搜索结果：Asia Pacific journal of clinical nutrition

It is imperative to recognise that the main components of the food environment in SEA are not processed foods and the so-called ultra-processed foods. Instead, large segments of the population have their meals frequently away from home, as demonstrated by data from Malaysia and Indonesia in this supplement. A myriad of eating places have mushroomed in countries in the region, ranging from street foods, coffee shops, hawker centres and restaurants as well as through numerous food delivery services. Many of these meals are imbalanced, lacking in the healthful food groups, whilst containing high amounts of sugar, oil and salt. Frequent and excessive consumption of these meals and beverages could very well be the main contributors to the nutrition related health problems in the region. Recognising this, the supplement summarises research car-ried out on developing nutrient profiles based on meals or dishes as one of the strategies to improve the food environment. One article in this supplement summarises the principles and utilisation of nutrient profiles while another three articles summarise such meal-based profiles developed by researchers in Thailand and Japan. Meal-based nutritional profile systems, based on food cultures of countries in the region, could help both food vendors to reformulate and improve their menus as well as to consumers to select healthier away-from-home meals. It is hoped that information in this supplement may prove useful for researchers, policy makers, and health care professionals in their efforts to improve the food environment in SEA.

Critical illness often leads to life-threatening organ dysfunction requiring intensive care. This catabolic condition significantly affects nutrition, causing muscle loss, weakness, and an in-creased risk of malnutrition, which complicates recovery. Traditional nutritional assessment tools often face limitations in critically ill patients. Systemic inflammation may improve the accuracy of nutritional risk screening. Data from the MIMIC-IV database were analyzed. The study aimed to assess the prognostic value of inflammatory markers combined with the mNUTRIC score. Survival analyses were conducted using Kaplan-Meier curves and Cox regression models to evaluate the association between these markers and patient mortality at 30-day, 60-day, and 90-day intervals. A total of 2,628 ICU patients were included. High C-reactive protein (CRP; cut-off value 75.2 mg/L) had a hazard ratio (HR) of 1.345 (Log-rank p = 0.004), high neutrophil-to-lymphocyte ratio (NLR; cut-off value 8.16) had an HR of 1.266 (Log-rank p = 0.021), and albumin (cut-off value 35 g/L) was associated with an HR of 0.576 (Log-rank p < 0.001). For 60-day and 90-day mortality, similar trends were observed, with significant p-values. Combining inflammatory markers such as CRP, NLR, and albumin with the mNUTRIC score enhances mortality prediction in critically ill patients, improving clinical decision-making. Further research with larger, multicenter cohorts is needed.

Malnutrition among older hospitalized adults with chronic heart failure (CHF) is associated with adverse clinical outcomes, yet reliable early risk stratification tools remain lacking. This study aimed to develop and validate a machine learning (ML) model for malnutrition risk stratification in this population. Malnutrition among older hospitalized adults with chronic heart failure (CHF) is associated with adverse clinical outcomes, yet reliable early risk stratification tools remain lacking. This study aimed to develop and validate a machine learning (ML) model for malnutrition risk stratification in this population. Malnutrition prevalence was 44.1% (348/790). In the internal testing, CatBoost (CAT) achieved superior performance with an AUC of 0.901 (95% confidence interval [CI]: 0.858-0.943), accuracy of 0.840, recall of 0.753, and the lowest Brier score of 0.113. This model demonstrated strong calibration, clinical utility, and the highest composite score (62/64). External validation confirmed CAT's generalizability (AUC: 0.916, 95% CI: 0.887-0.945). SHAP analysis identified body mass index (BMI), calf circumference, New York Heart Association (NYHA) classification, age, and diabetes as signifi-cant contributors to malnutrition risk. The CAT-based model effectively stratifies malnutrition risk in older hospitalized CHF patients, offering a tool for early intervention to improve outcomes. Further multicenter prospective studies are needed to validate its real-world applicability.

Undernutrition is prevalent among patients with cancer and may be associated with survival. The Patient-Generated Subjective Global Assessment (PG-SGA) is a widely recognised scale for the nutritional assessment of patients with cancer. The relationship between undernutrition, as defined by the PG-SGA, and cancer prognosis has been somewhat controversial, and this meta-analysis sought to clarify this. This meta-analysis was performed to elucidate the association between undernutrition, as defined by the PG-SGA, and survival outcomes in patients with cancer. Studies that investigated the association between undernutrition, defined by the PG-SGA, and survival outcomes in patients with cancer were included, and data were retrieved from PubMed, EMBASE, the Cochrane Library, and Web of Science until October 2023. A total of 18 prospective and 14 retrospective studies with 27120 cancer patients were identified in this analysis. All studies had high methodological quality, with an average score of 7.66. The results showed that undernutrition, as defined by the PG-SGA, was significantly correlated with worse overall survival (Hazard Ratio (HR) = 1.99, 95% Confidence Interval (CI): 1.62-2.45). Subgroup analyses further confirmed that the pooled HR was 1.64 (95% CI: 1.26-2.13) for moderate undernutrition, which increased gradually in cases of severe undernutrition (HR = 2.65, 95% CI: 2.45-2.87). The degree of undernutrition might be the source of the heterogeneity (p value for the test of subgroup differences was < 0.001). Sensitivity analyses confirmed the robustness and credibility of this meta-analysis. These results under-score the significant association between undernutrition, as defined by the PG-SGA, and reduced overall survival in patients with cancer. Detection of nutritional status using the PG-SGA may be beneficial for improving survival in patients with cancer.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1&#xb7;3 billion (95% uncertainty interval [UI] 1&#xb7;2 to 1&#xb7;4) individuals were estimated to be living with MASLD (ie, 16&#xb7;1% of the global population), with an age-standardised prevalence rate of 14&#x2009;429&#xb7;3 (95% UI 13&#x2009;268&#xb7;3 to 15&#x2009;990&#xb7;6) per 100&#x2009;000 population, representing a percentage increase of 142&#xb7;7% (95% UI 139&#xb7;2 to 146&#xb7;7) in crude numbers from 1990 (0&#xb7;5 billion [0&#xb7;5 to 0&#xb7;6]) and of 28&#xb7;6% (27&#xb7;8 to 29&#xb7;5) in the rate (11&#x2009;217&#xb7;2 [10&#x2009;276&#xb7;8 to 12&#x2009;467&#xb7;0] per 100&#x2009;000 in 1990). An estimated 3&#xb7;6 million (2&#xb7;8 to 4&#xb7;5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39&#xb7;6 (31&#xb7;2 to 49&#xb7;9) per 100&#x2009;000 population. Despite a 116&#xb7;3% (93&#xb7;3 to 139&#xb7;4) increase in crude DALYs (from 1&#xb7;7 million [1&#xb7;3 to 2&#xb7;1] in 1990), its age-standardised estimate remained consistent (1&#xb7;8% [-8&#xb7;6 to 12&#xb7;8]) from 1990 (38&#xb7;9 [30&#xb7;1 to 49&#xb7;8] per 100&#x2009;000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29&#x2009;246&#xb7;1 [26&#x2009;848&#xb7;3 to 32&#x2009;048&#xb7;7] per 100&#x2009;000) and Andean Latin America showed the highest DALY rate (152&#xb7;3 [114&#xb7;1 to 194&#xb7;7] per 100&#x2009;000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653&#xb7;5 [7923&#xb7;7 to 9592&#xb7;8] per 100&#x2009;000) and east Asia had the lowest DALY rate (16&#xb7;3 [13&#xb7;5 to 19&#xb7;9] per 100&#x2009;000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15&#x2009;616&#xb7;4 [14&#x2009;349&#xb7;2 to 17&#x2009;263&#xb7;3] per 100&#x2009;000 people in 2023) than in females (13&#x2009;245&#xb7;2 [12&#x2009;132&#xb7;0 to 14&#x2009;692&#xb7;6] per 100&#x2009;000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2&#xb7;2 [95% UI 1&#xb7;6 to 3&#xb7;1] per 100&#x2009;000 people), followed by high BMI (1&#xb7;4 [0&#xb7;6 to 2&#xb7;4] per 100&#x2009;000 people) and smoking (1&#xb7;0 [0&#xb7;3 to 1&#xb7;8] per 100&#x2009;000 people). Our forecasting model estimates that 1&#xb7;8 billion (95% UI 1&#xb7;6 to 2&#xb7;0) individuals are likely to have MASLD by 2050, representing a 42&#xb7;0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15&#x2009;774&#xb7;9 (95% UI 14&#x2009;613&#xb7;9 to 17&#x2009;336&#xb7;2) per 100&#x2009;000 people in 2050, representing an average annual percentage change of 0&#xb7;3% (95% UI 0&#xb7;3-0&#xb7;3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16&#xb7;1% and approximately 1&#xb7;3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

Traditional Japanese diet comprises staple food, main dish, and side dish (SMS). Studies reporting the association between the frequency of SMS meals consumption and nutritional adequacy remain limited. We aimed to examine the association between the frequency of SMS meals consumption and nutritional adequacy in young Japanese women. In this cross-sectional study, data from 329 female nutrition students aged 18-25 years were analysed. The frequency of SMS meals consumption more than twice a day was assessed using a self-administered questionnaire, and dietary intake was evaluated using a validated food frequency questionnaire. We examined the association between SMS meals consumption and likelihood of not meeting the Dietary Goal (DG) or the Estimated Average Requirement (EAR) as defined in the Japanese Dietary Reference Intakes for Japanese. Trend analyses were performed to evaluate the relationship between SMS meal frequency and the number of nutrients not meeting the DG or EAR, while adjusting for potential confounders. Participants with high frequency of SMS meals consumption (5-7 days/week) had the lowest number of nutrients not meeting the EAR and DG, with significant linear trends observed across categories (p for trend <0.001 for DG; 0.001 for EAR). Frequency of SMS meals consumption is positively associated with improved nutrient intake among young Japanese women. However, given that the participants were dietetic students with relatively high nutrition literacy, caution is needed when generalising these findings to the wider population of young Japanese women.

The Nutrition Self-Assessment App (APP), a novel smartphone-based tool, was developed to enable users of oral nutritional supplements (ONSs) to self-assess total energy expenditure (TEE) and identify energy deficits, providing personalized ONS recommendations. By integrating step-count track-ing and dietary intake reporting, the app estimates physical activity levels and energy deficits. However, validation against clinician assessments is essential prior to large-scale implementation. In this multicenter cross-sectional study (October-November 2023), TEE and deficits were evaluated using both the app and clinician assessments. Statistical analyses included paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots. Clinician satisfaction was measured via a 5-point Likert scale. Among 423 ONS users, no significant differences were found between clinician- and app-derived estimates for TEE (1606.2 &#xb1; 287.2 vs. 1541.6 &#xb1; 300.5 kcal/day, p >0.05) or energy deficits (610.4 &#xb1; 376.9 vs. 600.1 &#xb1; 384.6 kcal/day, p >0.05). Agreement was moderate for TEE (ICC = 0.66) and excellent for deficits (ICC = 0.94). Bland-Altman analysis showed 93.9% (397/423) of deficit differences within 95% limits of agreement. Clinicians rated the app as "very satisfied" (46.1%) or "fairly satisfied" (37.1%) for most participants. The app demonstrated moderate agreement with clinician assessments for TEE estimation, while showing high agreement in energy deficit estimation. These findings validate its potential reliabil-ity as a supportive tool for ONS management. Its integration of activity tracking and dietary monitoring supports scalable implementation to improve ONS adherence.

The global rise in sarcopenic obesity necessitates identifying key adherence determinants in nutritional and exercise interventions to optimize outcomes. This systematic review identifies characteristics affecting adherence and dropout in these interventions. We searched Web of Science, PubMed, Scopus, and Cochrane Library through January 2025, including reference lists. Using the Cochrane Risk of Bias Tool, we assessed RCTs on nutritional/exercise interventions for sarcopenic obesity. High heterogeneity and insufficient adherence reporting precluded meta-analysis for adherence; outcomes were narratively synthesized. For dropout rates, meta-analysis was conducted, including subgroup analyses (exercise, nutrition, multi-component) and meta-regression to explore moderators. From 1,205 records, 57 studies (4,166 participants) were included. The overall dropout rate was 9%, increasing with intervention duration. Only 45.6% of studies reported adherence data. Among exercise interventions, elastic resistance had the highest adherence (91.5%), resistance training the lowest (85%). In nutritional interventions, low-calorie diets with nutraceuticals outperformed diet-only (92.1% vs. 77%). Professionally supervised interventions showed superior adherence to self-monitored programs. Current trials often inadequately report adherence data, with longer durations correlating to higher dropout rates. Evidence suggests elastic resistance exercise, low-calorie diets with nutraceuticals, and professional supervision may improve adherence. Future research should refine intervention methods and prioritize adherence reporting to enhance sarcopenic obesity care quality.

The convergence of genomic science and culinary arts has led to a new paradigm in wellness tourism: nutrigenomic retreats. These programs merge genetic insights with tailored diets, immersive culinary education, and holistic wellness practices. While nutrigenomics and personalized nutrition are advancing rapidly, translation of gene-diet knowledge into structured, real-world experiential models remains underexplored. This paper proposes a conceptual and translational framework for nutrigenomic retreats, integrating scientific advances in personalized nutrition with gastronomy-driven wellness experiences. A narrative review of peer-reviewed literature was conducted, focusing on nutrigenomics, culinary medicine, functional foods, and wellness tourism. Insights from nutritional genomics databases and publicly available transcriptomic resources are used illustratively to highlight gene-diet interactions relevant to retreat settings. Conceptual models, including retreat agendas, gene-informed dietary personalization, and culinary education formats, are presented. Nutrigenomic retreats are proposed as a multidisciplinary platform for health optimization by combining: interpretation of common genetic variants associated with nutrient metabolism and dietary response (e.g., FTO, MTHFR, CYP1A2); personalized menus aligned with gene-diet interactions; culinary instruction emphasizing nutrient-dense, culturally diverse, functional foods; and complementary wellness interventions such as mindfulness, physical activity, and biofeed-back. These illustrative elements may enhance scientific literacy, empowering participants to better understand individual nutritional variability and adopt sustainable health behaviors. Nutrigenomic retreats represent a novel fusion of science, culinary innovation, and wellness culture. As interest in personalized health continues to expand, this model may offer an experiential pathway for preventive health education and functional gastronomy, while fostering public engagement with genomics.

Out-of-home food consumption in Thailand has risen markedly in recent decades, driven by urbanization, changing family structures, increased participation of women in the labour force, and expansion of digital food delivery platforms. This shift reflects broader transformations in the national food environment, in which convenience, accessibility, and cultural norms strongly influence dietary behaviours. Although eating outside the home is deeply embedded in Thai social life and contributes significantly to both informal and formal economies, meals prepared away from home are frequently energy-dense and nutritionally imbalanced. Evidence from national surveys and empirical studies consistently links frequent consumption of street food, restaurant meals, and delivery items with poorer dietary quality and an elevated risk of non-communicable diseases. In response, the Thai government has implemented multiple strategies to improve nutritional standards and consumer awareness. However, enforcement challenges, especially within the informal street food sector, and limited public understanding of nutrition hinder progress. Opportunities exist to strengthen the food environment through recipe reformulation, expanded menu labelling, vendor training, healthier cooking practices, and integration of digital nutrition tools. As Thailand's food landscape evolves, culturally responsive and multisectoral strategies will be essential to promote healthier out-of-home eating. Enhancing the nutritional quality, safety, and transparency of meals consumed outside the home will be critical to advancing national public health objectives and mitigating the growing burden of diet-related diseases.

Metabolites, as key mediators of nutrition-immune interactions, have attracted increasing interest in cancer research. However, the causal relationships between immune cells, plasma metabolites, and esophageal cancer, and their potential for guiding nutritional interventions remain unclear. We conducted a two-sample Mendelian randomization analysis using the inverse-variance weighted method to evaluate the causal effects of immune cells and plasma metabolites on esophageal cancer. We explored potential intermediary pathways by investigating associations between im-mune cell traits and plasma metabolites relevant to esophageal cancer risk. To test the robustness of our find-ings, we also carried out sensitivity analyses. We identified 19 immune cell phenotypes associated with esophageal cancer risk (8 protective, 11 risk factors). In addition, 22 plasma metabolites (including 5 ratios) were protective, while 26 metabolites (including 8 ratios) increased risk, highlighting potential targets for nutritional interventions. Our analysis identified four plasma metabolites that were associated with specific immune cell traits relevant to esophageal cancer risk. Sensitivity analyses confirmed the robustness of the findings, with no significant heterogeneity or pleiotropy observed. This study provides genetic evidence for potential causal associations among immune cells, plasma metabolites, and esophageal cancer, and identifies observed associations between immune cell traits and plasma metabolites. These findings provide a foundation for precision nutrition and support dietary modification as a promising strategy for prevention and adjunctive therapy.

Sarcopenia and malnutrition are highly prevalent among older adults with advanced-stage cancers. Although the SARC-F is a simple and widely used screening tool for sarcopenia, its extended prognostic value remains under investigation. This study aimed to evaluate the relationship between SARC-F scores, nutritional status, inflammatory biomarkers, and short-term mortality in hospitalized older adults with advanced solid organ malignancies. We conducted a retrospective cross-sectional analysis on 72 patients with advanced-stage solid tumors and 52 age and sex matched controls. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF), Nutrition Risk Screening (NRS-2002), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Functional and frailty assessments included Activities of Daily Living (ADL), Instrumental ADL (IADL), and the FRAIL scale. Laboratory markers of inflammation were also collected. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were used to identify predictors of mortality. A total of 124 participants were included (72 patients with advanced-stage cancer and 52 controls). The mean age was 74.3&#xb1;9.4 years, and 58.1% were male. Mortality rates at 1, 3, and 6 months were 41.9%, 59.7%, and 65.3%, respectively. In multivariate analysis, calcium levels were independently associated with increased mortality risk (OR: 4.59, p <0.001). The SARC-F score demonstrated moderate discriminative ability for mortality prediction (AUC: 0.675), with high specificity (96.2%) but low sensitivity (30.6%) at a cut-off of &#x2265;4. The SARC-F score serves as a multidimensional indicator reflecting sarcopenia risk, nutritional deficits, functional impairment, and short-term mortality. Its prognostic utility improves when combined with clinical and laboratory markers. This study proposes a novel prognostic model incorporating SARC-F, GLIM criteria, and serum calcium to enhance short-term mortality prediction in older adults with advanced cancer.

Vitamin deficiencies are closely associated with the development of chronic diseases. Therefore, effective and safe intervention strategies are critical to improving vitamin nutritional status. This study aimed to assess the effectiveness and differential impacts of nutrition education and multi-vitamin supplementation, providing a basis for selecting safer intervention strategies. A 4-week, double-blind, randomized controlled trial was conducted among 155 adults (aged 18-65 years) with confirmed deficiencies in fat-soluble vitamins (A, D, or E). Participants were randomly assigned to receive either nutrition education with a multivitamin supplement or nutrition education with placebo. The concentrations of fat-soluble vitamins (A, D, or E), as well as their deficiency rates, were compared before and after the intervention. A total of 155 participants completed the study. There were no significant differences in demographic characteristics between the two groups. In both groups, the concentration of vitamins (A, D, or E) significantly increased (all p < 0.001), and the deficiency rates for all three vitamins significantly decreased (all p < 0.001). However, there were no significant differences in the concentrations or deficiency rates of vitamins (A, D, or E) between the two groups after intervention (all p > 0.05). Multivitamin supplements are not superior to nutrition education. Nutrition education alone may be a safer and effective approach to addressing deficiencies in vitamins A, D, and E, while reducing the risks as-sociated with unnecessary vitamin supplementation in the general population.

Diet is a modifiable factor influencing serum uric acid levels, but evidence on the associations between dietary fat composition and hyperuricemia (HUA) remains limited. This study examined the relationships between the proportion of energy from total fat and specific dietary fatty acids and the risk of HUA among Chinese adults. Data were obtained from adults who participated in at least two follow&#x2011;up waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018. Associations and dose-response relationships were assessed using multivariate Cox proportional hazards and restricted cubic spline (RCS) models. During a mean follow&#x2011;up of 6.05&#x202f;years among 2,722 participants, the prevalence of HUA was 10.2% (men: 14.1%; women: 7.76%). In women, energy from saturated fatty acids (SFAs) in the fourth quintile (7.88%) and from monounsaturated fatty acids (MUFAs) in the third quintile (9.97%) was positively associated with HUA (HR&#x202f;=&#x202f;2.19,&#x202f;95%&#x202f;CI 1.19-4.05; HR&#x202f;=&#x202f;2.14,&#x202f;95%&#x202f;CI 1.21-3.79), whereas polyunsaturated fatty acids (PUFAs) in the third quintile (6.88%) were negatively associated (HR&#x202f;=&#x202f;0.41,&#x202f;95%&#x202f;CI 0.22-0.78). RCS analyses showed J&#x2011;shaped and U&#x2011;shaped as-sociations in men between total fat (37.9%,&#x202f;95%&#x202f;CI 11.0-40.3) and PUFAs energy ratio (9.60%,&#x202f;95%&#x202f;CI 2.25-10.7) with HUA, respectively, and an L&#x2011;shaped association in women for PUFAs energy ratio (6.25%,&#x202f;95%&#x202f;CI 5.54-9.42). These findings suggest sex&#x2011;specific, non&#x2011;linear relationships be-tween total fat and different fatty acid intakes and HUA risk. Men should consider moderating total fat intake, while women should limit SFAs and moderately increase PUFAs to help reduce HUA risk.

As dietitians actively engage in sectors beyond healthcare, practitioners are expected to uphold ethical standards that reflect both individual conduct and the profession's social identity. The growing influence of digital technologies, sustainability challenges, and interdisciplinary collaboration further underscores the need to understand current standards of ethical practice. However, global dialog on dietetic ethics remains limited and fragmented. To analyze how professional ethics are governed and enforced, and how ethical content domains are structured and expressed in dietetic codes worldwide. A qualitative document analysis was conducted on national or regional codes of ethics and conduct from 25 dietetic associations spanning North America, Europe, Asia-Pacific, and Africa. Documents were obtained from public repositories or through direct association outreach. Codes written in English or Chinese were analyzed directly; others were translated using artificial intelligence (AI) and verified by issuing organizations. Using a reflexive content analysis approach, we examined revision history, government and enforcement, and ethical content domains. Enactment of ethical guidelines ranged from 1982 to 2024, and only five documents reported revision practices, with update cycles varying from scheduled to ad hoc. Regional variation was observed across three dimensions of ethical guidelines: intended audience scope, aspirational enforcement approaches, and references to legal compliance in relation to local laws or legislation. All documents referenced bioethical principles, but only eight incorporated environmental ethics; ethical guidance addressed professional interactions outside patient-practitioner relationships. Conflicts of interest in these contexts included non-financial domains (e.g., media engagement), with advertising and marketing explicitly discussed in several recently updated guidelines. Findings highlight key opportunities to strengthen ethical guidance in dietetics, particularly in relation to environmental ethics, collaborative practice contexts, and conflicts of interest in digital settings.

In this multicentre prospective observational study, we aimed to investigate changes in energy intake and nutritional indices, including cardiovascular, cerebrovascular, respiratory, and musculoskeletal conditions, among older adults hospitalised in general hospitals who required long-term rehabilitation. This study included patients aged &#x2265;65 years who were admitted to 41 National Hospital Organization hospitals between September 2019 and March 2020 with cardiovascular, cerebrovascular, respiratory, or musculoskeletal diseases. Physical measurements, blood test values, energy intake, and activities of daily living were evaluated at admission and discharge. The analysis includ-ed 222 patients (125 men, 97 women; mean age, 78.9 years). On admission, 75.7% of patients were malnourished or at risk of malnutrition based on the Mini Nutritional Assessment-Short Form score, with the highest prevalence (84.1%) observed in patients with respiratory disease. Although energy intake significantly increased during hospitalisation in all disease groups, only 31.1% of patients met the estimated energy requirements at discharge, and their body mass index and nutritional indices decreased. Logistic regression analysis showed that older age, female sex, higher energy intake at admission, and lower inflammation were associated with sufficient energy intake at discharge. Energy intake at admission was consistently associated with sufficient energy intake at discharge regardless of disease category, whereas other associated factors dif-fered by disease. Nutritional management in general hospitals may be inadequate for older adults requiring long-term rehabilitation. These findings suggest the need for early individualised nutritional management in hospitalised older adults undergoing long-term rehabilitation.

There has been a debate regarding appropriate nutrition support during the ear-ly stages of intensive care unit (ICU) admission. This study investigated nutrition support implementation and its relationship with clinical outcomes based on nutrition status. We performed a retrospective cohort study of 595 critically ill adults receiving invasive mechanical ventilation. Patients were assessed by Global Leadership Initiative on Malnutrition criteria. Stages following ICU admission were cate-gorized as early acute phase (days 1-3), late acute phase (days 4-6), and recovery phase (days 7-10). Patients were divided into energy intake categories (<10, 10-20, and >20 kcal/kg/day) and protein intake cate-gories (<0.8, 0.8-1.2, and >1.2 g/kg/day). We examined differences in 90-day mortality at each stage using Cox proportional hazards analyses for total cohort, well-nourished, and malnourished groups. Mortality was not associated with nutrition intakes during the early and late acute phases. However, higher energy intake during the recovery phase was associated with lower mortality in total cohort (p = 0.002). Significant associations between energy intake and mortality during the recovery phase were observed in both well-nourished and malnourished patients (p = 0.007 and p = 0.05, respectively). Additionally, protein intake during the recovery phase was associated with mortality, specifically in malnourished patients (p = 0.007), but not in well-nourished patients. Energy intake after 7 days in ICU was associated with mortality in both nutrition status groups, while protein intake showed benefit only in malnourished patients. Therefore, phase-dependent nutrition intake depending on nutrition status may be applicable for optimizing ICU nutri-tion support strategies.

Severe community-acquired pneumonia (CAP) is one of the most common di-agnoses in the medical intensive care unit. The objective of this study is to seek an effective and clinically tolerable dosage of &#x3c9;-3 (EPA+DHA) fatty acids (FA) in enterally fed patients with severe pneumonia. A total of 84 patients were randomly assigned to a control group or two experimental groups from January 2022 to June 2024, each receiving 3.50g and 8.75g of &#x3c9;-3 FA daily for 7 days, and clinical outcomes and tolerance parameters were collected. &#x3c9;-3 FA supplementation significantly reduced mechanical ventilation (MV) duration, hospital expenses, and daily hospital costs. Mechanistically, the anticipated anti-inflammatory effect was not observed but a trend of immune enhancement was noted. The addition of 3.50g and 8.75g of &#x3c9;-3 FA daily was relatively well-tolerated in patients with severe pneumonia. In this pilot study, &#x3c9;-3 FA supplementation at 3.50-8.75 g/day to enterally fed patients with severe pneumonia for 7 days was relatively well-tolerated, shortened days of MV, and decreased hospital cost. Further investigation with adequate statistical power and larger sample size is warranted to confirm these clin-ical benefits and establish the optimal dosage for this supplementation strategy.

Weekly iron-folic acid (IFA) supplementation has been implemented in Indonesia to reduce the prevalence of anaemia in adolescent girls. This study aimed to assess the prevalence of anaemia and adherence to weekly IFA supplementation and their associated factors among adolescent girls in senior high schools in two high-stunting-prone areas of Ambon City, Indonesia. This cross-sectional study was conducted in August-September 2023, involving 645 adolescent girls enrolled at five senior high schools in two high-stunting-prone areas of Ambon City, namely Poka-Rumah Tiga and Laha Village. The dependent variables were anaemia (i.e., haemoglobin level <12 g/dL) and adherence to weekly IFA supplementation (i.e., consumption of one IFA tablet per week). Factors associated with anaemia and adherence to weekly IFA supplementation were examined using logistic regression. Of 645 ado-lescent girls surveyed, 19.7% had anaemia, and 19.5% consumed weekly IFA tablets. The likelihood of developing anaemia was associated with respondents with a high level of awareness of anaemia (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.16-2.57). Adherence to taking weekly IFA tablets increased in those with a high level of awareness of IFA supplementation (aOR = 3.88, 95%CI: 2.46-6.10). Our study showed that anaemia among adolescent girls represents a moderate to high public health problem, accompanied by low adherence to weekly IFA supplementation among adolescent girls in these areas. Strengthening school-based supplementation, parental engagement, and supply monitoring could enhance programme effectiveness and inform local health policies in Ambon City and other similar settings in Indonesia.