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Demand for Water-Soluble Vitamins in a Group of Patients with CKD versus Interventions and Supplementation-A Systematic Review.
Kędzierska-Kapuza, K, Szczuko, U, Stolińska, H, Bakaloudi, DR, Wierzba, W, Szczuko, M
Nutrients. 2023;(4)
Abstract
BACKGROUND Increasingly, chronic kidney disease (CKD) is becoming an inevitable consequence of obesity, metabolic syndrome, and diabetes. As the disease progresses, and through dialysis, the need for and loss of water-soluble vitamins both increase. This review article looks at the benefits and possible risks of supplementing these vitamins with the treatment of CKD. METHODS Data in the PubMed and Embase databases were analyzed. The keywords "chronic kidney disease", in various combinations, are associated with thiamin, riboflavin, pyridoxine, pantothenic acid, folates, niacin, cobalamin, and vitamin C. This review focuses on the possible use of water-soluble vitamin supplementation to improve pharmacological responses and the overall clinical condition of patients. RESULTS The mechanism of supportive supplementation is based on reducing oxidative stress, covering the increased demand and losses resulting from the treatment method. In the initial period of failure (G2-G3a), it does not require intervention, but later, especially in the case of inadequate nutrition, the inclusion of supplementation with folate and cobalamin may bring benefits. Such supplementation seems to be a necessity in patients with stage G4 or G5 (uremia). Conversely, the inclusion of additional B6 supplementation to reduce CV risk may be considered. At stage 3b and beyond (stages 4-5), the inclusion of niacin at a dose of 400-1000 mg, depending on the patient's tolerance, is required to lower the phosphate level. The inclusion of supplementation with thiamine and other water-soluble vitamins, especially in peritoneal dialysis and hemodialysis patients, is necessary for reducing dialysis losses. Allowing hemodialysis patients to take low doses of oral vitamin C effectively reduces erythropoietin dose requirements and improves anemia in functional iron-deficient patients. However, it should be considered that doses of B vitamins that are several times higher than the recommended dietary allowance of consumption may exacerbate left ventricular diastolic dysfunction in CKD patients. CONCLUSIONS Taking into account the research conducted so far, it seems that the use of vitamin supplementation in CKD patients may have a positive impact on the treatment process and maintaining a disease-free condition.
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Critical evaluation and comparison of nutritional clinical practice guidelines for cancer patients.
Bakaloudi, DR, Papaemmanouil, A, Vadarlis, A, Makrakis, D, Germanidis, G, Timotheadou, E, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2023;(5):670-686
Abstract
BACKGROUND The growing incidence of cancer globally, and the importance of nutrition support for these patients, emphasize the need for the development of nutritional clinical practice guidelines and consensus papers (CPGs) in the field. Numerous relevant CPGs have been published by several organizations worldwide. The aim of this systematic review was to compare the content of the existing CPGs and evaluate the quality of their development using the AGREE-II tool. METHODS A systematic literature search in PubMed, Embase and Web of Science databases was conducted for the identification of relevant CPGs and consensus papers. Eligible CPGs was blindly evaluated by four appraisers according to the Appraisal of Guidelines for Research and Evaluation ΙΙ (AGREE-II) tool. RESULTS In total 15 CPGs were identified and were evaluated. All but one set of CPGs underlined the importance of nutritional screening and assessment, whereas recommendations on nutritional interventions, supplements, management of complications and nutritional follow-up were also reported by several organizations. AGREE-II results showed that two CPGs were characterized as high, eight as moderate and five as low regarding their quality of development. CONCLUSIONS Variety on recommendations could be observed between CPGs that should be considered when applied into clinical practice. Limitations of the existing CPGs could be the fact that they are non-specific and only a minority of them are focused to specific cancer types. Frequent updates for CPGs and inclusion of more nutritional topics should be considered for some CPGs. Improvement of the quality of the CPGs development should also be pursued in future.
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High Versus Low Adherence to the Mediterranean Diet for Prevention of Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis.
Kotzakioulafi, E, Bakaloudi, DR, Chrysoula, L, Theodoridis, X, Antza, C, Tirodimos, I, Chourdakis, M
Metabolites. 2023;(7)
Abstract
Diabetes mellitus type 2 (DMT-2) presents with a growing incidence, and its complications contribute mainly to cardiovascular disease and overall mortality. DMT-2 prevention and early stage management include lifestyle modification by adopting healthy eating patterns and increasing physical activity levels. The Mediterranean diet (MD) is associated with beneficial effects on human health and has been found effective for preventing and managing DMT-2. The purpose of this meta-analysis is to investigate whether the level of MD adherence plays a role in DMT-2 prevention and to what extent. A systematic literature search in PubMed, EMBASE, Web of Science Core Collection, Scopus, and Google Scholar databases was conducted until November 2022, and related observational studies fulfilling the eligibility criteria were included. The literature search concluded with 24 studies in the qualitative analysis and 23 studies in the quantitative analysis. Of those, 18 cohort studies were eligible for meta-analysis with hazard ratio as effect size and five studies providing odds ratio as effect size. The cohort studies included 248,140 participants with a mean follow-up of 10.8 years (3 to 22 years). Individuals with high adherence to MD presented an 11% and 18% decrease in risk and odds, respectively, of developing DMT-2 compared to those with low MD adherence (HR 0.89, 95%CI 0.83 to 0.95) and (OR 0.82, 95%CI 0.72 to 0.93). In studies where the follow-up was longer than 10 years, the 12% decrease in the risk of developing DMT-2 remained (HR 0.88 95%CI 0.84 to 0.92), whereas in studies where follow-up was less than 10 years, no difference between groups with different levels of adherence was found. Long-term high MD adherence is associated with a reduced risk of developing DMT-2, but further studies are needed to confirm these results.
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The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: A systematic review of the evidence.
Bakaloudi, DR, Jeyakumar, DT, Jayawardena, R, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2022;(12):3038-3045
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Abstract
The pandemic of coronavirus disease 2019 (COVID-19) and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide. In this study we aimed to investigate the impact of the first COVID-19 lockdown period (March-May 2020) on snacking behavior, fast-food and alcohol consumption. A systematic search in PubMed®, Scopus® and Web of Science® databases was conducted and 32 studies were included. Changes in snacking, in fast-food and ordered food consumption and in alcohol intake were examined. Snacking was found to be increased for a significant portion of the population examined (18.9-45.1%), whereas fast food (15.0-41.3%) and ordered food (33.9%) showed a tendency towards decrease. As per alcohol consumption, an upward trend was observed in a significant part (10.4-51.0%) of the participants examined. The increased snacking and alcohol consumption observed for almost a third of the examined population could be alarming because long-term health problems could arise in cases of repeated lockdowns in the future. The observed downward trend in fast-food consumption and in frequency of ordered food could be an encouraging sign of turning to home-prepared foods, but further research is needed in this field.
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Impact of the first COVID-19 lockdown on body weight: A combined systematic review and a meta-analysis.
Bakaloudi, DR, Barazzoni, R, Bischoff, SC, Breda, J, Wickramasinghe, K, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2022;(12):3046-3054
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Abstract
The coronavirus disease 2019 (COVID-19) and the imposed lockdowns in order to control the pandemic, had undoubtedly influenced the lifestyle of millions of people worldwide. The period of confinement, which was characterized by seizing most business activities and allowing only for e-classes at schools and universities, leading also to a lower physical activity, could have affected eating behaviors of people of all ages. In this study we aimed to investigate the impact of the first lockdown period (March-May 2020) on body weight (BW) and on body mass index (BMI) in both adults and adolescents (>16 years old). A systematic literature search was conducted in PubMed®, Scopus®, Web of Science® and EMBASE® databases and 36 observational (35 cross-sectional and one cohort) studies were included. BW and BMI changes after/during the lockdown period were examined. BW was stated as increased in a significant part of the individuals (11.1-72.4%), although a range of 7.2-51.4% of individuals reported weight loss. A significant higher BW was observed with a weighted mean between-group difference (WMD) 1.57 (95% CI 1.01 to 2.14) in the post-lockdown period compared to the before lockdown time and higher BMI, 0.31 WMD (95% CI, 0.17 to 0.45) was identified before the lockdown period. At variance with general trends, one study in older adults (>60 years old) notably reported a significant BW loss, suggesting a higher risk for lockdown-induced weight loss and potentially malnutrition in the elderly population. Overall increments in BW are an alarming effect of lockdown during the COVID-19 pandemic, leading to potential higher incidence of overweight, obesity and related health-risks as well as other noncommunicable diseases. Further studies are needed to assess potential group-specific impacts, with particular regard to weight gain in younger people and risk of weight loss, malnutrition and sarcopenia in older adults.
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Vitamin D as a chemopreventive agent in colorectal neoplasms. A systematic review and meta-analysis of randomized controlled trials.
Emmanouilidou, G, Kalopitas, G, Bakaloudi, DR, Karanika, E, Theocharidou, E, Germanidis, G, Chourdakis, M
Pharmacology & therapeutics. 2022;:108252
Abstract
Colorectal cancer (CRC) is the third most common cancer in both sexes and the second in terms of mortality. Apart from genetic predisposition, dietary and lifestyle factors have been implicated in the development of CRC. Several studies suggested that vitamin D (VitD) might be a promising strategy in CRC prevention, while other studies did not confirm this finding. The aim of our study was to examine the role of Vit-D supplementation in the prevention of colorectal neoplasms (CRC and polyps). We conducted a systematic search in Pubmed, Embase and Web of Science databases for Randomized Controlled Trials (RCTs) examining the incidence of colorectal neoplasms in patients taking Vit-D supplementation compared to placebo. We synthetized results using Risk Ratio along with 95% Confidence Intervals (CIs). Nine RCTs (N = 71,386) were included. Non-significant correlations were observed between Vit-D supplementation and CRC incidence (RR:1.06, p = 0.52). Similarly, non-significant associations were observed between the use of Vit-D supplements and colorectal adenoma incidence (RR:1.00, p = 0.91). Advanced adenomas (OR:1.05, p = 0.63) and serrated polyps (RR:1.03, p = 0.63) were also not significantly inversely associated with Vit-D supplementation. Our study shows that Vit-D does not seem to have a role in the chemoprevention of colorectal neoplasms. However, additional well-designed studies are needed in order to draw safe conclusions. A potentially beneficial role of Vit-D supplementation in CRC primary prevention in individuals with severe vitamin D deficiency as well in the primary prevention of early-onset CRC, requires further investigation.
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The Impact of Lockdowns on Caffeine Consumption: A Systematic Review of the Evidence.
Bakaloudi, DR, Evripidou, K, Jayawardena, R, Breda, J, Dardavessis, T, Poulia, KA, Chourdakis, M
International journal of environmental research and public health. 2022;(9)
Abstract
The Coronavirus disease 2019 (COVID-19) has been characterized by the World Health Organization as a pandemic in March 2020 and the lockdown measures that were implemented in an effort to limit the transmission of the virus affected the daily life of many people in all over the world. The aim of this systematic review was to investigate the changes during/after the lockdowns in caffeine consumption by coffee and energy drinks. A systematic literature search was conducted in three databases (PubMed, Embase, Web of Science) up to 31 December 2021 and out of 19,511 studies found and 12,885 screened, 16 studies were included according to eligibility criteria. Results regarding coffee consumption showed that a significant part of individuals decreased their consumption and in five studies an increase was reported, including women and seniors >60 years old. Energy drinks were also consumed less during the lockdown compared to the pre-lockdown time. Attention should be given for menopausal women where an increase in coffee consumption was found which could impair bone density, but further research is needed in order to make safe conclusions.
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Intake and adequacy of the vegan diet. A systematic review of the evidence.
Bakaloudi, DR, Halloran, A, Rippin, HL, Oikonomidou, AC, Dardavesis, TI, Williams, J, Wickramasinghe, K, Breda, J, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2021;40(5):3503-3521
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Plain language summary
This systematic review investigated vegan diets in the European populations and their adequacy of macro-and micronutrient intake, compared to the recommendations of the World Health Organization. Included were 48 studies and their outcomes regarding protein, carbohydrates, fats and micronutrients summarized. The overall results and their impact on health are discussed in the later sections of the paper. Adequate intake amongst vegans was seen with carbohydrates, fats, Vitamin A, B1, В6, C, E, iron, phosphorus, magnesium, copper and folate. Sodium exceeded recommended intake, whilst protein, Vitamin B2, B3, B12, D, iodine, zinc, calcium, potassium, selenium was of low consumption in a vegan diet. The bioavailability of some nutrients was also acknowledged. In summary, following a vegan diet appears to have positive and negative aspects. A vegan diet profile can contribute to disease prevention with lower incidence rates of obesity, Type 2 diabetes, and cardiovascular disease. Yet veganism appears to increase the risk for mental health conditions, bone fractures, immune system impairments, anaemias and deficiencies from low nutrient intake. This review yields a comprehensive overview of the positive and negative health consequences of a vegan diet. It may be a useful reference for those looking to support vegans or individuals considering adopting a vegan diet pattern.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Vegan diets in European populations tend to be lower in protein intake, particularly amino acids lysine, methionine and tryptophan.
- Other micronutrients that tend to lower in vegan diets are Vitamin B12, zinc, calcium and selenium.
- Healthcare practitioners should be aware of these potential deficiencies when working with vegan clients.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Vegan diets have become increasingly popular in the last ten years. This systematic review of 48 studies investigated the adequacy of vegan diets in European populations. It compared their macro- and micronutrient intakes compared to World Health Organization recommendations. It found that vegan diets tend to be lower in protein and in essential amino acids (lysine, methionine and tryptophan). They can also be lower in micronutrients especially vitamin B12, zinc, calcium and selenium. However, the lower intakes are not always associated with health impairments.
Clinical practice applications:
Practitioners should be aware of the potential deficiencies in a vegan diet.
Considerations for future research:
More research is needed to determine whether lower nutrient intakes in vegans correlated with poor health outcomes.
Abstract
BACKGROUND Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. METHODS A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. RESULTS Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24-0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. CONCLUSIONS Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.
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Impact of the Level of Adherence to Mediterranean Diet on the Parameters of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Observational Studies.
Bakaloudi, DR, Chrysoula, L, Kotzakioulafi, E, Theodoridis, X, Chourdakis, M
Nutrients. 2021;(5)
Abstract
High adherence to the Mediterranean diet (MD) has been associated with a lower prevalence of Metabolic Syndrome (MetS). The present study aimed to investigate the impact of MD adherence on parameters of MetS. A systematic literature search was performed in PubMed, Cochrane Central Registry of Clinical Trials (CENTRAL), Scopus, EMBASE, Web of Science and Google Scholar databases. Observational studies that recorded adherence to MD and components/measures of the MetS, such as waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), high-density lipoprotein (HDL) cholesterol and triglycerides (TG), were included in this study. A total of 58 studies were included in our study. WC and TG were significantly lower in the high adherence MD group (SMD: -0.20, (95%CI: -0.40, -0.01), SMD: -0.27 (95%CI: -0.27, -0.11), respectively), while HDL cholesterol was significantly higher in the same group (SMD: -0.28 (95%CI: 0.07, 0.50). There was no difference in FBG and SBP among the two groups (SMD: -0.21 (95%CI: -0.54, 0.12) & SMD: -0.15 (95%CI: -0.38, 0.07), respectively). MD may have a positive impact on all parameters of MetS. However, further research is needed in this field.
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AGREEing on Nutritional Management of Patients with CKD-A Quality Appraisal of the Available Guidelines.
Bakaloudi, DR, Chrysoula, L, Poulia, KA, Dounousi, E, Liakopoulos, V, Chourdakis, M
Nutrients. 2021;(2)
Abstract
Chronic kidney disease (CKD) is an important public health issue with increasing prevalence worldwide. Several clinical practice guidelines have been recently published regarding the nutritional management of CKD patients. The purpose of the present study is to evaluate the quality of the published guidelines and provide recommendation for future updates. PubMed, Scopus and Google Scholar were searched for relevant guidelines and 11 clinical practice guidelines were finally included. Guidelines developed by the American Society for Parenteral and Enteral nutrition (ASPEN), the Dietitians Association of Australia (DAA), the German Society for Nutritional Medicine (DGEM), the European Best Practice Guidelines (EBPG), the European Dialysis and Transplantation Nurses Association-European Renal Care Association (EDTNA-ERCA), the European Society for Clinical Nutrition and Metabolism (ESPEN), the Andalusian Group for Nutrition Reflection and Investigation (GARIN) group, the National Kidney foundation-Kidney Disease Outcomes Quality Initiative (KDOQI), the Italian Society of Nephrology-Association of Dieticians-Italian Association of Hemodialysis, Dialysis and Transplant (SIN-ANDID-ANED), and the Renal Association were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Guidelines by KDOQI, ESPEN, and DAA were of moderate quality and the rest of them were low-quality guidelines. Our study demonstrates gaps related to the development of guidelines and therefore greater emphasis on methodological approaches is recommended. AGREE II tool can be useful to improve quality of guidelines.