Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D

Background: There are questions about the appropriate method for the accurate estimation of the population prevalence of nutrient inadequacy on the basis of a biomarker of nutrient status (BNS). Objective: We determined the applicability of a statistical probability method to a BNS, specifically serum 25-hydroxyvitamin D [25(OH)D]. The ability to meet required statistical assumptions was the central focus. Design: Data on serum 25(OH)D concentrations in adults aged 19–70 y from the 2005–2006 NHANES were used (n = 3871). An Institute of Medicine report provided reference values. We analyzed key assumptions of symmetry, differences in variance, and the independence of distributions. We also corrected observed distributions for within-person variability (WPV). Estimates of vitamin D inadequacy were determined. Results:We showed that the BNS [serum 25(OH)D] met the criteria to use the method for the estimation of the prevalence of inadequacy. The difference between observations corrected compared with uncorrected for WPV was small for serum 25(OH)D but, nonetheless, showed enhanced accuracy because of correction. The method estimated a 19% prevalence of inadequacy in this sample, whereas misclassification inherent in the use of the more traditional 97.5th percentile high-end cutoff inflated the prevalence of inadequacy (36%). Conclusions: When the prevalence of nutrient inadequacy for a population is estimated by using serum 25(OH)D as an example of a BNS, a statistical probability method is appropriate and more accurate in comparison with a high-end cutoff. Contrary to a common misunderstanding, the method does not overlook segments of the population. The accuracy of population estimates of inadequacy is enhanced by the correction of observed measures for WPV

The current state of hospital-based emergency medicine in Germany

Germany has a long tradition of having physicians, often anesthesiologists with additional training in emergency medicine, deliver prehospital emergency care. Hospital-based emergency medicine in Germany also differs significantly from the Anglo-American model, and until recently having separate emergency rooms for different departments was the norm. In the past decade, many hospitals have created “centralized emergency departments” [Zentrale Notaufnahme (ZNAs)]. There is ongoing debate about the training and certification of physicians working in the ZNAs and whether Germany will adopt a specialty board certification for emergency medicine

A systematic review and quantitative analysis of resting energy expenditure prediction equations in healthy overweight and obese children and adolescents

© The British Dietetic Association Ltd. This is the peer reviewed version of 'Chima, L., Mulrooney, H. M., Warren, J., & Madden, A. (2020). A systematic review and quantitative analysis of resting energy expenditure prediction equations in healthy overweight and obese children and adolescents. Journal of Human Nutrition and Dietetics. https://doi.org/10.1111/jhn.12735'. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Background:  Resting energy expenditure (REE) estimate sare often needed in young people and can be predicted using prediction equations based on body weight.  However,these equations may perform poorly in obesity and overweight. The aim of this systematic review was to identify equations based on simple anthropometric and demographic variables which provide the most accurate and precise estimates of REE in healthy obese and overweight young people. Methodology:Systematic searches for relevant studies in healthy obese and overweight young people aged ≤18 years were undertaken using PubMed, Scopus, Cinahl, OpenGrey and Cochrane Library (completed January 2018). Search terms included metabolism, calorimetry, obesity and prediction equation. Data extraction,study appraisal and synthesis followed PRISMA guidelines. Results:From 390 screened titles, 13 studies met inclusion criteria. The most accurate REE predictions (least biased) were provided by Schofield equations (+0.8%[3-18 years]; 0% [11-18 years]; +1.1% [3-10 years]). The most precise REE estimations (percentage of predictions ±10% of measured) for 11-18 years were provided by Mifflin equations (62%), and for 7-18 years by the equations of Schmelzle (57%), Henry (56%) and Harris Benedict (54%). Precision of Schofield predictions was 43% in both age groups. No accuracy data were available for those <3 years or for precision for those <7 years. Principal conclusions: No single equation provided accurate and precise REE estimations in this population.  Schofield equations provided the most accurate REE predictions so are useful for groups.  Mifflin equations provided the most precise estimates for individuals aged 11-18 but tended to underestimate REE.  Peer reviewedFinal Accepted Versio

Accuracy of predictive equations for resting energy expenditure (REE) in non-obese and obese Korean children and adolescents

Weight-controlling can be supported by a proper prescription of energy intake. The individual energy requirement is usually determined through resting energy expenditure (REE) and physical activity. Because REE contributes to 60-70% of daily energy expenditure, the assessment of REE is very important. REE is often predicted using various equations, which are usually based on the body weight, height, age, gender, and so on. The aim of this study is to validate the published predictive equations for resting energy expenditure in 76 normal weight and 52 obese Korean children and adolescents in the 7-18 years old age group. The open-circuit indirect calorimetry using a ventilated hood system was used to measure REE. Sixteen REE predictive equations were included, which were based on weight and/or height of children and adolescents, or which were commonly used in clinical settings despite its use based on adults. The accuracy of the equations was evaluated on bias, RMSPE, and percentage of accurate prediction. The means of age and height were not significantly different among the groups. Weight and BMI were significantly higher in obese group (64.0 kg, 25.9 kg/m2) than in the non-obese group (44.8 kg, 19.0 kg/m2). For the obese group, the Molnar, Mifflin, Liu, and Harris-Benedict equations provided the accurate predictions of > 70% (87%, 79% 77%, and 73%, respectively). On the other hand, for non-obese group, only the Molnar equation had a high level of accuracy (bias of 0.6%, RMSPE of 90.4 kcal/d, and accurate prediction of 72%). The accurate prediction of the Schofield (W/WH), WHO (W/WH), and Henry (W/WH) equations was less than 60% for all groups. Our results showed that the Molnar equation appears to be the most accurate and precise for both the non-obese and the obese groups. This equation might be useful for clinical professionals when calculating energy needs in Korean children and adolescents

Prediction of winter vitamin D status and requirements in the UK population based on 25(OH) vitamin D half-life and dietary intake data

On a population basis, there is a gradual decline in vitamin D status (plasma 25(OH)D) throughout winter. We developed a mathematical model to predict the population winter plasma 25(OH)D concentration longitudinally, using age-specific values for 25(OH)D expenditure (25(OH)D3t1/2), cross-sectional plasma 25(OH)D concentration and vitamin D intake (VDI) data from older (70+ years; n=492) and younger adults (18-69 years; n=448) participating in the UK National Diet and Nutrition Survey. From this model, the population VDI required to maintain the mean plasma 25(OH)D at a set concentration can be derived. As expected, both predicted and measured population 25(OH)D (mean (95%CI)) progressively declined from September to March (from 51 (40-61) to 38 (36-41)nmol/L (predicted) vs 38 (27-48)nmol/L (measured) in older people and from 59 (54-65) to 34 (31-37)nmol/L (predicted) vs 37 (31-44)nmol/L (measured) in younger people). The predicted and measured mean values closely matched. The predicted VDIs required to maintain mean winter plasma 25(OH)D at 50nmol/L at the population level were 10 (0-20) to 11 (9-14) and 11 (6-16) to 13(11-16)μg/d for older and younger adults, respectively dependent on the month. In conclusion, a prediction model accounting for 25(OH)D3t1/2, VDI and scaling factor for the 25(OH)D response to VDI, closely predicts measured population winter values. Refinements of this model may include specific scaling factors accounting for the 25(OH)D response at different VDIs and as influenced by body composition and specific values for 25(OH)D3 t1/2 dependent on host factors such as kidney function. This model may help to reduce the need for longitudinal measurements

Health inequalities, physician citizens and professional medical associations: an Australian case study

<p>Abstract</p> <p>Background</p> <p>As socioeconomic health inequalities persist and widen, the health effects of adversity are a constant presence in the daily work of physicians. Gruen and colleagues suggest that, in responding to important population health issues such as this, defining those areas of professional obligation in contrast to professional aspiration should be on the basis of evidence and feasibility. Drawing this line between obligation and aspiration is a part of the work of professional medical colleges and associations, and in doing so they must respond to members as well as a range of other interest groups. Our aim was to explore the usefulness of Gruen's model of physician responsibility in defining how professional medical colleges and associations should lead the profession in responding to socioeconomic health inequalities.</p> <p>Methods</p> <p>We report a case study of how the Royal Australian College of General Practitioners is responding to the issue of health inequalities through its work. We undertook a consultation (80 interviews with stakeholders internal and external to the College and two focus groups with general practitioners) and program and policy review of core programs of College interest and responsibility: general practitioner training and setting of practice standards, as well as its work in public advocacy.</p> <p>Results</p> <p>Some strategies within each of these College program areas were seen as legitimate professional obligations in responding to socioeconomic health inequality. However, other strategies, while potentially professional obligations within Gruen's model, were nevertheless contested. The key difference between these lay in different moral orientations. Actions where agreement existed were based on an ethos of care and compassion. Actions that were contested were based on an ethos of justice and human rights.</p> <p>Conclusion</p> <p>Colleges and professional medical associations have a role in explicitly leading a debate about values, engaging both external stakeholder and practicing member constituencies. This is an important and necessary step in defining an agreed role for the profession in addressing health inequalities.</p

A realist review to explore how low-income pregnant women use food vouchers from the UK’s Healthy Start programme

Objectives: To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, which women might experience these impacts and why. Design: A realist review. Eligibility criteria for selecting studies: Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (US) programmes. The assessment of ‘relevance’ was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence. Analysis: A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory ‘context – mechanism – outcome’ (CMO) configurations. Results: 38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the ‘relative value’ of healthy eating (prioritisation of resources); retailer discretion (pressure to ‘bend the rules’); the influence of other family members (disempowerment). Conclusions: This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow’s milk, whereas others may use them to reduce food expenditure and save money for other things

Associations between branched chain amino acid intake and biomarkers of adiposity and cardiometabolic health independent of genetic factors: a twin study

Background: Conflicting data exist on the impact of dietary and circulating levels of branched chain amino acids (BCAA) on cardiometabolic health and it is unclear to what extent these relations are mediated by genetics.  Methods: In a cross-sectional study of 1997 female twins we examined associations between BCAA intake, measured using food frequency-questionnaires, and a range of markers of cardiometabolic health, including DXA-measured body fat, blood pressure, HOMA-IR, highsensitivity C-reactive protein (hs-CRP) and lipids. We also measured plasma concentrations of BCAA and known metabolites of amino acid metabolism using untargeted mass spectrometry. Using a within-twin design, multivariable analyses were used to compare the associations between BCAA intake and endpoints of cardiometabolic health, independently of genetic confounding.  Results: Higher BCAA intake was significantly associated with lower HOMA-IR (-0.1, Ptrend 0.02), insulin (-0.5 µU/mL, P-trend 0.03), hs-CRP -0.3 mg/L, P-trend 0.01), systolic blood pressure (-2.3 mm Hg, P-trend 0.01) and waist-to-height ratio (-0.01, P-trend 0.04), comparing extreme quintiles of intake. These associations persisted in within-pair analysis for monozygotic twins for insulin resistance (P<0.01), inflammation (P=0.03), and blood pressure (P=0.04) suggesting independence from genetic confounding. There were no association between BCAA intake and plasma concentrations, although two metabolitespreviously associated with obesity were inversely associated with BCAA intake (alphahydroxyisovalerate and trans-4-hydroxyproline).  Conclusions: Higher intakes of BCAA were associated, independently of genetics, with lower insulin resistance, inflammation, blood pressure and adiposity-related metabolites. The BCAA intake associated with our findings are easily achievable in the habitual diet.  Abbreviations: BCAA, branched chain amino acids; DBP, diastolic blood pressure; DZ, dizygotic; FFQ, food frequency questionnaire; HDL-C, high density lipoprotein cholesterol; hs-CRP, high sensitivity C-reactive protein; MZ, monozygotic; SBP, systolic blood pressure; T2DM, type 2 diabetes; SBP, systolic blood pressure; WHtR, waist to height rati

Biomedical Issues of Dietary fiber β-Glucan

β-glucan is a polysaccharide in the form of fiber and the main element of fiber in grains such as barley, oats, yeast and mushrooms. Many studies have examined the efficacy of β-glucan in terms of the lipid lowering effects, blood sugar reduction, weight reduction, immune modulator, and anticarcinogenic effect. However, there is no comprehensive review article on the biomedical issues regarding β-glucan. The authors searched for systematic reviews and clinical experiments for each relevant topic and reviewed the biomedical effects of β-glucan, for the purpose of developing research strategies for the future