Evgen Benedik

Comparison of paper- and web-based dietary records: a pilot study.

Background/Aims: Paper-based dietary records (Paper-DR) can be replaced by web-based dietary records (Web-DR) in both epidemiological studies and clinical practice to reduce the time and logistic burden. We aimed to compare Paper-DR and Web-DR. Methods: We compared the matching of different food items (n = 1,103) from Paper-DR and Web-DR for energy and 48 nutrients among 16 pregnant volunteers, with DR for the same individuals matched for the same 4 days. Paper-DR were coded into the web-based version (referred to as Paper-Web-DR) independently by the same research dietitian. The Wilcoxon signed-rank test comparing mean rank differences, Spearmans ρ to measure associations and Bland-Altman limits of agreement to evaluate the level of agreement between the two dietary methods across the range of parameters were used. Volunteers also completed an evaluation questionnaire regarding the user acceptability of Paper-DR and Web-DR. Results: A high correlation between Paper-DR and Web-DR was noted. There were statistically insignificant differences among 45 nutrients, except for free sugars (p < 0.001), α-linolenic acid (p = 0.041), folate (p = 0.036) and pantothenic acid (p = 0.023). Volunteers found the Paper-DR equally time-consuming as the Web-DR. The majority of the volunteers (75%) preferred the Web-DR. Conclusions: Paper-DR and Web-DR were comparable across a range of nutritional parameters, with a few exceptions. The Web-DR was more convenient for the majority and has substantial logistic and cost advantages.

Food composition databases for effective quality nutritional care.

BACKGROUND AND OBJECTIVES The main aim of this study was to validate a nutrient-estimation method applied using OPEN, a Slovenian platform for clinical nutrition. As the most desirable validation is a direct comparison of the calculated values with the values obtained from a chemical analysis of the same food, we performed a chemical analysis and a calculation for a representative set of daily meals (n=20) and compared the data. The secondary aim was to evaluate the usability of the OPEN for dietary assessment. METHODS We used a Students t test to observe any differences between the analysed and calculated nutrient-content data, considering the 0.01 significance level. RESULTS No statistically significant differences were observed in the mean contents of energy, total dietary fibre, water, macro-nutrients, and selected essential minerals: Ca, Fe, Mg, Zn, Na, P, Cu and I. We notice statistically significant difference in the mean calculated and analytical values of selenium. CONCLUSIONS We noticed remarkable, but not statistically significant, difference in the mean values of iodine (-11%). The present study also indicates that the OPEN is a useful and cost-effective tool for both dieticians and patients.

Microbes in Infant Gut Development: Placing Abundance Within Environmental, Clinical and Growth Parameters

Sound and timely microbial gut colonization completes newborn’s healthy metabolic programming and manifests in infant appropriate growth and weight development. Feces, collected at 3, 30, and 90 days after birth from 60 breastfed Slovenian newborns, was submitted to microbial DNA extraction and qPCR quantification of selected gut associated taxa. Multivariate regression analysis was applied to evaluate microbial dynamics with respect to infant demographic, environmental, clinical characteristics and first year growth data. Early microbial variability was marked by the proportion of Bacilli, but diminished and converged in later samples, as bifidobacteria started to prevail. The first month proportions of enterococci were associated with maternity hospital locality and supplementation of breastfeeding with formulae, while Enterococcus faecalis proportion reflected the mode of delivery. Group Bacteroides-Prevotella proportion was associated with infant weight and ponderal index at first month. Infant mixed feeding pattern and health issues within the first month revealed the most profound and extended microbial perturbations. Our findings raise concerns over the ability of the early feeding supplementation to emulate and support the gut microbiota in a way similar to the exclusively breastfed infants. Additionally, practicing supplementation beyond the first month also manifested in higher first year weight and weight gain Z-score.

Exclusive and Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) is a well-establised primary therapy in active pediatric Crohn’s disease (CD). EEN promotes mucosal healing, restores bone mineral density, and improves growth. On the contrary, treatment of active CD with corticosteroids (CS) has a strong negative impact on the linear growth and bone density. Therefore, EEN is recommended as a first-line therapy in children with active CD. EEN has been evaluated in a number of clinical studies including randomized controlled trials. While metaanalyses of adult studies suggest superiority of CS, pediatric studies have shown that EEN is at least as effective as CS in inducing remission. The mechanisms by which EEN suppresses inflammation are not yet fully elucidated. Hypotheses include improvement in nutritional status, decreasing of the inflammatory cascade mechanism, limiting luminal antigen exposure, improving intestinal permeability, and modification of intestinal microbiota.

Nutrition of patients with severe neurologic impairment

Abstract Background Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds. Patients and methods A 6-month nutritional intervention was made with 37 malnourished children, adolescents and young adults (2–26 years old) with severe neurologic impairment (Gross Motor Function Classification system [GMFCS] grade V). The individual needs were calculated. Participants were fed by gastrostomy with either enteral formulas (n = 17) or pureed food (n = 20). Measurements to assess nutritional status were made at the beginning and at the end of intervention. Results The Z scores for weight-for-age and for the body-mass index increased more in enteral formula than in pureed food group (2.07 vs. 0.70, p = 0.0012; and 3.75 vs. 0.63, p = 0.0014, respectively). Fat mass index increased more in enteral formula than in pureed food group (1.12 kg/m2 vs. 0.38 kg/m2; p = 0.0012). Patients in the enteral formula group showed increase in lean body mass expressed as fat-free mass index (0.70 kg/m2), while those in pureed food group did not (-0.06 kg/m2) (p = 0.0487). Conclusions The results suggest that even professionally planned pureed food diet is less effective than commercial enteral formula for nutritional rehabilitation of malnourished patients with severe neurologic impairment. However, larger and if possible randomised clinical studies should be made to confirm our findings.

Comparison of a Web-Based Dietary Assessment Tool with Software for the Evaluation of Dietary Records.

Abstract Background. Dietary assessment in clinical practice is performed by means of computer support, either in the form of a web-based tool or software. The aim of the paper is to present the results of the comparison of a Slovenian web-based tool with German software for the evaluation of four-day weighted paper-andpencil- based dietary records (paper-DRs) in pregnant women. Methods. A volunteer group of pregnant women (n=63) completed paper-DRs. These records were entered by an experienced research dietitian into a web-based application (Open Platform for Clinical Nutrition, OPEN, http://opkp.si/en, Ljubljana, Slovenia) and software application (Prodi 5.7 Expert plus, Nutri- Science, Stuttgart, Germany, 2011). The results for calculated energy intake, as well as 45 macro- and micronutrient intakes, were statistically compared by using the non-parametric Spearman’s rank correlation coefficient. The cut-off for Spearman’s rho was set at >0.600. Results. 12 nutritional parameters (energy, carbohydrates, fat, protein, water, potassium, calcium, phosphorus, dietary fiber, vitamin C, folic acid, and stearic acid) were in high correlation (>0.800), 18 in moderate (0.600-0.799), 11 in weak correlation (0.400-0.599), while 5 (arachidonic acid, niacin, alphalinolenic acid, fluoride, total sugars) did not show any statistical correlation. Conclusion. Comparison of the results of the evaluation of dietary records using a web-based dietary assessment tool with those using software shows that there is a high correlation for energy and macronutrient content. Izvleček Izhodišča. V klinični praksi za ovrednotenje prehranskih dnevnikov običajno uporabljamo računalniško podporo, bodisi v obliki računalniškega programa ali spletne aplikacije. Namen članka je predstaviti rezultate primerjave nemškega računalniškega programa in slovenske spletne aplikacije za ovrednotenje prehranskega vnosa na osnovi metode štiridnevnega papirnega tehtanega prehranskega dnevnika (papirni PD), ki so ga vodile nosečnice. Metode. Skupina nosečnic prostovoljk (n=63) je vodila papirni PD. Izkušeni klinični dietetik je vnesel dnevnike v spletno aplikacijo (Odprta platforma za klinično prehrano, OPKP, http://opkp.si, Ljubljana, Slovenija) in računalniški program (Prodi 5.7 Exper Plus, Nutri-Science, Stuttgart, Germany, 2011). Rezultate za izračunani energijski vnos ter vnos 45 makro- in mikrohranil s pomočjo aplikacije in programa smo statistično primerjali z neparametričnim Spearmanovim koeficientom (>0,600). Rezultati. Visoko korelacijo (>0,800) med metodama smo ugotovili za 12 hranil (energija, ogljikovi hidrati, skupne maščobe, beljakovine, voda, kalij, kalcij, fosfor, skupna prehranska vlaknina, vitamin C, folna kislina in stearinska kislina), zmerno (0,600-0,799) za 18 hranil, šibko (0,400-0,599) za 11 hranil, medtem ko za 5 hranil ni bilo korelacije (arahidonska kislina, niacin, alfa-linolenska kislina, fluor, skupni sladkorji). Zaključki. Rezultati ovrednotenja prehranskih dnevnikov s spletno aplikacijo in računalniškim programom so v visoki korelaciji za energijsko vrednost in vsebnost makrohranil.