Young children often display similar eating behaviour as their parents, with a parent’s own eating style influencing how they feed their children, research at Aston University has shown.
The work, published in the journal Appetite, suggests that parents can help to shape healthy eating behaviour in their children both by how they themselves eat, as well as how they feed their children.
A team led by Professor Jacqueline Blissett at Aston University, asked parents to assess their own eating behaviour and looked for associations between those behaviours and those of their children.
The team grouped parents into four eating styles – ‘typical eating’, ‘avid eating’, ‘emotional eating’ and ‘avoidant eating’. Typical eaters, who made up 41.4% of the sample, have no extreme behaviours. Avid eaters (37.3%) have high food approach traits such as eating in response to food cues in the environment and their emotions, rather than hunger signals. Emotional eaters (15.7%) also eat in response to emotion but do not enjoy food as much as avid eaters. Avoidant eaters (5.6%) are extremely selective about food and have a low enjoyment of eating.
The direct links between child and parent behaviour were particularly clear in parents with avid or avoidant eating behaviours, whose children tended to have similar eating behaviour. Parents who had avid or emotional eating styles were more likely to use food to soothe or comfort a child, who then in turn displayed avid or emotional eating traits. Where parents with avid or emotional eating traits provided a balanced and varied range of foods, the child was less likely to display the same behaviour.
The research follows on from previous work by the team, which identified the four main types of eating behaviour in children and linked parental feeding practices to those traits.
“Parents are a key influence in children’s eating behaviour but equally, parents have the perfect opportunity to encourage a balanced diet and healthy eating from a young age in their children. Therefore, it is important to establish how a parent’s eating style is associated with their children’s eating style and what factors could be modified to encourage healthy relationships with food.”
She and the team will now look at developing an intervention to support parents to use other ways to regulate emotions, model healthy eating, and create a healthy home food environment. This could help to prevent less favourable eating behaviours being passed down the generations from parent to child.
Products containing potentially hepatotoxic botanical ingredients are being widely consumed in the US, according to a study from University of Michigan researchers. The study, which was published in JAMA, examined national survey data from 2017–2020 and found that over a 30-day period, 4.7% of the adults surveyed 2020 took herbal and dietary supplements containing at least one of the hepatotoxic botanicals selected for the study.
Over 80 000 herbal and dietary supplement (HDS) products are available for purchase without a prescription for the purposes of promoting general health and treating minor ailments, and are largely unregulated. Most of these are products such as multivitamins, with well-defined ingredients on the label. But an estimated 5% to 12% of HDS products are plant-derived, complex multi-ingredient botanicals, some of which have been shown to have hepatotoxic properties. These included products containing turmeric, green tea, ashwagandha, black cohosh, garcinia cambogia, and red yeast rice.
Lead author Alisa Likhitsup, MD, MPH, clinical assistant professor of Medicine at U-M spoke about the motivation for the study. “Our interest started when we saw cases of liver toxicity from herbal and dietary supplement use in people enrolled into the ongoing NIH-funded DILIN study,” Likhitsup said.
“But it was difficult to say how many people were using these supplements and why. The major finding here is the large number of Americans taking these products with an estimated 15 million adult Americans taking them on a regular basis.”
Supplements are of particular concern for the researchers for several interrelated reasons: lack of government regulation, insufficient attention in medical screenings, and frequent mislabelling.
“In a previous study, we found that there was a great deal of mislabelling of some of these products,” said senior author Robert Fontana MD, U-Me hepatologist, professor of medicine.
“We performed analytical chemistry and found about a 50% mismatch between stated ingredients on the label and what they actually contained, which is quite alarming. If you buy a supplement and it says it has a certain ingredient, it’s basically a coin flip if that’s true or not.”
The mislabelling comes about from a lack of regulation, and since the effects are poorly understood, patients are not often asked what supplements they are taking.
Another study had found a 70% increase in liver transplants due to injury caused by supplements from 2010–2020, compared to 1994–2009.
“We weren’t aware that so many people were taking these supplements,” said Likhitsup, a transplant hepatologist.
“So, when doctors see patients in the office, they don’t necessarily ask about supplement use or take into consideration their effects.”
In the studied population, the highest proportion of people consumed turmeric (3.46%), followed by green tea (1.01%), ashwagandha and black cohosh (0.38%), garcinia cambogia (0.27%), and red yeast rice products (0.19%). Most of the users did not start consuming the botanicals on doctor’s advice, instead it was their own accord. They most commonly cited reason was the improvement or maintenance of health.
Of the turmeric users, 26.8% consumed the products specifically for supposed benefits for joint health or arthritis, while 27.2% of the green tea users were hoping to improve their energy levels.
The majority of the garcinia cambogia users hoped it would help them lose weight.
The JAMA study was not able to establish any kind of causal relationship between consumption of the six botanicals and liver injury since it was intended to assess supplement exposure in the general US population. Given the lack of regulation, however, the researchers still hope to make clinicians and patients aware of just how much is still unknown about these supplements.
“We’re not trying to create alarm,” Fontana said.
“We’re just trying to increase awareness that the over-the-counter supplements people are taking and buying have not been tested nor necessarily proven to be safe.”
A study from the University of Bath reveals that ketogenic low-carbohydrate diets can increase cholesterol levels and reduce beneficial gut bacteria, specifically Bifidobacterium.
Published in Cell Reports Medicine, the research from the Centre for Nutrition, Exercise, and Metabolism involved 53 healthy adults for up to 12 weeks. Participants followed either a moderate sugar diet (control), a low-sugar diet (less than 5% of calories from sugar), or a ketogenic (keto) low-carbohydrate diet (less than 8% of calories from carbohydrates).
Key findings include:
•Increased Cholesterol: The keto diet raised cholesterol levels, particularly in small and medium sized LDL particles. The diet increased apolipoprotein B (apoB), which causes plaque buildup in arteries. In contrast, the low-sugar diet significantly reduced cholesterol in LDL particles.
•Reduced Favourable Gut Bacteria: The keto diet altered gut microbiome composition, notably decreasing Bifidobacteria, beneficial bacteria often found in probiotics. This bacteria has wide ranging benefits: producing b vitamins, inhibiting pathogens and harmful bacteria and lowering cholesterol. Sugar restriction did not significantly impact the gut microbiome composition.
•Glucose Tolerance: The keto diet reduced glucose tolerance, meaning the adults’ bodies became less efficient at handling carbohydrates.
•Both Diets Resulted In Fat Loss: Keto Diet resulted in an average of 2.9kg fat mass loss per person, whilst the sugar restricted diet followed with an average 2.1kg fat mass loss per person at 12 weeks.
•Metabolism: Researchers also noticed that the keto diet caused significant changes in lipid metabolism and muscle energy use, shifting the body’s fuel preference from glucose to fats.
•Physical Activity Levels: Both sugar restriction and keto diets achieved fat loss without changing physical activity levels. Previous studies from the Centre for Nutrition, Exercise and Metabolism have shown that skipping breakfast or intermittent fasting cause reductions in physical activity.
Lead researcher Dr. Aaron Hengist highlighted the concerning cholesterol findings:
“Despite reducing fat mass, the ketogenic diet increased the levels of unfavourable fats in the blood of our participants, which, if sustained over years, could have long-term health implications such as increased risk of heart disease and stroke.”
Dr. Russell Davies, who led the microbiome research, explained the impact on gut health:
“Dietary fibre is essential for the survival of beneficial gut bacteria like Bifidobacteria. The ketogenic diet reduced fibre intake to around 15 grams per day, half the NHS recommended intake. This reduction in Bifidobacteria might contribute to significant long-term health consequences such as an increased risk of digestive disorders like irritable bowel disease, increased risk of intestinal infection and a weakened immune function.”
Professor Javier Gonzalez, who oversaw the research, commented on the glucose findings:
“The ketogenic diet reduced fasting glucose levels but also reduced the body’s ability to handle carbs from a meal. By measuring proteins in muscle samples taken from participants’ legs, we think this is probably an adaptive response to eating less carbohydrates day-to-day and reflects insulin resistance to storing carbs in muscle. This insulin resistance is not necessarily a bad thing if people are following a ketogenic diet, but if these changes persist when people switch back to a higher carbohydrate diet it could increase the risk of developing type 2 diabetes in the long-term”
In light of this new research, the academics conclude that if you’re considering a diet, a low sugar one will be better for most people. More work is needed to understand how individuals may benefit from each type of diet. The government recommends that free sugars (those added to food or drink or found naturally in honey, syrups, fruit juices and smoothies) should be restricted to less than 5% of total energy intake. Professor Dylan Thompson, who also oversaw the work, said:
“The ketogenic diet is effective for fat loss, but it comes with varied metabolic and microbiome effects that may not suit everyone. In contrast, sugar restriction supports government guidelines for reducing free sugar intake, promoting fat loss without apparent negative health impacts.”
Researchers at UC San Francisco have found a link between following a diet that is rich in vitamins and minerals, especially one without much added sugar, and having a younger biological age at the cellular level.
They looked at how three different measures of healthy eating affected an “epigenetic clock” – a biochemical test that can approximate both health and lifespan – and found that the better people ate, the younger their cells looked. Even when people ate healthy diets, each gram of added sugar they consumed was associated with an increase in their epigenetic age.
“The diets we examined align with existing recommendations for preventing disease and promoting health, and they highlight the potency of antioxidant and anti-inflammatory nutrients in particular,” said Dorothy Chiu, PhD, a postdoctoral scholar at the UCSF Osher Center for Integrative Health and first author of the study, appearing in JAMA Network Open. “From a lifestyle medicine standpoint, it is empowering to see how heeding these recommendations may promote a younger cellular age relative to chronological age.”
The study is one of the first to show a link between added sugar and epigenetic aging, and the first to examine this link in a heterogenous group of women – both Black and white – in midlife. Most studies on the topic have involved older white participants.
The study helps deepen our understanding of why sugar is so detrimental to health, said study co-senior author Elissa Epel, PhD, a UCSF professor in the Department of Psychiatry and Behavioral Sciences.
“We knew that high levels of added sugars are linked to worsened metabolic health and early disease, possibly more than any other dietary factor,” Epel said. “Now we know that accelerated epigenetic aging is underlying this relationship, and this is likely one of many ways that excessive sugar intake limits healthy longevity.”
Women in the study reported consuming an average of 61.5 grams of added sugar per day, though the range was large: from 2.7 to 316 grams of added sugar daily. A bar of milk chocolate has about 25 grams of added sugar, while a can of cola has about 39 grams. The US Food and Drug Administration recommends adults consume no more than 50 grams of added sugar per day.
A nutrient-based approach
For the cross-sectional study, researchers analysed food records from 342 Black and white women with a mean age of 39 years from Northern California. Then, they compared their diets with epigenetic clock measures, which were derived from saliva samples.
Researchers scored the women’s diets to see how they compared to a Mediterranean-style diet rich in anti-inflammatory and antioxidant foods and then to a diet linked to lower risk for chronic disease.
Finally, they scored the women’s diets against a measure they created called the “Epigenetic Nutrient Index (ENI),” which is based on nutrients (not foods) that have been linked to anti-oxidative or anti-inflammatory processes and DNA maintenance and repair. These include Vitamins A, C, B12 and E, folate, selenium, magnesium, dietary fibre and isoflavones.
Adherence to any of the diets was significantly associated with lower epigenetic age, with the Mediterranean diet having the strongest association.
The researchers examined sugar intake separately and found that consuming foods with added sugar was associated with accelerated biological aging, even in the presence of an otherwise healthy diet.
“Given that epigenetic patterns appear to be reversible, it may be that eliminating 10 grams of added sugar per day is akin to turning back the biological clock by 2.4 months, if sustained over time,” said co-senior author Barbara Laraia, PhD, RD, a UC Berkeley professor in the Food, Nutrition and Population Health program. “Focusing on foods that are high in key nutrients and low in added sugars may be a new way to help motivate people to eat well for longevity.”
Gut Microbiome. Credit Darryl Leja National Human Genome Research Institute National Institutes Of Health
New research led by Frank Duca, associate professor at the University of Arizona, suggests that consuming foods rich in beta-glucan, a type of fibre found in oats and barley, can reduce body weight and obesity by stimulating the release of glucagon-like peptide-1 (GLP-1). The study, published in The Journal of Nutrition, analysed the impact of different fibres on gut microbiota.
“We know that fibre is important and beneficial; the problem is that there are so many different types of fibre,” Duca said. “We wanted to know what kind of fibre would be most beneficial for weight loss and improvements in glucose homeostasis so that we can inform the community, the consumer and then also inform the agricultural industry.”
Not all fibre is created equal
The researchers looked at the effect of five different plant-based fibres in rodent diets: pectin, beta-glucan, wheat dextrin, starch and cellulose. Only beta-glucan resulted in reduction of body weight and fat, as well as improvements in glucose homeostasis. Beta-glucan is a unique fibre that is found in many foods, including oats, barley, mushrooms and yeasts, and future studies will examine how different sources of beta-glucan could differ in their effectiveness.
Changes in metabolites – the molecules produced when gut bacteria interact with fibre – seemed to be responsible for the weight-loss effects, particularly a specific metabolite called butyrate. Butyrate is a key fuel source for colon cells, promoting a healthy gut barrier to reduce systemic inflammation. Butyrate also induces the release of gut peptides, or messengers that regulate the functions of the gut, such GLP-1.
Drugs like semaglutide are synthetic versions of GLP-1, which stimulate insulin and can also help people feel full. One key difference of naturally occurring GLP-1 is its rapid degradation near the intestine, whereas semaglutide is made to last longer and target the brain.
“Part of the benefits of consuming dietary fibre is through the release of GLP-1 and other gut peptides that regulate appetite and body weight,” Duca said. “However, we don’t think that’s all of the effect. We think that there are other beneficial things that butyrate could be doing that are not gut peptide related, such as improving gut barrier health and targeting peripheral organs like the liver.”
Duca is researching other types of fibre that can be beneficial for weight reduction. In a previous study, the Duca Lab discovered that barley flour was the most effective in promoting weight loss compared to several other commercially available flours. Other studies involving oligofructose have also demonstrated beneficial effects. In the future, Duca hopes to collaborate with other researchers to develop enhanced fibres that can optimise the release of butyrate.
Retina showing reticular pseudodrusen. Although they can infrequently appear in individuals with no other apparent pathology, their highest rates of occurrence are in association with age-related macular degeneration (AMD), for which they hold clinical significance by being highly correlated with end-stage disease sub-types, choroidal neovascularisation and geographic atrophy. Credit: National Eye Institute
In a new analysis of data, researchers at the National Institutes of Health (NIH) have found that taking a daily supplement containing antioxidant vitamins and minerals slows progression of late-stage dry age-related macular degeneration (AMD), potentially helping people with late-stage disease preserve their central vision.
Age-related macular degeneration affects the macula, the part of the retina that provides central vision.
Researchers reviewed the original retinal scans of participants in the Age-Related Eye Diseases Studies (AREDS and AREDS2) and found that, for people with late-stage dry AMD, taking the antioxidant supplement slowed expansion of geographic atrophy regions towards the central foveal region of the retina. The study was published in the journal Ophthalmology.
“We’ve known for a long time that AREDS2 supplements help slow the progression from intermediate to late AMD. Our analysis shows that taking AREDS2 supplements can also slow disease progression in people with late dry AMD,” said Tiarnan Keenan, MD, PhD, of NIH’s National Eye Institute (NEI) and lead author of the study. “These findings support the continued use of AREDS2 supplements by people with late dry AMD.”
In their new analysis, the researchers reviewed the original retinal scans of participants in the AREDS (total 318 participants, 392 eyes) and AREDS2 (total 891 participants, 1210 eyes) trials who developed dry AMD, calculating the position and expansion rate of their regions of geographic atrophy. For those people who developed geographic atrophy in their central vision, the supplements had little benefit. But for the majority who developed geographic atrophy far from the fovea, the supplements slowed the rate of expansion towards the fovea by approximately 55% over an average of three years.
In early and intermediate AMD, the light-sensing retina at the back of the eye develops small yellow deposits of fatty proteins called drusen. When the disease progresses to the late stage, people can develop leaky blood vessels (“wet” AMD) or can lose regions of light-sensitive cells in the retina (“dry” AMD). The geographic atrophy in these regions slowly expands over time, causing people to progressively lose their central vision.
The original AREDS trial found that a supplement formula containing antioxidants (vitamin C, E, and beta-carotene), along with zinc and copper, could slow progression of intermediate to late-stage AMD. The subsequent AREDS2 trial found that substituting the antioxidants lutein and zeaxanthin for beta-carotene improved the efficacy of the supplement formula and eliminated certain risks. At the time, neither trial detected any further benefit once participants had developed late-stage disease.
However, that original analysis did not account for a phenomenon in the dry form of late AMD called “foveal sparing.” While all regions of the retina are sensitive to light, the region that gives us the highest acuity central vision is called the fovea. Many people with dry AMD first develop geographic atrophy outside this foveal region, and they only lose their central vision when the geographic atrophy regions expand into the foveal area.
“Our high acuity central vision is essential for tasks like reading and driving. Given that there are few therapeutic options for people with late-stage dry AMD to retain or restore their vision, antioxidant supplementation is a simple step that may slow central vision loss, even for those with late disease,” Keenan said. “We plan to confirm these findings in a dedicated clinical trial in the near future.”
High-protein diets, known as ‘‘Paleolithic diets’’, are popular. Using mouse models, scientists at the University of Geneva (UNIGE) have studied their impact. While effective in regulating weight and stabilizing diabetes, these diets are not without risks. Excess protein greatly increases ammonium production, overwhelming the liver. Excess ammonium can cause neurological disorders and, in severe cases, lead to coma. These results, published in the Journal of Biological Chemistry, suggest caution when following these diets.
While current treatments help control the progression of the type 2 diabetes, they do not cure it. Losing weight is often an essential part of the treatment.
‘‘Diets rich in animal and/or plant proteins, known as Paleolithic diets, can be used to stabilise type 2 diabetes and regulate weight,’’ explains Pierre Maechler, full professor at the Department of Cell Physiology and Metabolism at the UNIGE Faculty of Medicine, who led this research. These diets are inspired by the meat-based diets of pre-agricultural time. ‘‘But what impact do they have on the body? Are they harmless? That’s what we set out to find out.’’
Liver under Pressure
Ammonium is a normal waste product of protein breakdown, essentially eliminated in the liver by the enzyme glutamate dehydrogenase (GDH). In the event of protein overload, the GDH enzyme comes under pressure. To study the impact of high-protein diets, Pierre Maechler’s team fed healthy mice and mice lacking the GDH enzyme in their liver a diet with a protein content mimicking the so-called Paleolithic diet.
Scientists observed that in healthy mice, although excess protein increased ammonium production, the liver managed this excess due to the action of the GDH enzyme, which detoxifies ammonium before it can cause damage. ‘‘In contrast, in mice lacking the GDH enzyme, the liver is unable to eliminate the excess of toxic ammonium derived from proteins. No need to wait for weeks or months; a change of diet lasting a few days is enough to observe major consequences,’’ explains Karolina Luczkowska, a former PhD student at the Department of Cell Physiology and Metabolism at the UNIGE Faculty of Medicine, and the study’s first author.
Caution is Advised
These results suggest that in case of dysfunctional GDH enzyme, high-protein diets may cause a harmful excess of ammonium. Ammonium not eliminated by the liver can cause severe disorders, particularly neurological ones. A blood test could assess GDH activity to avoid overloading the metabolism with proteins in people whose GDH enzyme is deficient. ‘‘It is therefore important to be well informed before following a high-protein diet,’’ concludes Pierre Maechler.
American diets may have gotten healthier and more diverse in the months following the start of the COVID-19 pandemic, according to a new study led by Penn State researchers.
The study, published in PLOS ONE, found that as states responded to the pandemic with school closures and other lockdown measures, citizens’ diet quality improved by up to 8.5% and food diversity improved by up to 2.6%.
Co-author Edward Jaenicke, professor of agricultural economics in the College of Agricultural Sciences, said the findings provide a snapshot of what Americans’ diet and eating habits might look like in the nearly complete absence of restaurant and cafeteria eating.
“When dine-in restaurants closed, our diets got a little more diverse and a little healthier,” Jaenicke said. “One post-pandemic lesson is that we now have some evidence that any future shifts away from restaurant expenditures, even those not caused by the pandemic, could improve Americans’ food diversity and healthfulness.”
Prior to the pandemic, the researchers said, the average US diet was considered generally unhealthy. According to the Dietary Guidelines for Americans, eating patterns in the US have remained far below the guidelines’ recommendations, with only slight improvements in the population’s average Healthy Eating Index score between 2005 and 2016.
Also, before the pandemic, the research team was in the midst of a grant-funded project that asked how people would feed themselves after a giant global catastrophe, such as an asteroid strike or nuclear war. In particular, Jaenicke’s team was tasked with investigating how consumers and food retailers might behave during such a disaster.
“At first, the most impactful events we could study using actual, real-world data were hurricanes and other natural disasters,” Jaenicke said. “But then, along came the COVID-19 pandemic, and we realised that this event was an opportunity to study the closest thing we had to a true global catastrophe.”
For the study, the researchers analyzed data from the NielsenIQ Homescan Consumer Panel on grocery purchases, which includes 41,570 nationally representative U.S. households. Data consisted of the quantity and price paid for every universal product code each family purchased during the study period.
Data was gathered from both before the pandemic hit and after the pandemic led to schools, restaurants and other establishments temporarily closing. Because states did not respond to the pandemic simultaneously, the researchers designated each household’s post-pandemic period as the weeks following the date that their county of residence closed schools in 2020.
Jaenicke noted that this allowed the team to show a true causal effect of the pandemic school closures, which generally occurred around the same time that restaurants and other eateries also closed.
“To establish causality, an individual household’s pre- and post-pandemic food purchases were first compared to the same household’s food purchases from one year earlier,” Jaenicke said. “This way, we controlled for the food-purchasing habits, preferences and idiosyncrasies of individual households.”
The researchers found that in the two to three months following pandemic-based school closures (roughly March to June 2020) there were modest increases in Americans’ food diversity, defined as how many different categories of food a person eats over a period of time.
They also found larger, temporary increases in diet quality, meaning the foods purchased were healthier. This was measured by how closely a household’s purchases adhered to the U.S. Department of Agriculture’s (USDA) Thrifty Food Plan, which was designed to meet the requirements of the recommended healthy diet according to the Dietary Guidelines for Americans.
These patterns were found across households with many different demographics; however, those households with young children, lower incomes and without a car exhibited smaller increases in these measures.
“During the COVID-19 pandemic, dine-in restaurants closed, schools and school cafeterias closed, and many supermarket shelves were empty,” Jaenicke said. “Since about 50% of Americans’ food dollars are spent on ‘away from home’ food from restaurants and cafeterias, the pandemic was a major shock to the food system.”
The researchers said there are several possible explanations for these findings. First, because other studies have found that food from restaurants is often less healthy than food made at home, the dramatic decrease of meals eaten at and purchased from restaurants during the pandemic could have contributed to an increase of food diversity and healthfulness at home.
Second, they said it was possible that a global pandemic triggered some consumers to become more health conscious and contributed to them buying healthier, more diverse groceries. Third, because the pandemic caused widespread disruptions to the supply chain, it’s possible that when familiar products were sold out, consumers shifted to newer ones that led to increased diversity and healthfulness.
Finally, school and business closures may have led to many households having more time to cook and prepare foods than they had before, while others – like those with small children – may have had less free time than pre-pandemic.
Jaenicke said that in the future, additional studies could continue to explore how different disasters affect purchasing and eating habits.
Douglas Wrenn, associate professor of environmental and resource economics at Penn State, and Daniel Simandjuntak, research associate at Newcastle University, were also co-authors on the study.
In a study in the Journal of Cosmetic Dermatology that included 60 individuals with mild to moderate acne, following the Mediterranean diet and taking omega-3 fatty acid supplements led to significant reductions in inflammatory and non-inflammatory skin lesions, as well as improved quality of life.
Notably, 98.3% of participants had omega-3 fatty acid deficits at the start of the study. Acne severity lessened significantly in those who reached target omega-3 fatty acid levels during the study.
“Lifestyle interventions, including dietary recommendations, should not be considered in opposition to prescription medications, but rather as a valuable adjunct to any modern acne treatment plan,” said corresponding author Anne Guertler, MD, of the Ludwig Maximilian University of Munich, in Germany. “Future studies should build on the foundation laid by our current findings in a randomised, placebo-controlled design to improve dietary recommendations for acne patients.”
As many as half of all patients admitted to hospital, other healthcare facilities are malnourished. This has serious consequences for the individual in terms of poorer quality of life and mortality. Providing nutrients can alleviate these problems, but not enough attention is paid to this knowledge, write researchers from Uppsala University and the University of Gothenburg published in the NEJM.
“Far too few patients are diagnosed with malnutrition. Underdiagnosis and undertreatment of the condition remains a problem in healthcare and elderly care, not only in Sweden but worldwide. However, by using fairly simple methods, patients and older adults could be made to feel much better,” says Tommy Cederholm, professor of clinical nutrition at Uppsala University.
Together with Ingvar Bosaeus, a consultant at Sahlgrenska University Hospital, Cederholm is coauthor of a review article on undernourishment published in the New England Journal of Medicine. The article summarises the global state of knowledge over the last 50 years, with the emphasis on developments over the last 5 years, concluding that the healthcare sector needs to make much greater use of the experience and knowledge revealed in the research.
It is estimated that between 5 and 10% of all older adults in Sweden are malnourished. This figure rises to up to 50% of patients being cared for in hospitals, nursing homes or similar facilities. Weight loss and malnutrition have traditionally been viewed as a natural expression of disease or aging, and something about which nothing can be done. It is now recognised that the most common cause is an underlying disease that causes the individual to eat less, leading to the breakdown of bodily organs and tissues.
People suffering from malnutrition will lose weight and the lack of nutrients may lead to muscle atrophy, making it difficult to cope with everyday life. They may also be more susceptible to infection and require more care, possibly involving long periods of hospitalisation and increased mortality.
Great strides have been made in knowledge about malnutrition and how to treat it over recent years. There is now global consensus among researchers and clinicians on the criteria for diagnosing malnutrition: weight loss, low body mass index, and reduced muscle mass in an individual with poor appetite, either with or without an underlying disease.
Recent large-scale clinical studies clearly show that malnutrition can be reversed. Counselling and treatment offered in collaboration with dietitians and the use of nutritional drinks can slow weight loss and reduce mortality.
“These are simple measures that are ignored every day. We now know that, with the exception of those in the advanced stages of terminal illnesses such as metastatic cancer, the vast majority of patients can be treated. In Sweden, for example, we have been working on this for many years, but we need to be even better,” says Ingvar Bosaeus, a consultant at Sahlgrenska University Hospital.
The researchers propose concrete measures to reduce suffering among older adults.
“It is crucial to register risk factors for malnutrition at an early stage and to be alert to weight loss and loss of appetite. One also needs to recommend nutrient-dense foods at an early stage and begin nutritional therapy in good time with, for example, nutritional drinks. This knowledge must become a much more explicit component of both basic and specialist training for doctors and nurses,” says Tommy Cederholm.
