were lower in infants with CHD at 3 months of age. The percentage of body fat (%FAT) in postoperative infants with SV (24% ± 6, P = 0.02) and BV (23% ± 5, P < 0.001) physiology were lower than in healthy infants (27% ± 5), with no difference in REE. CONCLUSION At 3 months of age, there was no difference in REE between postsurgical infants with CHD and healthy infants. Infants with CHD had lower growth z-scores and %FAT. These data demonstrate decreased %FAT contributed to growth failure in the infants with CHD.
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Affiliation(s)
- Sharon Y Irving
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
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18
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Malete L, Motlhoiwa K, Shaibu S, Wrotniak BH, Maruapula SD, Jackson J, Compher CW. Body image dissatisfaction is increased in male and overweight/obese adolescents in Botswana. J Obes 2013; 2013:763624. [PMID: 23634296 PMCID: PMC3619546 DOI: 10.1155/2013/763624] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/21/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The purpose of this study was to examine linkages between obesity, physical activity, and body image dissatisfaction, with consideration of socioeconomic status (SES) and urbanization in adolescents in Botswana. MATERIALS AND METHODS A nationally representative, cross-sectional survey in 707 secondary school students included measured height and weight to determine overweight (OW) or obesity (OB) using World Health Organization standards; physical activity (PA) using the International Physical Activity Questionnaire; and body image satisfaction using the Body Ideals Questionnaire. SES was described by private school versus public school attendance. RESULTS AND DISCUSSION OW/OB students felt farther from ideal and greater dissatisfaction with their weight and body proportions than optimal weight students. Boys felt greater difference from ideal and more dissatisfaction with muscle tone, chest size, and strength than girls. Lower SES students and those from rural villages had more minutes of PA than higher SES or urban students. In this rapidly developing African country, these trends reflect the nutrition transition and offer opportunity to motivate OW/OB students and boys for PA as a health promotion obesity prevention behavior. CONCLUSIONS As urbanization and improved SES are desirable and likely to continue, the public health system will be challenged to prevent obesity while preserving a healthy body image.
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Affiliation(s)
- L Malete
- University of Botswana, Gaborone, Botswana.
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19
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Holsten JE, Compher CW. Children's food store, restaurant, and home food environments and their relationship with body mass index: a pilot study. Ecol Food Nutr 2012; 51:58-78. [PMID: 22292712 DOI: 10.1080/03670244.2012.635572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This pilot research assessed the feasibility and utility of a study designed to examine the relationship between children's BMI and food store, restaurant, and home food environments. Home visits were conducted with sixth-grade children (N = 12). BMI z-scores were calculated with weight and height measurements. Nutrition Environment Measures Surveys evaluated children's food environments. The study protocol involved a feasible time duration, minimal missing data for primary variables, and participant satisfaction. Potential design problems included the homogeneous store environments and low restaurant exposure of the sample recruited from one school, and the adequacy of a single cross-sectional measure of the home environment.
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Affiliation(s)
- Joanna E Holsten
- School of Nursing, University of Pennsylvania, Phildelphia, Pennsylvania 19104-4217, USA.
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20
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Compher CW, Hanlon A, Kang Y, Elkin L, Williams NN. Attendance at Clinical Visits Predicts Weight Loss After Gastric Bypass Surgery. Obes Surg 2011; 22:927-34. [DOI: 10.1007/s11695-011-0577-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shaibu S, Holsten JE, Stettler N, Maruapula SD, Jackson JC, Malete L, Mokone G, Wrotniak BH, Compher CW. Adolescent obesity prevention in Botswana: beliefs and recommendations of school personnel. J Sch Nurs 2011; 28:220-9. [PMID: 22114299 DOI: 10.1177/1059840511429003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The study's objectives were to gain school personnel's (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools' financial resources, interest of students, and time limitations of all involved.
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Affiliation(s)
- Sheila Shaibu
- School of Nursing, University of Botswana, Gaborone, Botswana
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Buchman AL, Howard LJ, Guenter P, Nishikawa RA, Compher CW, Tappenden KA. Micronutrients in parenteral nutrition: too little or too much? The past, present, and recommendations for the future. Gastroenterology 2009; 137:S1-6. [PMID: 19874941 DOI: 10.1053/j.gastro.2009.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This research workshop in 2009 grew out of a concern in the United States, Europe, and other countries with advanced medicine that it was time to revisit the parenteral requirements for a number of micronutrients. Critical questions sought to be answered included the following: Were there micronutrients not routinely added that should be part of a parenteral nutrition (PN) formula? Were other micronutrients present but in inappropriate amounts? How are various micronutrient requirements altered in the critically or chronically ill?
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Affiliation(s)
- Alan L Buchman
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois 60611, USA.
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23
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Abstract
BACKGROUND Adaptive hyperphagia is associated with reduced dependence on parenteral nutrition in patients with short bowel syndrome, but mechanisms have not been described. Ghrelin (GHR) has orexigenic effects, whereas peptide YY (PYY) reduces intake. GHR also acts as a hormone to control body fat stores. The authors evaluated whether GHR or PYY was related to caloric intake or absorption in patients with short bowel syndrome and whether GHR was associated with body mass index. METHODS Patients were admitted twice for nutrient balance. Height and body weight were obtained using standardized protocols. Energy intake > 40 kcal/kg/day was defined as adaptive hyperphagia. Fasting plasma PYY and GHR were assayed in duplicate with Linco enzyme-linked immunosorbent assay kits. RESULTS The median age of the 7 study participants was 62 (range, 45-66) years, time with short bowel syndrome was 6.6 (range, 2-29) years, and body mass index was 21.2 kg/m(2) (range, 19-27.7). Five patients had adaptive hyperphagia. Neither GHR nor PYY was significantly related to energy intake or absorption (GHR: R = 0.22 and R = -0.233, PYY: R = 0.10 and R = -0.13). Body mass index trended toward an inverse association with GHR (GHR: R = -0.540, P = .211). CONCLUSION The rigorous adaptive hyperphagia seen in these patients with short bowel syndrome was not related to fasting GHR or PYY, suggesting the need to explore other mechanisms.
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Affiliation(s)
- Charlene W Compher
- University of Pennsylvania School of Nursing, Philadelphia 19104-6096, USA.
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24
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Compher CW, Kinosian BP, Rubesin SE, Ratcliffe SJ, Metz DC. Energy Absorption Is Reduced With Oleic Acid Supplements in Human Short Bowel Syndrome. JPEN J Parenter Enteral Nutr 2008; 33:102-8. [DOI: 10.1177/0148607108325074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Charlene W. Compher
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Bruce P. Kinosian
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Stephen E. Rubesin
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Sarah J. Ratcliffe
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - David C. Metz
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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25
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Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: a review. Obes Surg 2008; 18:220-4. [PMID: 18176832 DOI: 10.1007/s11695-007-9289-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 08/29/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Adiposity has been inversely associated with vitamin D concentration across a range of body mass index values and cultural groups. As obesity has increased markedly worldwide, a greater number of patients with severe obesity have been treated with gastric restrictive and/or malabsorptive surgical procedures. The purpose of this review was to describe current knowledge about vitamin D and severe obesity, and the impact of obesity surgery on vitamin D status. RESEARCH METHODS AND PROCEDURES A systematic review was conducted with search terms obesity, vitamin D, osteoporosis, bone disease, gastric bypass, and obesity surgery in various combinations. Publications were limited to those since 2000 to control for similarity in vitamin D assays and obesity prevalence levels. RESULTS Mean 25-hydroxy vitamin D was <80 nmol/l in more than 1,900 patients preoperatively, and was not restored to the optimal concentration of >80 nmol/l postoperatively. Both secondary hyperparathyroidism and bone loss were common, particularly when the obesity surgery included a malabsorptive component. Standard postsurgical supplementation with vitamin D and calcium have not been adequate to suppress secondary hyperparathyroidism or to restore 25-hydroxy vitamin D status. DISCUSSION The mechanisms behind vitamin D deficiency in severe obesity and evidence-based corrective actions have not been well-defined. Of particular concern are adolescents who qualify for and elect surgical treatment of their obesity, where subsequent metabolic bone disease may be long-standing.
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Affiliation(s)
- Charlene W Compher
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-6096, USA.
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26
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Compher CW, Kinosian BP, Metz DC. No impact of ghrelin on adaptive hyperphagia in short bowel syndrome. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a100-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Charlene W Compher
- School of Nursing, University of Pennsylvania420 Guardian DrivePhiladelphiaPA19104‐6096
| | - Bruce P Kinosian
- School of Medicine, University of Pennsylvania1914 Penn Tower, 3400 Spruce StreetPhiladelphiaPA19104
| | - David C Metz
- School of Medicine, University of PennsylvaniaGastroenterology, 2 Ravdin, 3400 Spruce StreetPhiladelphiaPA19104
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27
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Ikezawa F, Fukatsu K, Moriya T, Maeshima Y, Okamoto K, Hara E, Hiraide H, Compher CW. Albumin infusion after reperfusion prevents gut ischemia-reperfusion-induced gut-associated lymphoid tissue atrophy. JPEN J Parenter Enteral Nutr 2006; 30:380-6; discussion 386-7. [PMID: 16931605 DOI: 10.1177/0148607106030005380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our recent study clarified that gut ischemia-reperfusion (I/R) causes gut-associated lymphoid tissue (GALT) mass atrophy, a possible mechanism for increased morbidity of infectious complications after severe surgical insults. Because albumin administration reportedly reduces hemorrhagic shock-induced lung injury, we hypothesized that albumin treatment prevents GALT atrophy due to gut I/R. METHODS Male mice (n = 37) were randomized to albumin, normal saline, and sham groups. All groups underwent jugular vein catheter insertion. The albumin and normal saline groups underwent 75-minute occlusion of the superior mesenteric artery. During gut ischemia, all mice received normal saline infusions at 1.0 mL/h. The albumin group was given 5% bovine serum albumin in normal saline at 1.0 mL/h for 60 minutes after reperfusion, whereas the normal saline group received 0.9% sodium chloride at 1.0 mL/h. The sham group underwent laparotomy only. Mice were killed on day 1 or 7, and the entire small intestine was harvested. GALT lymphocytes were isolated and counted. Their phenotypes (alphabetaTCR, gammadeltaTCR, CD4, CD8, B220) were determined by flow cytometry. RESULTS On day 1, the gut I/R groups showed significantly lower total lymphocyte and B cell numbers in Peyer's patches and the lamina propria than the sham group. However, the albumin infusion partially but significantly restored these cell numbers. On day 7, there were no significant differences in any of the parameters measured among the 3 groups. CONCLUSIONS Albumin infusion after a gut ischemic insult may maintain gut immunity by preventing GALT atrophy.
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Affiliation(s)
- Fumie Ikezawa
- Division of Basic Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
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28
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Spencer CT, Compher CW. Total parenteral nutrition, an ally in the management of patients with intestinal failure and malnutrition: a long-term view. JPEN J Parenter Enteral Nutr 2003; 27:374-81. [PMID: 12971737 DOI: 10.1177/0148607103027005374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Compher CW, Kinosian BP, Stoner NE, Lentine DC, Buzby GP. Choline and vitamin B12 deficiencies are interrelated in folate-replete long-term total parenteral nutrition patients. JPEN J Parenter Enteral Nutr 2002; 26:57-62. [PMID: 11833752 DOI: 10.1177/014860710202600157] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Choline has recently been recognized as an essential nutrient, in part based on deficiency data in long-term home total parenteral nutrition (TPN) patients. Choline, a methyl donor in the metabolism of homocysteine, is intricately related to folate status, but little is known about choline and vitamin B12 status. Long-term TPN patients are also subject to vitamin B12 deficiency. OBJECTIVE The objective of the study was to evaluate any interaction between choline, vitamin B12, and folate in patients with severe malabsorption syndromes, requiring long-term TPN. DESIGN Plasma free choline, serum and red blood cell (RBC) folate, serum vitamin B12 methylmalonic acid, B6, and plasma total homocysteine concentrations were assayed by standard methods. Low choline was defined as values that fall 1 to < or =3 and marked low choline concentration as >3 SD below the control mean. RESULTS Both low choline concentrations (52% were marked low, 33% low, 14% normal) and elevated methylmalonic acid concentrations (47%) were prevalent. Choline concentration was significantly lower and RBC folate higher in patients with elevated methylmalonic acid. Total homocysteine elevations were rare (3 of 21) and mild. CONCLUSIONS These data suggest a strong interaction between vitamin B12 and choline deficiencies and folate status in this population, which may be due in part to variations in vitamin and choline delivery by TPN. Folate adequacy may increase B12 use for homocysteine metabolism, thus limiting B12 availability for methylmaIonic acid metabolism. Choline use may also increase, and choline deficiency may worsen if choline substitutes when the vitamin B12 side of the homocysteine metabolic pathway cannot be used.
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Affiliation(s)
- Charlene W Compher
- Clinical Nutrition Support Service, University of Pennsylvania, Philadelphia 19104, USA.
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Compher CW, Kinosian BP, Evans-Stoner N, Huzinec J, Buzby GP. Hyperhomocysteinemia is associated with venous thrombosis in patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2001; 25:1-7; discussion 7-8. [PMID: 11190983 DOI: 10.1177/014860710102500101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hyperhomocysteinemia is associated with venous thrombosis and vitamin deficiency. Patients with short bowel syndrome have increased risk of venous thrombosis due to central catheters, and of vitamin deficiency due to malabsorption. The current investigation was designed to evaluate the relationship between history of venous thrombosis and current hyperhomocystinemia and vitamin deficiency in patients with short bowel syndrome. METHODS Plasma total homocysteine (tHcy), serum vitamin B12, folate, B6, and methylmalonic acid (MMA) were measured. Venous thrombosis was documented by venogram or ultrasound. RESULTS Ten of 17 patients had venous thromboses, including 17 of 38 observed superior and 12 of 26 inferior veins. Total homocysteine was correlated with number of thromboses. The relative risk of multiple thromboses in the highest tHcy tertile was 3.6-fold that of the lowest tertile. Vitamin B12 and folate levels were within normal limits, but B12 deficiency by MMA or tHcy level was apparent in 7 patients. Vitamin-deficient patients had higher tHcy and MMA than those without deficiency. CONCLUSIONS Venous thrombosis in patients with short bowel syndrome is related to hyperhomocystinemia, which is also related to vitamin B12 deficiency, not detected by serum vitamin B12 concentration. Whether treatment of vitamin deficiencies and associated reduction in tHcy will reduce recurrent venous thrombosis in these patients is not known.
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Affiliation(s)
- C W Compher
- Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia 19104, USA.
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Compher CW, Frankel WL, Tazelaar J, Lawson JA, McKinney S, Segall S, Kinosian BP, Williams NN, Rombeau JL. Wheat bran decreases aberrant crypt foci, preserves normal proliferation, and increases intraluminal butyrate levels in experimental colon cancer. JPEN J Parenter Enteral Nutr 1999; 23:269-77; discussion 277-8. [PMID: 10485439 DOI: 10.1177/0148607199023005269] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dietary wheat bran protects against colon cancer, but the mechanism(s) of this effect is not known. Butyrate, produced by colonic bacterial fermentation of dietary polysaccharides, such as wheat bran, induces apoptosis and decreases proliferation in colon cancer cell lines. Whether similar effects occur in vivo is not well defined. We hypothesized that wheat bran's antineoplastic effects in vivo may be mediated in part by butyrate's modulation of apoptosis and proliferation. METHODS Male F344 rats were fed wheat bran-supplemented or an isocaloric, isonitrogenous fiber-free diet. Rats were treated with one dose of the carcinogen azoxymethane or vehicle with sacrifice after 5 days (tumor initiation); or two doses (days O and 7) with sacrifice after 56 days (tumor promotion). Study variables included fecal butyrate levels and the intermediate biomarkers of colon carcinogenesis, aberrant crypt foci (ACF), and changes in crypt cell proliferation and apoptosis. RESULTS During tumor initiation, wheat bran produced greater apoptosis (p = .01), a trend toward less proliferation, and preserved the normal zone of proliferation (p = .01). At tumor promotion, wheat bran decreased the number of ACF (proximal colon, p = .005; distal colon, p = .047) and maintained the normal proliferative zone. The fiber-free diet shifted the zone of proliferation into the premalignant pattern in both studies. Wheat bran produced significantly higher fecal butyrate (p = .01; .004, .00001) levels than the fiber-free diet throughout the tumor promotion study. CONCLUSIONS Wheat bran increased apoptosis and controlled proliferation during tumor initiation and resulted in decreased ACF. Wheat bran's antineoplastic effects occurred early after carcinogen exposure, and were associated with increased fecal butyrate levels.
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Affiliation(s)
- C W Compher
- Harrison Department of Surgical Research, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, USA
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