Wellness Check: Nutrition

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in nutrition. 

Preterm formula is similarly effective to human milk fortifiers as breastmilk supplement

1. Low-weight infants fed with breast milk supplemented with pre-term formula had noninferior weight gain compared to infants fed with breast milk supplemented with commercial human milk fortifiers (HMF).

2. The incidence of feed intolerance was lower in low-weight infants fed with breast milk supplemented with pre-term formula compared to infants fed with breast milk supplemented with HMF.

Evidence Rating Level: 1 (Excellent)

For low-birth weight infants, human milk does not provide adequate nutrients at usual feeding volumes. Therefore, several human milk fortifiers (HMF) have been developed as breast milk supplements to supply high nutrient requirements of low-birth weight infants. However, HMFs do pose potential risk of complications such as feed intolerance and necrotizing enterocolitis (NEC) and are very costly, which may preclude accessibility in low-and-middle income countries.

This new noninferiority randomized trial was conducted to determine if preterm formula (PTF) was as clinically effective as HMF supplementation. 123 low-birth weight infants receiving at least 100 ml/kg/d of feeds and consuming 75% of milk or more were randomized to breast milk fortified with PTF (60 participants) or HMF (63 participants). Neonates with major congenital abnormalities were excluded. The primary outcome was rate of in-hospital weight gain from randomization. Overall, there was no difference in weight gain observed between groups up to time of discharge or at 40 weeks’ corrected gestational age. Furthermore, infants in the PFT group had lower incidence of complications such as feed intolerance and NECs. Lastly, the cost differential for PTF was around $0.3 per day, which was significantly lower than that of HMF (around $4 per day). Overall, these findings demonstrated that PFT was a non-inferior, safe, and lower-cost fortification strategy that may be more widely accessible and used. However, a study with longer post-discharge follow-up and a systematic cost-effectiveness analysis would be needed to better understand the clinical efficacy and feasibility of implementing this measure globally. 

Gluten intake in females without celiac disease is not associated with cognitive function

1. In middle-aged women without celiac disease, there is no significant association between gluten intake and cognitive function across quintiles of gluten intake.

2. Further stratification by potential confounding factors such as age, smoking status, and history of diabetes also yielded null results.

Evidence Rating Level: 2 (Good)        

In patients with celiac disease, gluten intake, which triggers severe autoimmune responses, has been linked with cognitive impairment. However, whether gluten intake is associated with cognitive impairment in individuals without celiac disease or nonceliac gluten sensitivity is unclear.

This prospective cohort study aimed to determine if long-term gluten intake in women without celiac disease is associated with cognitive function. Dietary data from 13,494 women were collected every 4 years from 1991-2015. The primary outcome was cognitive function, which was measured using Cogstate Brief Battery™, an online, self-administered assessment commonly used to measure cognitive decline in patients with Alzheimer’s Disease and other neuropsychiatric conditions. Cognitive scores in 1) psychomotor speed and attention, 2) learning and working memory, and 3) global cognition were collected from 2014-2019. Women who did not complete the full cognitive assessment, had implausible low scores suggestive of technical errors, previous history of stroke, or diagnosis of celiac anytime during study period were excluded. Overall, there were no significant associations between amount of gluten intake and cognition scores. Further stratification by potential confounders such as age, smoking status, BMI, depression status, and history of diabetes, hypertension, and hypercholesterolemia mostly yielded null results. Lastly, changes in gluten intake pattern during study period was also not associated with cognitive scores. Overall, this large-sized, long-term cohort study suggests that gluten intake is not associated with cognitive impairment in women without celiac disease. However, there is limit in generalizability of these results, and further studies with longitudinal assessment of cognitive function and in both female and male patients are warranted.

Smartphone-based lifestyle interventions improve weight management in patients with diabetes

1. In Asian patients with type 2 diabetes, culturally contextualized smartphone-based application was effective in improving weight management and metabolic parameters within 6 months of use.

2. Patients randomized to include smartphone-based lifestyle interventions had a greater reduction in HbA1c levels and diabetes medications within 6 months of use.

Evidence Rating Level: 1 (Excellent)

Weight management through lifestyle changes is an important component of type 2 diabetes management. With advent of technology, smartphone-based lifestyle interventions are becoming increasingly available and popular. However, the effectiveness of such smart phone-based lifestyle interventions has not been rigorously tested.

This randomized control trial tested the effectiveness of smartphone-based intervention on weight and metabolic outcomes in Asian adult patients with type 2 diabetes. 204 patients with type 2 diabetes, body mass index > 23, English literacy, and smartphone access were included. Patients with co-morbidities such as heart failure, type 1 diabetes, or cognitive or psychological disabilities were excluded. 105 patients were randomized to the control group, where they received one advisory session with a dietitian, a digital scale for home use and ongoing diabetes care. 99 patients were randomized to usual care plus use of smartphone app for 6 months to track weight, diet, exercise, and blood glucose. The smartphone app supported numerous culturally contextualized features such as frequent communication with local dietitians familiar with cultural practices surrounding food, weekly educational videos, and algorithms that suggested healthier options to local cuisine. The primary outcome measured changes in body weight. Compared to those receiving usual care, patients randomized to smartphone interventions had greater weight reduction at 6 months. Furthermore, patients in smartphone group had reduced HbA_1c levels, increased level of physical activity, and reduced use of diabetes medications compared to control group. However, this study had limitations such as the generalizability of results due to strict exclusion criteria. Nonetheless, this study’s results are significant and suggest a smartphone-based lifestyle intervention may be effective in achieving glycemic and weight reductions amongst Asian adults with type 2 diabetes.

Image: PD

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