Christophe Matthys

Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data.

The present systematic review critically examines the available scientific literature on risk factors for malnutrition in the older population (aged ≥65 y). A systematic search was conducted in MEDLINE, reviewing reference lists from 2000 until March 2015. The 2499 papers identified were subjected to inclusion criteria that evaluated the study quality according to items from validated guidelines. Only papers that provided information on a variables effect on the development of malnutrition, which requires longitudinal data, were included. A total of 6 longitudinal studies met the inclusion criteria and were included in the systematic review. These studies reported the following significant risk factors for malnutrition: age (OR: 1.038; P = 0.045), frailty in institutionalized persons (β: 0.22; P = 0.036), excessive polypharmacy (β: -0.62; P = 0.001), general health decline including physical function (OR: 1.793; P = 0.008), Parkinson disease (OR: 2.450; P = 0.047), constipation (OR: 2.490; P = 0.015), poor (OR: 3.30; P value not given) or moderate (β: -0.27; P = 0.016) self-reported health status, cognitive decline (OR: 1.844; P = 0.001), dementia (OR: 2.139; P = 0.001), eating dependencies (OR: 2.257; P = 0.001), loss of interest in life (β: -0.58; P = 0.017), poor appetite (β: -1.52; P = 0.000), basal oral dysphagia (OR: 2.72; P = 0.010), signs of impaired efficacy of swallowing (OR: 2.73; P = 0.015), and institutionalization (β: -1.89; P < 0.001). These risk factors for malnutrition in older adults may be considered by health care professionals when developing new integrated assessment instruments to identify older adults risk of malnutrition and to support the development of preventive and treatment strategies.

Faecal metabolite profiling identifies medium-chain fatty acids as discriminating compounds in IBD

Background Bacteria play a role in the onset and perpetuation of intestinal inflammation in IBD. Compositional alterations may also change the metabolic capacities of the gut bacteria. Objective To examine the metabolic activity of the microbiota of patients with Crohns disease (CD), UC or pouchitis compared with healthy controls (HC) and determine whether eventual differences might be related to the pathogenesis of the disease. Methods Faecal samples were obtained from 40 HC, 83 patients with CD, 68 with UC and 13 with pouchitis. Disease activity was assessed in CD using the Harvey–Bradshaw Index, in UC using the UC Disease Activity Index and in pouchitis using the Pouchitis Disease Activity Index. Metabolite profiles were analysed using gas chromatography–mass spectrometry. Results The number of metabolites identified in HC (54) was significantly higher than in patients with CD (44, p<0.001), UC (47, p=0.042) and pouchitis (43, p=0.036). Multivariate discriminant analysis predicted HC, CD, UC and pouchitis group membership with high sensitivity and specificity. The levels of medium-chain fatty acids (MCFAs: pentanoate, hexanoate, heptanoate, octanoate and nonanoate), and of some protein fermentation metabolites, were significantly decreased in patients with CD, UC and pouchitis. Hexanoate levels were inversely correlated to disease activity in CD (correlation coefficient=−0.157, p=0.046), whereas a significant positive correlation was found between styrene levels and disease activity in UC (correlation coefficient=0.338, p=0.001). Conclusions Faecal metabolic profiling in patients with IBD relative to healthy controls identified MCFAs as important metabolic biomarkers of disease-related changes. Trial Registration No: NCT 01666717.

Maternal Micronutrient Deficiencies and Related Adverse Neonatal Outcomes after Bariatric Surgery: A Systematic Review

Pregnant and postpartum women with a history of bariatric surgery are at risk of micronutrient deficiencies as a result of the combination of physiologic changes related to pregnancy and iatrogenic postoperative alterations in the absorption and metabolism of crucial nutrients. This systematic review investigates micronutrient deficiencies and related adverse clinical outcomes in pregnant and postpartum women after bariatric surgery. A systematic approach involving critical appraisal was conducted independently by 2 researchers to examine deficiencies of phylloquinone, folate, iron, calcium, zinc, magnesium, iodide, copper, and vitamins A, D, and B-12 in pregnant and postpartum women after bariatric surgery, together with subsequent outcomes in the neonates. The search identified 29 relevant cases and 8 cohort studies. The quality of reporting among the case reports was weak according to the criteria based on the CARE (CAse REporting) guidelines as was that for the cohort studies based on the criteria from the Cohort Study Quality Assessment list of the Dutch Cochrane Center. The most common adverse neonatal outcomes related to maternal micronutrient deficiencies include visual complications (vitamin A), intracranial hemorrhage (phylloquinone), neurological and developmental impairment (vitamin B-12), and neural tube defects (folate). On the basis of the systematically collected information, we conclude that the evidence on micronutrient deficiencies in pregnant and postpartum women after bariatric surgery and subsequent adverse neonatal outcomes remains weak and inconclusive.

Iron Deficiency After Roux-en-Y Gastric Bypass: Insufficient Iron Absorption from Oral Iron Supplements

BackgroundRoux-en-Y gastric bypass (RYGB) may reduce the absorption of iron, but the extent to which this absorption is impeded is largely unknown. First, we determined the prevalence of iron deficiency following RYGB and explored the risk factors for its development. Second, we examined to what extent oral iron supplements are absorbed after RYGB.MethodsMonocentric retrospective study in 164 patients (123 females, 41 males; mean age 43xa0years) who underwent RYGB between January 2006 and November 2010 was done. Pre- and postoperative data on gender, age, BMI, serum levels of iron, ferritin, hemoglobin, vitamin B12, 25-hydroxy vitamin D, and use of proton pump inhibitors and H2 antagonists were collected. Generalized linear mixed models were used for the analysis of the data. In 23 patients who developed iron deficiency after surgery, an oral challenge test with 100xa0mg FeSO4·7H2O was performed.ResultsFollowing RYGB, 52 (42.3xa0%) female patients and 9 male (22.0xa0%) patients developed iron deficiency (serum ferritin concentration ≤20xa0μg/L). The prevalence of iron deficiency was significantly higher in females than males (pu2009=u20090.0170). Young age (pu2009=u20090.0120), poor preoperative iron status (pu2009=u20090.0004), vitamin B12 deficiency (pu2009=u20090.0009), and increasing time after surgery (pu2009<u20090.0001) were also associated with iron deficiency. In the oral iron challenge test, only one patient out of 23 showed sufficient iron absorption.ConclusionsIron deficiency is extremely frequent after RYGB and is linked with different risk factors. Iron supplementation seems essential, but the effect of oral tablets may be limited as absorption of oral iron supplements is insufficient post-RYGB.

Suboptimal iron status and associated dietary patterns and practices in premenopausal women living in Auckland, New Zealand

PurposeTo investigate associations between dietary patterns and suboptimal iron status in premenopausal women living in Auckland, New Zealand.MethodsPremenopausal women (nxa0=xa0375; 18–44xa0years) were included in this cross-sectional analysis. Suboptimal iron status was defined as serum ferritin <20xa0μg/L. Participants completed a 144-item iron food frequency questionnaire (FeFFQ) and a questionnaire on dietary practices to assess dietary intake over the past month. Factor analysis was used to determine dietary patterns from the FeFFQ. Logistic regression was used to determine associations between these dietary patterns and iron status.ResultsSeven dietary patterns were identified: refined carbohydrate and fat; Asian; healthy snacks; meat and vegetable; high tea and coffee; bread and crackers; and milk and yoghurt. Logistic regression suggested that following a “meat and vegetable” dietary pattern reduced the risk of suboptimal iron status by 41xa0% (95xa0% CI: 18, 58xa0%; Pxa0=xa00.002) and following a “milk and yoghurt” pattern increased the risk of suboptimal iron status by 50xa0% (95xa0% CI: 15, 96xa0%; Pxa0=xa00.003).ConclusionsThese results suggest that dietary patterns characterized by either a low intake of meat and vegetables or a high intake of milk and yoghurt are associated with an increased risk of suboptimal iron status. Dietary pattern analysis is a novel and potentially powerful tool for investigating the relationship between diet and iron status.

Micronutrient intake, from diet and supplements, and association with status markers in pre- and post-RYGB patients

BACKGROUND & AIMSnRoux-en-Y gastric bypass (RYGB) is associated with an increased risk for micronutrient deficiencies. This study aimed to assess total (dietary and supplement) intake and association with iron (including hepcidin), vitamin B12, vitamin C and zinc status markers before and after Roux-en-Y gastric bypass (RYGB).nnnMETHODSnThis prospective study included patients with a planned RYGB in University Hospitals Leuven, Belgium; who were followed until 12 months post-RYGB. Patients completed an estimated dietary record of two non-consecutive days before and 1, 3, 6 and 12 months post-RYGB and supplement/drug use was registered. Associations between total micronutrient intake and status markers were analyzed.nnnRESULTSnFifty-four patients (21 males; mean age: 48.0 [95%CI 46.6; 49.3] years; mean preoperative BMI: 40.4 [95%CI 39.4; 41.4] kg/m2) were included. One month post-RYGB, usual dietary intake of the studied micronutrients was significantly decreased compared to pre-RYGB, but gradually increased until 12 months post-RYGB, remaining below baseline values. By including micronutrient supplement intake, 12 months post-RYGB values were higher than baseline, except for zinc. Hemoglobin, ferritin, vitamin B12 and C-reactive protein serum concentrations were significantly decreased and transferrin saturation and mean corpuscular volume were significantly increased 12 months post-RYGB. Serum hepcidin concentration was significantly decreased 6 months post-RYGB.nnnCONCLUSIONSnMedical nutritional therapy is essential following RYGB as dietary intake of iron, vitamin B12, vitamin C, copper and zinc was markedly decreased postoperatively and some patients still had an inadequate total intake one year post-RYGB.

Breast Milk Macronutrient Composition After Bariatric Surgery

Breast milk samples from 12 lactating women with bariatric surgery were investigated by comparing the macronutrient and energy content with samples from 36 non-surgical controls. Samples were analyzed with the Human Milk Analyzer and the maternal diet 24xa0h prior to sampling with a food record. A higher fat, energy, and a slightly higher carbohydrate milk content was found in the surgical group compared to the non-surgical group (3.0u2009±u20090.7 versus 2.2u2009±u20090.9xa0g/100xa0ml, Pu2009=u20090.008; 61.0u2009±u20097.2 versus 51.7u2009±u20099xa0kcal/100xa0ml, Pu2009=u20090.002; and 6.6u2009±u20090.6 versus 6.3u2009±u20090.4xa0g/100xa0ml, Pu2009=u20090.045, respectively). No correlations and no strong explanatory variance were found between milk macronutrient composition and corresponding maternal dietary intake. The nutritional value of breast milk after bariatric surgery appears to be at least as high as in non-surgical controls.

Foodborne cereulide causes Beta-cell dysfunction and apoptosis

Aims/Hypothesis To study the effects of cereulide, a food toxin often found at low concentrations in take-away meals, on beta-cell survival and function. Methods Cell death was quantified by Hoechst/Propidium Iodide in mouse (MIN6) and rat (INS-1E) beta-cell lines, whole mouse islets and control cell lines (HepG2 and COS-1). Beta-cell function was studied by glucose-stimulated insulin secretion (GSIS). Mechanisms of toxicity were evaluated in MIN6 cells by mRNA profiling, electron microscopy and mitochondrial function tests. Results 24 h exposure to 5 ng/ml cereulide rendered almost all MIN6, INS-1E and pancreatic islets apoptotic, whereas cell death did not increase in the control cell lines. In MIN6 cells and murine islets, GSIS capacity was lost following 24 h exposure to 0.5 ng/ml cereulide (P<0.05). Cereulide exposure induced markers of mitochondrial stress including Puma (p53 up-regulated modulator of apoptosis, P<0.05) and general pro-apoptotic signals as Chop (CCAAT/-enhancer-binding protein homologous protein). Mitochondria appeared swollen upon transmission electron microscopy, basal respiration rate was reduced by 52% (P<0.05) and reactive oxygen species increased by more than twofold (P<0.05) following 24 h exposure to 0.25 and 0.50 ng/ml cereulide, respectively. Conclusions/Interpretation Cereulide causes apoptotic beta-cell death at low concentrations and impairs beta-cell function at even lower concentrations, with mitochondrial dysfunction underlying these defects. Thus, exposure to cereulide even at concentrations too low to cause systemic effects appears deleterious to the beta-cell.

Genes and nutrition, is personalised nutrition the next realistic step

Early 2014, the US Academy of Nutrition and Dietetics wrote in its position statement that “nutritional genomics provides insight into how diet and genotype interactions affect phenotype”[1] Nutrients can dictate phenotypic expression of an individual’s genotype by influencing the processes of gene transcription and protranscriptional processes (including translation). More important, the US Academy identified the practical application of nutritional genomics in the management of complex chronic disease as an emerging science [1]. Nutritional genomics is often presented as the new ‘holy grail’ in nutrition with an ultimate goal to establish a so-called personalised nutrition – i.e. an individual diet tailored to genotype-driven needs. However, one could wonder what the current state of the art is of this concept and to what extent it is realistic to expect such achievements in the near future. n nDuring the fourth Belgian Nutrition Society Symposium the different aspects of the broad field of personalised nutrition have been discussed. New evidence of the importance of diet through the life-course is coming from epigenetics, i.e. changes in the regulation of the expression of gene activity without alteration of genetic structure [2]. There is now considerable evidence for nutritional epigenetic programming of biological functions. Impaired programming has been related to a wide range of phenotypes including obesity and diabetes. Prof Cnop covered in her talk the role of epigenetics in the development of obesity and diabetes. n nA nutritionally relevant Single Nucleotide Polymorphism (SNP) is the C677T polymorphism. It is a common SNP of the methylenetetrahydrofolate reductase (MTHFR) gene, which encodes for the 5,10-MTHFR enzyme and uses folate to metabolize and thereby remove homocysteine. As homocysteine increase is considered a risk factor of cardiovascular diseases, the nutritional importance of this SNP is clear. Prof Helene McNulty has discussed in her talk the role of MTHFR, riboflavin and hypertension based on new and recently published data. n nIn December 2013, Science’s editors announced that research regarding the role of bacteria living inside the human body and their vital roles in determining how the body responds to challenges as malnutrition or cancer was one of the “Breakthroughs of the Year” [3]. In the same time period a letter in Nature was published which indicated the importance of the composition of the gut microbiota to explain the response towards nutritional intervention in obese individual [4,5]. In 2011, our annual meeting had been fully devoted to the relationship between the gut microbiota, nutrition and health (abstracts available at http://www.belgiannutritionsociety.be/data/userfiles/File/BNS2011-abstract-book.pdf). This year, Prof Jeroen Raes discussed in more depth the importance of the genome and the microbiome in human well-being. n nAlthough the US Academy of Nutrition and Dietetics announced the practical application of nutritional genomics for complex chronic disease as an emerging science, it has recently been argued that personalised nutrition will not have the dramatic impact that was once expected [6]. Before personalised nutrition is part of the daily clinical practice further understanding of the complex influences of genetics and the interaction with diet is necessary. Nevertheless Prof Anne-Marie Minihane presented in detail the translational aspects of nutrigenomics. Finally Jo Goossens has discussed the possibilities of nutrigenomics from a business point of view. n nThis session has been assorted of oral presentations presented upon selection of abstracts, putting forward the dynamism of our young researchers in the field of nutrition and health in our country.

EURRECA—Framework for Aligning Micronutrient Recommendations

There is currently no standard approach for deriving micronutrient recommendations, and large variations exist across Europe, causing confusion among consumers, food producers, and policy makers. More aligned information could influence dietary behaviors and potentially lead to a healthier population. Funded by the European Commission, EURRECA (EURopean micronutrient RECommendations Aligned) has developed methods and applications to guide Nutrient Recommendation Setting Bodies through the process of setting micronutrient reference values. The EURRECA approach is crystallized into its framework that outlines a standard process for deriving and using dietary reference values for micronutrients in a transparent, systematic, and scientific way. The 9 activities of the framework can be clustered into four stages (i) defining the problem, (ii) monitoring and evaluating, (iii) deriving dietary reference values, and (iv) using dietary reference values in policy making. The EURRECA framework should not be interpreted as a prescriptive description of a linear process, but as a structured guide for checking that all issues essential for deriving requirements have at least been considered.