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[Relationship between visceral diseases and oral health].
Gazhva, SI, Igolkina, NA
Terapevticheskii arkhiv. 2013;(10):116-8
Abstract
The paper analyzes the literature showing that there is not only a phylogenetic relationship, but also a functional one between visceral diseases and oral health. It gives data on the unity of the occurrence of somatic and dental diseases. There is evidence for cause-and-effect relationships between them, which arise from immune imbalance, interleukin dysregulation, and nonspecific inresistance. There was a negative comorbidity of visceral diseases and oral health, namely, a relationship of dental diseases to the patients' general condition, as well as the impact of the foci of chronic oral infection on the development of systemic diseases. Mechanisms of a relationship between oral infection and secondary systemic manifestations are also described. It has been established that transient bacteremia odontogenic is detected at a dental visit and conditions for its transformation to any infectious diseases are also outlined. Unified systems approaches to treating polymorbidity are found to be needed.
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Nutritional and metabolic correlates of cardiovascular and bone disease in HIV-infected patients.
Fitch, K, Grinspoon, S
The American journal of clinical nutrition. 2011;(6):1721S-1728S
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Abstract
The treatment of HIV infection has dramatically reduced the incidence of AIDS-related illnesses. At the same time, non-AIDS-related illnesses such as cardiovascular and bone disease are becoming more prevalent in this population. The mechanisms of these illnesses are complex and are related in part to the HIV virus, antiretroviral medications prescribed for HIV infection, traditional risk factors exacerbated by HIV, and lifestyle and nutritional factors. Further prospective research is needed to clarify the mechanisms by which HIV, antiretroviral medications, and nutritional abnormalities contribute to bone and cardiovascular disease in the HIV population. Increasingly, it is being recognized that optimizing the treatment of HIV infection to improve immune function and reduce viral load may also benefit the development of non-AIDS-related illnesses such as cardiovascular and bone disease.
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Assessment of endocrine and nutritional status in age-related catabolic states of muscle and bone.
Lytras, A, Tolis, G
Current opinion in clinical nutrition and metabolic care. 2007;(5):604-10
Abstract
PURPOSE OF REVIEW Bone loss and muscle wasting are associated with increased morbidity and mortality in the elderly, most frequently as a result of fractures associated with poor neuromuscular conditioning leading to accidental falls. This paper reviews data that link pathways of the immune and endocrine systems with bone and muscle pathophysiology, as well as data on the impact of nutrition and physical activity on these systems. RECENT FINDINGS The growth hormone-insulin-like growth factor I axis and deficiencies in sex steroid hormones in aging appear linked with changes in the hypothalamic-pituitary-adrenal axis and immune function, accompanied by increased activity of the tumour necrosis factor-alpha axis. This is associated with activation of the RANK/RANKL/osteoprotegerin pathway and insulin resistance, affecting muscle and bone physiology. Vitamin D deficiency contributes to bone loss and muscle wasting, whereas other nutritional defects such as zinc or magnesium deficiencies may further complicate these catabolic states. SUMMARY As nutritional deficiencies responsible for bone and muscle derangement are correctable factors, careful nutritional assessment, in addition to evaluation of endocrine and immune status, may provide clinically important information allowing successful management of elderly patients in danger of neuromuscular dysfunction, accidental falls and bone fractures.
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[Effects of perioperative enteral immunonutrition on nutritional status, immunity and inflammatory response of elderly patients].
Wang, ZD, Peng, JS, Chen, S, Huang, ZM, Huang, L
Zhonghua yi xue za zhi. 2006;(20):1410-3
Abstract
OBJECTIVE To evaluate the effects of perioperative enteral immunonutrition on the nutritional status, immunity, and inflammatory response of the elderly patients. METHODS Eighty malnourished patients aged over 60 with malignant gastrointestinal tumors undergoing radical surgery were randomly divided into 2 groups: experimental group (immunonutrition group, n = 37), and control group (n = 43). In the experimental group Supportan and glutamine, with the calorific value of 125.4 kJ.kg(-1).d(-1), were given orally or by nasointestinal tube for 5 days before operation, through jejunostomy or nasointestinal tube during operation, and then through nasointestinal tube since the day 2 to day 9 after post-operationally. In the control group Nutrition with the same amount of calorific value was given in the same manner as mentioned above. Peripheral blood samples were collected 5 and 1 days pre-operationally, and 1 and 9 days post-operatively to examine the serum albumin (ALB), prealbumin (PA), transferrin (TFN), CD3, CD4, CD8, CD4/CD8, immunoglobulin (Ig) G, IgA, IgM, and C-reactive protein (CRP). RESULTS Nine days after operation, the serum TFN was 2.18 g/L +/- 0.29 g/L, PA was 0.23 g/L +/- 0.09 g/L, CD4 was 33.8% +/- 5.4%, CD4/CD8 was 1.17 +/- 0.12, and IgG was 13.2 g/L +/- 1.8 g/L. all significantly higher than those of the control group (1.95 g/L +/- 0.28 g/L, 0.19 g/L +/- 0.03 g/L, 31.1% +/- 5.2%, 1.05 +/- 0.10, and 12.11 g/L +/- 1.53 g/L respectively, all P < 0.05). CONCLUSION Perioperative enteral immunonutrition improves the nutritional status and immune function, und reduces the acute inflammatory response of elderly patients.
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New lipids in enteral feeding.
Roy, CC, Bouthillier, L, Seidman, E, Levy, E
Current opinion in clinical nutrition and metabolic care. 2004;(2):117-22
Abstract
PURPOSE OF REVIEW Lipid sources for enteral nutrition continue to be an exciting area of investigation. It is timely to review recent developments which have largely contributed to thrust enteral feeding into a new era. RECENT FINDINGS Although much more research needs to be done, there is a better understanding of the competitive relationships between n-6/n-3 fatty acids in conditions of metabolic and immune stress as well as in autoimmune and degenerative diseases. Although structured lipids are more completely absorbed and cleared, other more important clinical benefits need to be documented before they can be considered cost-effective. Immune enhancing formulas are the subject of controversy and some have been shown to be more effective than others. Enteral formulations with short-chain fatty acids are promising but more experimental work on the normal, and the sick colon is needed. Finally, there are a few isolated studies suggesting that enteral feeding with liposomes and with lipolytic products may have advantages when the digestive phase needs to be circumvented. The era of nutrigenomics, in which the effect of specific lipids on genes and proteins is being explored, is with us. We can look forward to nutrigenetics when the effect of genetic variation on the interaction between diet and disease will guide our practice. SUMMARY Clinicians already have access to lipid sources and formulations which allow them to individualize enteral feeding programs. More clinical and technological research needs to be carried out, however, before products can be tailored to produce optimal effects in specific conditions.
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The effect of aging on mucosal host defense.
Cunningham-Rundles, S
The journal of nutrition, health & aging. 2004;(1):20-5
Abstract
Mucosal immune response is primed at birth and responses generated at this time support specific immunity in later life. Conversely development of mucosal immune response to new antigens is diminished in aging. Availability of key nutrients that are conditionally essential especially in the context of sub-acute infections may limit immune response. A critical hypothesis is that conditionally essential nutrient requirements are associated with aging and form the fundamental basis of observed immune senescence. Since mucosal immunity is modulated by the interaction of microflora with the gut immune system, it is likely that changes in the gut during aging affect this microenvironment. Probiotic lactic acid bacteria offer one approach to stimulating the gastrointestinal immune system thereby enhancing systemic as well as mucosal immune response in aging. The mechanisms of action appear to include specific stimulation of natural killer cells (NK) and the innate immune system.
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Preoperative nutritional support at home in head and neck cancer patients: from nutritional benefits to the prevention of the alcohol withdrawal syndrome.
Bertrand, PC, Piquet, MA, Bordier, I, Monnier, P, Roulet, M
Current opinion in clinical nutrition and metabolic care. 2002;(4):435-40
Abstract
PURPOSE OF REVIEW Preoperative nutritional support in severely malnourished patients decreases complications after major surgery. This review summarizes previous studies on head and neck cancer patients undergoing surgery, and offers recommendations on preoperative nutritional support based on the literature and our experience. RECENT FINDINGS Head and neck cancer has a large impact on the patient's quality of life and a high mortality rate. Aggressive surgical resection followed by soft-tissue and osseous reconstruction is the gold standard of treatment. The incidence of postoperative complications is high at 20-50%. Malnutrition and alcohol withdrawal syndrome are often present, and are considered risk factors for developing wound infection after head and neck cancer surgery. Proactive intervention by preoperative nutritional support may correct nutrient deficiencies, minimize malnutrition-related morbidity and mortality, reduce the length and cost of hospitalization, and may prevent alcohol withdrawal syndrome. Nutritional support given preoperatively for 7-10 days decreases postoperative complications by approximately 10% in malnourished patients with weight loss of 10% or more. Oral liquid supplements and enteral nutrition are useful to support head and neck cancer patients preoperatively. Enteral nutrition is safer, more physiological, less expensive and practicable at home compared with parenteral nutrition, which is not usually indicated in these patients. SUMMARY Enteral nutrition is efficient in preoperative phase to prevent postoperative complications. However evidence is insufficient to conclude that preoperative immune-enhancing enteral feeding provides any supplementary benefit by comparison with a standard diet. Our experience with the preoperative approach in head and neck cancer patients is reported in this paper.
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Nutritional aspects of liver transplantation.
Campos, AC, Matias, JE, Coelho, JC
Current opinion in clinical nutrition and metabolic care. 2002;(3):297-307
Abstract
Most adult and pediatric liver transplantation candidates present several metabolic disturbances that lead to malnutrition. Because malnutrition may adversely affect morbidity and mortality of orthotopic liver transplantation, it is very important to carefully assess the nutritional status of the waiting list patients. Pretransplant nutritional therapy -- enteral or parenteral -- may positively influence liver metabolism, muscle function, and immune status. Nutrition therapy should continue in the short- and also in the long-term post-transplant periods. For malnourished patients, early post-transplant enteral or parenteral nutrition have been useful in improving nutritional status. Finally, the metabolic and nutritional care of the liver transplant donor must be considered to reduce allograft dysfunction indices.
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Use of clinical laboratory parameters to evaluate wound healing potential in diabetes mellitus.
Abu-Rumman, PL, Armstrong, DG, Nixon, BP
Journal of the American Podiatric Medical Association. 2002;(1):38-47
Abstract
Clinicians caring for chronic wounds can easily overlook nutritional status. Patients with diabetes are at high risk for primary and secondary malnutrition. Although profiles exist defining the extent of the deficiency, the process of wound healing and the interactions of the macronutrients and micronutrients necessary to accomplish it must first be understood. In elderly patients with diabetes, additional factors such as liver and renal function, the interdependence of the immune system, and protein synthesis, also must be considered. This article provides a practical format to assist clinicians in better evaluating this often difficult-to-assess area of care.
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10.
Role of breast-feeding in managing malnutrition and infectious disease.
Filteau, SM
The Proceedings of the Nutrition Society. 2000;(4):565-72
Abstract
Breast-feeding policy tends to be an emotive issue. International agencies recommend exclusive breast-feeding for 4-6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimize the damage caused by the malnutrition-infection cycle. To what extent are these recommendations supported by the experimental evidence? Are they a simplification for emotional reasons or public health purposes? Breast-feeding is believed to benefit infants because breast milk contains the ideal mix of nutrients for infants, because it contains factors which promote development of the infant's gut and immune system and which prevent pathogen invasion, and because exclusive breast-feeding prevents intake of pathogens in food or water. However, some apparently contradictory evidence exists. First, in environments which are not highly contaminated breast-fed infants tend to growth falter relative to those fed formula. Second, in such environments partial breast-feeding is not associated with significantly increased gut damage relative to exclusive breast-feeding, suggesting that active promotion of gut development by breast-feeding is more important than simple avoidance of pathogens from other foods. Third, many immune factors in breast milk are probably present primarily to protect the mother, not the infant. Finally, breast milk itself may contain bacteria or viruses. This problem has come to the fore with the human immunodeficiency virus epidemic, since it is clear breast-feeding is an important mode of mother-to-child transmission. The present review will examine these challenges to the basis of the international infant feeding recommendations and will suggest that the science does actually support the policy.