Effect of obesity on success of renal grafts

Exploring associations between anthropometric indices and graft function in patients receiving renal transplant

Tsirigoti et al., JHND Early View

Background

The aim of the present study was to identify indicators of malnutrition, as obtained by anthropometric measurements, that might be potential predictors of transplant outcomes.

Methods

One hundred and three patients receiving a graft from a living or a deceased donor were included in this prospective study. Body mass index (BMI) based on pretransplant dry body weight, triceps skinfold, mid-arm muscle circumference and corrected mid-arm muscle area were measured. Post-transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were collected until patient discharge.

Results

Delayed graft function developed in 36.9% of the patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07–1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [β = −0.014 (0.005), = 0.004], being overweight [β = −0.151 (0.041), < 0.001] and obesity [β = −0.188 (0.053), = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves.

Conclusions

The likelihood of DGF was higher among obese patients, whereas GFR at discharge was negatively associated with being overweight and obesity.

Nutritional care after critical illness

Nutritional care after critical illness: a qualitative study of patients’ experiences

Merriweather et al., JHND Early View

The present qualitative study aimed to explore the factors influencing nutritional recovery in patients after critical illness and to develop a model of care to improve current management of nutrition for this patient group.

Methods

Patients were recruited into the study on discharge from a general intensive care unit (ICU) of a large teaching hospital in central Scotland. Semi-structured interviews were carried out after discharge from the ICU, weekly for the duration of their ward stay, and at 3 months post ICU discharge. Observations of ward practice were undertaken thrice weekly for the duration of the ward stay.

Results

Seventeen patients were recruited into the study and, using a grounded theory approach, ‘inter-related system breakdowns during the nutritional recovery process’ emerged as the overarching core category that influenced patients’ experiences of eating after critical illness. This encompassed the categories, ‘experiencing a dysfunctional body’, ‘experiencing socio-cultural changes in relation to eating’ and ‘encountering nutritional care delivery failures’.

Conclusions

The findings from the present study provide a unique contribution to knowledge by offering important insights into patients’ experiences of eating after critical illness. The study has identified numerous nutritional problems and raises questions about the efficacy of current nutritional management in this patient group. Adopting a more individualised approach to nutritional care could ameliorate the nutritional issues experienced by post ICU patients. This will be evaluated in future work.

Detox diets- critically reviewed

Detox diets for toxin elimination and weight management: a critical review of the evidence

Klein and Kiat, JHND Early View

Detox diets are popular dieting strategies that claim to facilitate toxin elimination and weight loss, thereby promoting health and well-being. The present review examines whether detox diets are necessary, what they involve, whether they are effective and whether they present any dangers. Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. A handful of clinical studies have shown that commercial detox diets enhance liver detoxification and eliminate persistent organic pollutants from the body, although these studies are hampered by flawed methodologies and small sample sizes. There is preliminary evidence to suggest that certain foods such as coriander, nori and olestra have detoxification properties, although the majority of these studies have been performed in animals. To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. This is an area that deserves attention so that consumers can be informed of the potential benefits and risks of detox programmes.

Our Christmas break

Unknown

The Christmas holidays are almost upon us. The Associate Editors and I will be taking a break over the next two weeks or so. This time of year is also a difficult period for finding peer-reviewers for papers. This means that manuscripts will not be handled as quickly as usual until normal business resumes on the 5th January.

Please accept our apologies for any frustrations that this may cause.

Happy Christmas from JHND

Feeding infants with congenital heart disease

Dietary intake in infants with complex congenital heart disease: a case–control study on macro- and micronutrient intake, meal frequency and growth  

Hansson et al., JHND Early View

Background

Children with severe congenital heart disease (CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD.

Methods

At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated.

Results

Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg−1day−1), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day−1) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age (P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower (P < 0.01) at all time points.

Conclusions

Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants.

New Commissioned Reviews Editor appointed

We are pleased to announce that the new Commissioned Reviews Editor for JHND will be Dr Daniele Del Rio from the University of Parma. Dan will take up his role in the New Year and will take responsibility for commissioning state-of-the-art review articles from distinguished experts across the disciplines of nutrition and dietetics. We hope to reach the stage where every JHND issue will include one of these high profile review articles.

Dan is Associate Professor of Human Nutrition at Parma but is also  an Honorary Visiting Scholar with the British Medical Research Council Human Nutrition Research Unit in Cambridge and Visiting Scholar at Wolfson College, University of Cambridge. His expertise lies in phenolics and health and he has authored more than 80 papers since 2002 and is truly a rising star in the field.