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Definition of malnutrition from routinely-collected data for orthopedic surgery research: the global leadership initiative on malnutrition (GLIM) tool and others.
Briguglio, M, Wainwright, TW, Lombardi, G
Frontiers in nutrition. 2023;:1200049
Abstract
The correct identification of malnourished patients in the context of hip, knee, or spine surgery research would enhance the quality of analytical studies investigating the prediction potential of preoperative nutritional disorders on postoperative recovery. However, accurate malnutrition screening and diagnostic assessment rely on parameters that were not routinely collected in routine practice until a few years ago. The authors of this article present substitute literature-based equations that can be built up using historical routinely collected data to classify patients that had been at risk of malnutrition or malnourished. For what concerns the risk screening, several methods are available to identify patients at risk of over- or undernutrition, encompassing the BWd (body weight difference from the ideal weight), GNRI (geriatric nutritional risk index), INA (instant nutritional assessment), LxA (combination of lymphocyte count and albumin), PMA (protein malnutrition with acute inflammation), PMAC (protein malnutrition with acute and chronic inflammation), IDM (iron deficit malnutrition), and VBD (vitamin B deficit malnutrition). Conversely, the GLIM (global leadership initiative on malnutrition) criteria can be used to assess malnutrition and diagnose subclasses of undernutrition. Rational use of these tools can facilitate the conduction of efficient prospective studies in the future, as well as bespoke retrospective cohort studies and database research.
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Is there a link between vitamin D status, SARS-CoV-2 infection risk and COVID-19 severity?
Ferrari, D, Locatelli, M, Briguglio, M, Lombardi, G
Cell biochemistry and function. 2021;(1):35-47
Abstract
The outbreak of COVID-19 emerged in December 2019 rapidly spread across the globe and has become pandemic. Little is known about the protective factors of this infection, which is equally distributed between genders and different ages while severe and poor prognosis cases are strongly associated to old males and the presence of comorbidities. Thus, preventive measures aiming at reducing the number of infection and/or their severity are strongly needed. Vitamin D has got great attention and has been claimed as potentially protective against the infection since it may be associated with immunocompetence, inflammation, aging, and those diseases involved in determining the outcomes of COVID-19. This narrative review aims at collecting the literature available on the involvement of the vitamin D status in the pathogenesis of COVID-19 and the putative utility of vitamin D supplementation in the therapeutics. It emerges that a poor vitamin D status seems to associate with an increased risk of infection whereas age, gender and comorbidities seem to play a more important role in COVID-19 severity and mortality. While randomized control trials are needed to better inquire into this topic, vitamin D supplementation may be useful beside its potential effects on SARS-CoV-2 infection and COVID-19.
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The Central Role of Iron in Human Nutrition: From Folk to Contemporary Medicine.
Briguglio, M, Hrelia, S, Malaguti, M, Lombardi, G, Riso, P, Porrini, M, Perazzo, P, Banfi, G
Nutrients. 2020;(6)
Abstract
Iron is a fundamental element in human history, from the dawn of civilization to contemporary days. The ancients used the metal to shape tools, to forge weapons, and even as a dietary supplement. This last indication has been handed down until today, when martial therapy is considered fundamental to correct deficiency states of anemia. The improvement of the martial status is mainly targeted with dietary supplements that often couple diverse co-factors, but other methods are available, such as parenteral preparations, dietary interventions, or real-world approaches. The oral absorption of this metal occurs in the duodenum and is highly dependent upon its oxidation state, with many absorption influencers possibly interfering with the intestinal uptake. Bone marrow and spleen represent the initial and ultimate step of iron metabolism, respectively, and the most part of body iron circulates bound to specific proteins and mainly serves to synthesize hemoglobin for new red blood cells. Whatever the martial status is, today's knowledge about iron biochemistry allows us to embrace exceedingly personalized interventions, which however owe their success to the mythical and historical events that always accompanied this metal.
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The Malnutritional Status of the Host as a Virulence Factor for New Coronavirus SARS-CoV-2.
Briguglio, M, Pregliasco, FE, Lombardi, G, Perazzo, P, Banfi, G
Frontiers in medicine. 2020;7:146
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This opinion article explores the role of an individual’s nutrition status when subjected to infection by viruses, in particular Covid-19. Distinction is made between the susceptibility to infection in the first instance and the ability to persist in fighting infection once it is established. For Covid-19, it is argued that a healthier nutritional status, in particular Vitamins A, B, C, D and E, iron selenium and zinc, will lower susceptibility to infection, lower the severity of the virus and therefore reduce the length of time an individual has to find reserves to fight the virus. More severe cases of Covid-19 infection also often include gastro-intestinal symptoms which further exacerbate nutritional status with lowered appetite. The authors conclude that malnourished individuals may be more susceptible to Covid-19 infection and that nutritional support is vital in severe cases. The article includes a useful diagram of both hyponutrition and hypernutrition and possible impacts of Covid-19.
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Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial.
Briguglio, M, Hrelia, S, Malaguti, M, De Vecchi, E, Lombardi, G, Banfi, G, Riso, P, Porrini, M, Romagnoli, S, Pino, F, et al
Nutrients. 2020;(2)
Abstract
Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient's functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient's tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (≥ 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost -2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% of circulating hemoglobin from baseline (p = 0.019). Gastrointestinal diseases, medications, and possible dietary factors could affect the efficacy of iron supplements. Future opportunities may consider to couple ferric pyrophosphate with other nutrients, to pay attention in avoiding absorption disruptors, or to implement interventions to obtain an earlier martial status optimization at the population level.
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Food Bioactive Compounds and Their Interference in Drug Pharmacokinetic/Pharmacodynamic Profiles.
Briguglio, M, Hrelia, S, Malaguti, M, Serpe, L, Canaparo, R, Dell'Osso, B, Galentino, R, De Michele, S, Dina, CZ, Porta, M, et al
Pharmaceutics. 2018;(4)
Abstract
Preclinical and clinical studies suggest that many food molecules could interact with drug transporters and metabolizing enzymes through different mechanisms, which are predictive of what would be observed clinically. Given the recent incorporation of dietary modifications or supplements in traditional medicine, an increase in potential food-drug interactions has also appeared. The objective of this article is to review data regarding the influence of food on drug efficacy. Data from Google Scholar, PubMed, and Scopus databases was reviewed for publications on pharmaceutical, pharmacokinetic, and pharmacodynamic mechanisms. The following online resources were used to integrate functional and bioinformatic results: FooDB, Phenol-Explorer, Dr. Duke's Phytochemical and Ethnobotanical Databases, DrugBank, UniProt, and IUPHAR/BPS Guide to Pharmacology. A wide range of food compounds were shown to interact with proteins involved in drug pharmacokinetic/pharmacodynamic profiles, starting from drug oral bioavailability to enteric/hepatic transport and metabolism, blood transport, and systemic transport/metabolism. Knowledge of any food components that may interfere with drug efficacy is essential, and would provide a link for obtaining a holistic view for cancer, cardiovascular, musculoskeletal, or neurological therapies. However, preclinical interaction may be irrelevant to clinical interaction, and health professionals should be aware of the limitations if they intend to optimize the therapeutic effects of drugs.
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Dietary Neurotransmitters: A Narrative Review on Current Knowledge.
Briguglio, M, Dell'Osso, B, Panzica, G, Malgaroli, A, Banfi, G, Zanaboni Dina, C, Galentino, R, Porta, M
Nutrients. 2018;10(5)
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Neurotransmitters (NTs) are chemical messengers, found mainly within the nervous system. Common NTs are acetylcholine (ACh), glutamate, γ-aminobutyric acid (GABA), dopamine, serotonin (5-HT), and histamine. Many foods are natural sources of NTs that may influence the nervous system, and therefore mood and mental health. This review paper looked at books and studies and discusses the NT content of foods and the possible implications for human health. Acetylcholine is a NT involved in muscle movement, learning and memory. Its presence is documented in more than 50 plant species, including squash, aubergine spinach and nettles. Glutamate is the most abundant excitatory NT in the brain. Glutamic acid naturally occurs in foods with high protein content. Seaweeds, cheeses, fish sauces, soy sauces, fermented beans, and tomato showed high levels of free glutamic acid. Dried cod, salami, caviar, and instant coffee powder are other sources of this amino acid. Salts of glutamic acid, such as monosodium glutamate, are added to certain foods as flavour enhancers. GABA is a calming NT. Studies have found the highest contents of GABA in raw spinach, potato, sweet potato and cruciferous vegetables such as kale and broccoli. Shiitake mushrooms and chestnuts also contained a significant amount of GABA. Dopamine plays an essential role in the coordination of body movements, motivation, and reward. Information on the content of dopamine foods is very limited. Bananas, plantains and avocado were reported to contain high levels of dopamine. 5-HT pathways modulate behaviours, eating, and sleep, and in the gut are involved in the regulation of gastrointestinal motility. In recent years, the number of studies on the content of 5-HT in plants has increased. 5-HT appeared to be prevalent in the green bananas, with higher concentrations found in the peel compared with the flesh. 5-HT was also found in peppers, paprika, hazelnut, tomatoes, pineapple, plum, passion fruit, papaya and kiwi fruit. Histamine is involved in arousal, attention, and reactivity, as well as in local immune responses. The presence of histamine in processed foods, such as aged cheeses, contributes to characteristic flavours and textures. Wine and beer may contain a significant amount of histamine. Fermented foods contain histamine. The food industry generally aims to maintain the levels of amines in foods as low as possible; consumption of fish, cured meat products, sauerkraut, and cheese varieties such as Cheddar, Swiss, Gruyère, and Gouda have been associated with amine poisoning. The significance of dietary NTs intake needs to be further investigated, as there is little data about their bioavailability or clinical implications. New studies should consider if dietary NTs can be transported across the blood-brain barriers or act on the central nervous system via other organs. The authors suggest that in future, including or excluding particular foods containing NTs could be beneficial for patients suffering from Alzheimer’s disease or dementia (an ACh diet), epilepsy or migraines (a glutamate-free diet), anxiety or insomnia (a GABA diet), Parkinson’s disease (a dopamine diet), depressive disorders (a serotonin diet), and vascular headaches (a histamine-free diet).
Abstract
Foods are natural sources of substances that may exert crucial effects on the nervous system in humans. Some of these substances are the neurotransmitters (NTs) acetylcholine (ACh), the modified amino acids glutamate and γ-aminobutyric acid (GABA), and the biogenic amines dopamine, serotonin (5-HT), and histamine. In neuropsychiatry, progressive integration of dietary approaches in clinical routine made it necessary to discern the more about some of these dietary NTs. Relevant books and literature from PubMed and Scopus databases were searched for data on food sources of Ach, glutamate, GABA, dopamine, 5-HT, and histamine. Different animal foods, fruits, edible plants, roots, and botanicals were reported to contain NTs. These substances can either be naturally present, as part of essential metabolic processes and ecological interactions, or derive from controlled/uncontrolled food technology processes. Ripening time, methods of preservation and cooking, and microbial activity further contributes to NTs. Moreover, gut microbiota are considerable sources of NTs. However, the significance of dietary NTs intake needs to be further investigated as there are no significant data on their bioavailability, neuronal/non neuronal effects, or clinical implications. Evidence-based interventions studies should be encouraged.