Nutritional Outcome Measures of Preadolescents and Adolescents Diagnosed with Anorexia Nervosa after Receiving Nasogastric Feedings versus Oral Diet upon Hospitalization

The purpose of this project was to review the literature related to the demographic, clinical, anthropometric, and nutrition therapy characteristics of inpatient preadolescents and adolescents diagnosed with anorexia nervosa (AN). The literature review includes an overview of the prevalence and diagnostic criteria for AN, screening and evaluation of patients, inpatient treatment protocols, the complications associated with AN, and nutrition treatment options (oral diet, enteral feeding, and parenteral nutrition)

Measured Resting Energy Expenditure Using a Fixed Function Indirect Calorimeter in the Clinical Setting as a Predictor of Success with Weight Change in an Obese Pediatric Population

The American Dietetic Association (ADA) standard of care for obese adults utilizes indirect calorimetry for calculating caloric targets for weight loss (1). Even though rates appear to be leveling off (2), childhood obesity is one of the major public health concerns of our time and much attention is currently being given to understanding the obese state. Resting energy expenditure (REE) makes up 60-70% of total energy expenditure and plays a major role in determining an individuals' daily energy needs and metabolism. In the clinical setting, indirect calorimetry is often unavailable, thus predictive equations are typically used to help set caloric goals for weight loss.   The first objective was to compare measured resting energy expenditure (MREE) using a portable indirect calorimeter with five predictive equations used to determine energy needs for children participating in the East Carolina University's Healthy Weight Clinic. The investigators also wanted to determine which of these equations are best to use in an obese pediatric population in the clinical setting. Results indicate that there is a significant (p< 0.05) and strong correlation between MREE and these five predictive equations; however, there are also significant discrepancies. Overall, the Harris Benedict equation demonstrates the lowest mean calorie difference when compared to MREE.   Secondly, it was hypothesized that those subjects with a higher baseline MREE would be more successful with weight loss, and that metabolic factors such as leptin may contribute to weight change in an obese pediatric population. It was also proposed that there may be validity in adjusting MREE to body weight and/or body composition to account for confounders such as age and gender. MREE does not appear to predict success with weight change in obese youth aged 7-18 years. In older obese youth (Tanner Stage 5) it appears that those with a lower baseline fat mass and higher adjusted MREE to fat mass, may have more success with decline in BMI z score. Also, leptin and fat mass significantly (p < 0.05) and negatively correlated with BMI z score change in older youth.  Ph.D

Large Neutral Amino Acid Status in Association with P:T Ratio and Diet in Adult and Pediatric Patients with Phenylketonuria

Background Intake of large neutral amino acids (LNAA) may inhibit phenylalanine (PHE) transport across the blood brain barrier and assist with blood PHE control in patients with phenylketonuria (PKU). We evaluated the interrelationship between LNAA in plasma and diet on Phe:Tyr (P:T) ratio in patients with PKU and the influence of dietary factors on plasma LNAA markers. Methods Plasma amino acid values and 3‐day food record analysis from two studies (34 male/30 female; age 4.6‐47 years) were examined. For pediatrics (years) and adults (≥18 years) the relationship between P:T ratio, plasma LNAA, and dietary intake patterns were investigated. Results Dietary factors influencing P:T ratio included intake of total protein (g/kg), medical food (MF) protein (g/kg, % below Rx), and LNAA (g) in the full cohort (P \u3c .05). Associations were found between plasma valine and other dietary and plasma LNAA in pediatrics (P \u3c .05) and plasma LNAA with dietary LNAA intake in adults (P = .019). Plasma P:T ratio was inversely associated with plasma LNAA concentrations in both age groups (P \u3c .05). Aside from histidine in pediatrics (P = .024), plasma LNAA did not differ by having plasma PHE levels within or above the therapeutic range (120‐360 μmol/L). Plasma LNAA in both age groups was similar to reported healthy control values. Conclusion P:T ratio is significantly tied to dietary LNAA, adherence to MF Rx, and plasma LNAA concentrations. Additionally, P:T ratio and valine may be effective clinical proxies for determining LNAA metabolic balance and LNAA quality of the diet in patients with PKU

The Relationship between the Source of Protein Intake and Obesity Risk in Children

Background: Previous research has reported a relationship between high protein intake (\u3e15% of energy) during early childhood and an increased risk of obesity later in life. However, few studies have investigated this relationship during middle childhood to early adolescence or examined the effects of different sources of protein. Objective: The aim of this study was to investigate the relationship between the source of protein intake (animal vs. plant) and body mass index (BMI) in children between the ages 6-14 years. Participants/setting: 285 healthy 6-14 year old (male n=154) Caucasian and African American (n=171) children from Pittsburgh, Pennsylvania completed a food frequency questionnaire. Main outcome measures: Median protein intake (grams) by total, animal, and plant protein and BMI-for-age classification. Statistical analysis: The Kruskal-Wallis test was used to evaluate differences in median protein intake (grams) by weight classification (normal weight [BMI 5th%ile to \u3c85th%ile], overweight [BMI 85th%tile to \u3c95th%tile], obese [BMI \u3e95th%tile]). Correlation statistics were also conducted to examine the relationship between protein intake and BMI. Results: The population used in the data analysis included 285 children/early adolescents (median age 9.8 ± 2.1 years; 53% boys; 40% Caucasian). Data from 11 children were excluded due to outliers or missing data. Girls had a significantly higher BMI than boys (20.1 vs. 18.2 kg/m2, respectively; P=P=P= Conclusions: We observed a significant curvilinear versus linear trend in total protein and animal and plant protein intake by weight classification in middle-aged children that may be due to under-reporting in overweight and obese children. Total percent protein intake was significantly higher in children of normal weight. Future longitudinal studies using multiple measures of body fatness should be conducted to determine the relationship between protein intake and BMI during middle childhood to early adolescence

The Effect of Intact Protein from Foods and Phenylalanine Free Medical Foods on Large Neutral Amino Acids in Patients with Phenylketonuria.

Objective: The primary aim of this retrospective cohort study was to determine the association between the source of dietary protein intake and the sum of plasma concentration of large neutral amino acids (LNAA) in patients with Phenylketonuria (PKU). A secondary aim of the study was to examine the effect of dietary compliance on plasma concentration of LNAA. Methods: The analysis included combined participant data from two previous studies conducted at the Emory University School of Medicine. Subjects are males (n=34) and females (n=43) with PKU ages 4-50 years. A Student t-test was used to compare total combined plasma LNAA (excluding tryptophan and phenylalanine) by dietary compliance status (alpha=0.05). Correlation statistics were used to determine the association between the ratio of reported intact food protein to medical food protein on plasma levels of LNAA. Multiple regression analysis was used to examine the contribution of intact protein to medical food protein ratio and other variables to plasma LNAA. Results: The median ratio of intact protein to medical food protein reported was 0.354 (IQR: 0.188, 0.914). Median percent of PHE intake over the PHE intake recommendation was 31.64 (Interquartile range [IQR]; 7.44, 104.98). Plasma concentration of LNAA did not differ significantly between those with plasma PHE levels within the therapeutic range μmol/L (compliant; 611.7 μmol/L [n=19]) vs levels above the therapeutic range (non-compliant; 595.3 μmol/L [n=47]); p=0.613). There was an inverse marginal correlation between the ratio of intact protein to medical food protein and plasma concentration of LNAA for those who were compliant (r = -0.436, r = 0.1) although the association was not statistically significant (p=0.08). No correlation was found for patients who were non-compliant. Regression analysis revealed that plasma concentration of LNAA was not significantly affected by the ratio of intact protein to medical food protein ratio, age, or gender. Conclusions: Although not statistically significant, a negative trend was observed between plasma LNAA concentration and the intact protein to medical food protein ratio in patients compliant with the PHE prescription. This suggests that the ratio of intact dietary protein to protein coming from medical food, as reported by patient diet records, may promote increased plasma LNAA levels in the effective treatment of PKU. The majority of the sample (74%) were non-compliant with diet based on plasma PHE levels. Future studies are needed to determine the consequences of non-compliance by decreased intake of medical food protein or increased intake of intact protein on plasma LNAA concentration and downstream health effects

Examining the Effectiveness of a Nutrition Education Intervention for Hispanic Participants

Background: The Expanded Food and Nutrition Education Program (EFNEP) Food Talk nutrition education curriculum in the state of Georgia was specifically tailored towards Hispanic EFNEP participants in order to test the effectiveness of the intervention in the Hispanic population. Methods: 455 Hispanic EFNEP individuals ages 18-61 in the state of Georgia participated in the data collection. Measures collected include a 24 hour diet recall, and a food behavior checklist to compare consumption and food behavior practices both before and after nutrition education intervention. Results: Measurable objectives of the study include statistically significant (p\u3c.001) in fruit, vegetable and milk consumption and consumption of fruits, vegetables and milk group foods closer to the recommended levels of USDA MyPlate guidelines for the nutrition education intervention group. Results also showed statistically significant (p\u3c.0001) improvements in nutrition-related behaviors. Conclusion: This study supports a nutrition intervention developed to improve dietary behaviors for EFNEP participants will be effective in the Hispanic population of Georgia with modifications to the nutrition education curriculum

THE EFFECTS OF ULTRA-FILTERED MILK CONSUMPTION ON STRENGTH AND PERFORMANCE FOLLOWING RESISTANCE TRAINING IN FEMALE COLLEGIATE ATHLETES

Resistance training is beneficial in the improvement of skeletal muscle functionality. Improvements in performance, increased resistance to injury, and great force production are associated with resistance training. Hypertrophy of skeletal muscle mass is important for improving fitness, decreasing body fat percentage, improvements in whole-body metabolism, and enhancements in quality of life. The ability to recovery properly following subsequent training sessions is critical for maximizing training adaptations. Nutrient supplementation has been previously studied. The supplementation of carbohydrates has been shown to replenish muscle glycogen stores. The consumption of carbohydrates following resistance training benefits muscle protein balance by attenuating muscle protein breakdown. Another commonly consumed supplement is amino acids/protein. Supplementation of protein has demonstrated improvements in body composition (i.e. increased fat free mass), increases in hypertrophy, and muscular strength. Two type of proteins used by individuals that resistance train are whey protein and casein protein. Whey protein is a fast digesting protein that leads to quick stimulation of protein synthesis. Casein protein is a slower digesting protein that also attenuates the breakdown of muscle protein. Milk is a natural product that contains carbohydrates, whey protein, and casein protein. Whole milk, low fat milk (i.e., 1-2%), and fat free milk have shown positive results in the ability to improve muscle protein synthesis, lean body mass, strength gains. Therefore, the purpose of the following dissertation is to compare the effects of higher protein, less sugar content chocolate milk to traditional low fat chocolate milk on adaptations to (1) strength and performance measures and (2) body composition following resistance training

“Take Off 4-Health�: Nutrition Education Curriculum for a Healthy Lifestyle Camp for Overweight Youth

There is evidence that residential summer weight loss camps can be effective to initiate or support the small change approach to address childhood obesity. This report describes the development and evaluation of nutrition education for overweight adolescents attending a three week healthy lifestyle camp. Campers were given a diet prescription based on MyPryamid and self-selected their meals and snacks that were served family style. The curriculum included eating strategies known to contribute to healthy weight in youth. Campers demonstrated improved ability to estimate portion sizes. Thirty-four campers completed the three week experience with a weight loss considered to be safe. Note: the deposited item is not the final published version, but rather is the last revised manuscript sent to the publisher

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P &lt; 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P &lt; 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P &lt; 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P &lt; 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P &lt; 0.001; OR(BP) = 2.4, P &lt; 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P &lt; 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P &lt; 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely