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1.
Acute Hepatic Failure and Nutrition.
Kappus, MR
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2020;(1):30-35
Abstract
Malnutrition is prevalent in patients with hepatic failure and remains an independent risk factor for morbidity and mortality in these patients. Factors that contribute to malnutrition in this patient population include altered metabolic rate, fat malabsorption, and impaired gastric emptying, all in the setting of an acute and potentially prolonged hospitalization. Acute liver failure (ALF), different from cirrhosis or chronic liver disease, is an uncommon but dramatic clinical syndrome that demonstrates severe and rapid decline in hepatic metabolic function. ALF has a significant risk of mortality. There are >10 cases per million persons per year in developed countries, but ALF presents with unique challenges in clinical management related to heterogeneity in severity and etiology. Patients with ALF by definition should not have a prior history of liver disease, and liver disease is subsequently defined by the onset of liver injury, the presence of hepatic encephalopathy (HE), and coagulopathy as defined by an international normalized ratio > 1.5. HE usually develops within 1-4 weeks of the onset of liver injury but may occur within 26 weeks of the initial presentation. Rates of survival from ALF have improved over recent years, but the rarity and severity of presentation have resulted in traditionally limited evidence to guide basic supportive care. Over time, advances in critical care management and the use of emergency liver transplantation have improved. In this article, we will review current nutrition considerations for patients with ALF.
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2.
Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty.
Tamura, Y, Omura, T, Toyoshima, K, Araki, A
Nutrients. 2020;(11)
Abstract
The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.
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3.
The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition.
Pobłocki, J, Jasińska, A, Syrenicz, A, Andrysiak-Mamos, E, Szczuko, M
Nutrients. 2020;(5)
Abstract
Nuroendocrine neoplasms (NENs) are a group of rare neoplasms originating from dispersed neuroendocrine cells, mainly of the digestive and respiratory tract, showing characteristic histology and immunoprofile contributing to classification of NENs. Some NENs have the ability to produce biogenic amines and peptide hormones, which may be associated with clinical syndromes like, e.g., the carcinoid syndrome caused by unmetabolized overproduced serotonin, hypoglycemic syndrome in case of insulinoma, or Zollinger-Ellison syndrome accompanying gastrinoma. Diagnostics for these include ultrasound with endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography/computed tomography (PET/CT). Different nuclear medicine procedures can also be used, like somatostatin analogues scintigraphy (SRS) and 68Ga-Dota-Peptide PET/CT, as well as biochemical methods to determine the level of general neuroendocrine markers, such as chromogranin A (CgA), 5-hydroxyindolacetic acid (5-HIAA), synaptopfysin and cell type-specific peptide hormones, and neurotransmitters like gastrin, insulin, serotonin, and histamine. NENs influence the whole organism by modulating metabolism. The treatment options for neuroendocrine neoplasms include surgery, somatostatin analogue therapy, radionuclide therapy, chemotherapy, molecular targeted therapies, alpha-interferon therapy, and inhibitors of serotonin production. In the case of hypersensitivity to biogenic amines, a diet that limits the main sources of amines should be used. The symptoms are usually connected with histamine, tyramine and putrescine. Exogenic sources of histamine are products that take a long time to mature and ferment. Patients with a genetic insufficiency of the diamine oxidase enzyme (DAO), and those that take medicine belonging to the group of monoamine oxidases (MAO), are particularly susceptible to the negative effects of amines. Diet plays an important role in the initiation, promotion, and progression of cancers. As a result of the illness, the consumption of some nutrients can be reduced, leading to nutritional deficiencies and resulting in malnutrition. Changes in metabolism may lead to cachexia in some patients suffering from NENs. The aim of this narrative review was to advance the knowledge in this area, and to determine possibilities related to dietary support. The authors also paid attention to role of biogenic amines in the treatment of patients with NENs. We can use this information to better understand nutritional issues faced by patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), and to help inform the development of screening tools and clinical practice guidelines.
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4.
Plasma proteomics reveals markers of metabolic stress in HIV infected children with severe acute malnutrition.
Gonzales, GB, Njunge, JM, Gichuki, BM, Wen, B, Potani, I, Voskuijl, W, Bandsma, RHJ, Berkley, JA
Scientific reports. 2020;(1):11235
Abstract
HIV infection affects up to 30% of children presenting with severe acute malnutrition (SAM) in Africa and is associated with increased mortality. Children with SAM are treated similarly regardless of HIV status, although mechanisms of nutritional recovery in HIV and/or SAM are not well understood. We performed a secondary analysis of a clinical trial and plasma proteomics data among children with complicated SAM in Kenya and Malawi. Compared to children with SAM without HIV (n = 113), HIV-infected children (n = 54) had evidence (false discovery rate (FDR) corrected p < 0.05) of metabolic stress, including enriched pathways related to inflammation and lipid metabolism. Moreover, we observed reduced plasma levels of zinc-α-2-glycoprotein, butyrylcholinesterase, and increased levels of complement C2 resembling findings in metabolic syndrome, diabetes and other non-communicable diseases. HIV was also associated (FDR corrected p < 0.05) with higher plasma levels of inflammatory chemokines. Considering evidence of biomarkers of metabolic stress, it is of potential concern that our current treatment strategy for SAM regardless of HIV status involves a high-fat therapeutic diet. The results of this study suggest a need for clinical trials of therapeutic foods that meet the specific metabolic needs of children with HIV and SAM.
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5.
Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD.
Worm, N
Nutrients. 2020;(5)
Abstract
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent liver disease in industrialized countries. It is regarded as the hepatic manifestation of the metabolic syndrome (MetS) resulting from insulin resistance. Moreover, insulin resistance impairs glycogen synthesis, postprandially diverting a substantial amount of carbohydrates to the liver and storing them there as fat. NAFLD has far-reaching metabolic consequences involving glucose and lipoprotein metabolism disorders and risk of cardiovascular disease, the leading cause of death worldwide. No pharmaceutical options are currently approved for the treatment of NAFLD. Exercise training and dietary interventions remain the cornerstone of NAFLD treatment. Current international guidelines state that the primary goal of nutritional therapy is to reduce energy intake to achieve a 7%-10% reduction in body weight. Meal replacement therapy (formula diets) results in more pronounced weight loss compared to conventional calorie-restricted diets. However, studies have shown that body mass index (BMI) or weight reduction is not obligatory for decreasing hepatic fat content or to restore normal liver function. Recent studies have achieved significant reductions in liver fat with eucaloric diets and without weight loss through macronutrient modifications. Based on this evidence, an integrative nutritional therapeutic concept was formulated that combines the most effective nutrition approaches termed "liver-fasting." It involves the temporary use of a low calorie diet (total meal replacement with a specific high-protein, high-soluble fiber, lower-carbohydrate formula), followed by stepwise food reintroduction that implements a Mediterranean style low-carb diet as basic nutrition.
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6.
Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis.
Sikand, G, Cole, RE, Handu, D, deWaal, D, Christaldi, J, Johnson, EQ, Arpino, LM, Ekvall, SM
Journal of clinical lipidology. 2018;(5):1113-1122
Abstract
BACKGROUND Faced with increasing health care costs, it is incumbent to discern whether managing dyslipidemia with medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) is clinically and cost effective. OBJECTIVE To systematically examine evidence on the clinical effectiveness and cost benefit of MNT by an RDN for the treatment of dyslipidemia. METHODS English and full-text research articles published between January 2003 and October 2014 were identified using PubMed, MEDLINE, and the Worldcat.org site to identify literature specific to clinical and cost effectiveness of MNT for dyslipidemia. Studies were required to have at least one outcome measure of dyslipidemia: total cholesterol (Total C), low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol, and/or metabolic syndrome. RESULTS This systematic review identified 34 primary studies with 5704 subjects. Multiple individual face-to-face MNT sessions by an RDN over 3 to 21 months led to significant improvements in lipid profile, body mass index, glycemic status, and blood pressure. Results were summarized as mean differences with 95% confidence intervals when meta-analysis was possible. In a pooled analysis, MNT interventions lowered low-density lipoprotein cholesterol, total C, triglycerides, fasting blood glucose, hemoglobin A1c, and body mass index compared to a control group. Cost effectiveness and economic savings of MNT for dyslipidemia showed improved quality-adjusted life years and cost savings from reduced medication use. CONCLUSION Evidence from this systematic review and meta-analysis demonstrates that multiple MNT sessions by an RDN are clinically effective and cost beneficial in patients with dyslipidemia and cardiometabolic risk factors.
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7.
Medical Nutrition Therapy and Weight Loss Questions for the Evidence Analysis Library Prevention of Type 2 Diabetes Project: Systematic Reviews.
Raynor, HA, Davidson, PG, Burns, H, Nadelson, MDH, Mesznik, S, Uhley, V, Moloney, L
Journal of the Academy of Nutrition and Dietetics. 2017;(10):1578-1611
Abstract
BACKGROUND Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library's prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong. OBJECTIVE Present the basis of systematic reviews for MNT and weight loss recommendations. METHODS Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months. MAIN OUTCOME MEASURES Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated. RESULTS For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure. CONCLUSIONS Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes.
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8.
Tomato (Solanum lycopersicum) Carotenoids and Lycopenes Chemistry; Metabolism, Absorption, Nutrition, and Allied Health Claims--A Comprehensive Review.
Perveen, R, Suleria, HA, Anjum, FM, Butt, MS, Pasha, I, Ahmad, S
Critical reviews in food science and nutrition. 2015;(7):919-29
Abstract
Tomato (Solanum lycopersicum) is one of the most essential herbaceous plants that have been probed against various life sight related disorders owing to array of phytochemicals. It is important source of vitamin C, potassium, folic acid, and carotenoids, such as lycopene. Carotenoids are the pigments synthesized during fruit ripening and responsible for the final red color of the tomato. Consumption of tomato and tomato-based products contribute to the absorption of carotenoids and lycopenes in human serum. Lycopene is chemically acyclic carotene with 11 conjugated double bonds, normally in transconfiguration while isomerization occur in blood plasma for its better absorption. It has ability for adenosine deaminase inhibition that plays important role in the regression of tumor. Tomato also contain other active compounds, namely, neoxanthin, lutein, α-cryptoxanthin, α-carotene, β-carotene, cyclolycopene, and β-carotene 5, 6-epoxide. These components provide synergistic effect against various threats but still need further attention of the researchers. Both in vitro and in vivo studies have elucidated the potential of tomato against variety of metabolic syndromes. Latest research highlights the relationship between consuming tomato and its products with reduced risk of various maladies like obesity, hyperglycemic and hypercholesterolemic attributes, cardiovascular disorders, and cancer insurgences. Moreover, tomato and its bioactive components hold potential to become effective modules in diet-based regimens; however, integrated research and meta-analysis are still required to enhance meticulousness.
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9.
NOVEL INSIGHTS ON INTAKE OF MEAT AND PREVENTION OF SARCOPENIA: ALL REASONS FOR AN ADEQUATE CONSUMPTION.
Rondanelli, M, Perna, S, Faliva, MA, Peroni, G, Infantino, V, Pozzi, R
Nutricion hospitalaria. 2015;(5):2136-43
Abstract
INTRODUCION sarcopenia is defined as a syndrome characterized by progressive and generalized loss of muscle mass and strength. The main cause of sarcopenia is the alteration of protein metabolism, in which the proteolytic processes are not accompanied by an appropriate protein synthesis and muscle cells lose progressively the sensitivity to the anabolic stimulus. The most rational approach to delay the progression of sarcopenia and counteract the anabolic resistance is proper nutrition. Meat contains biologically active compounds, such as creatine, carnitine, Conjugated Linoleic Acid (CLA) which have significant impacts upon human protein metabolism. METHODS we performed a narrative literature review to evaluate the till-now evidence regarding: 1. adequate intake of meat in elderly as a topic for prevention of sarcopenia; 2. the correct intake of biologically active compounds contain in meat, which have significant impacts upon human protein metabolism and so have beneficial effects on prevention of sarcopenia. This review included 62 eligible studies. RESULTS the results demonstrated that in elderly the optimum diet therapy for the sarcopenia prevention and treatment, which must aim at achieving specific metabolic goals, must recommend the consumption of 113 g of meat (220 kcal; 30 g protein) five time a week. CONCLUSION in a varied and balanced diet, for preventing sarcopenia, it is recommended to assume meat 4-5 times a week (white meat 2 times per week, lean red meat less than 2 times per week, processed meat less than 1 time per week), as suggested in the diet pyramid for elderly.
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10.
Nutritional armor for the injured warfighter: omega-3 fatty acids in surgery, trauma, and intensive care.
McCarthy, MS, Morgan, BB, Heineman, JT, Martindale, RG
Military medicine. 2014;(11 Suppl):88-94
Abstract
Nutrients have traditionally been viewed as a means to provide basic energy for cellular homeostasis and amino acids for protein synthesis in all humans. Young, healthy men and women in the military today are presumed to be well nourished and mentally and physically fit to perform their duties in austere environments. Exposure to high-intensity projectiles, blast injuries, and other wounds of war, however, is an everyday occurrence during deployment that potentially challenges all homeostatic mechanisms. After sustaining such devastating injuries, critically ill, surgical, and trauma patients are in a constant dynamic state between the systemic inflammatory response syndrome (and compensatory anti-inflammatory response syndrome. Compelling evidence supports both immune and metabolic response modulation by specific nutrients, including omega-3 fatty acids, primarily eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The concept of providing nutrients as therapeutic rather than supportive agents to meet the basic cellular caloric and metabolic demands requires a major paradigm shift. Although the exact route and dose of these metabolically active lipids has yet to be determined, data from large clinical studies of cellular ex-vivo experiments in patients support the liberal use of eicosapentaenoic acid and docosahexaenoic acid in the setting of trauma, surgery, and intensive care.