Atkins Diet Research Articles

Application and Effectiveness of Dietary Therapies for Pediatric Migraine

Migraine is a representative type of primary headache and a common chronic neurological disease that accounts for a large proportion of headaches in children, adolescents, and adults. Unlike migraine in adulthood, pediatric migraine occurs when brain development is not yet complete. This characteristic may require a new perspective for the treatment and management of pediatric migraine. Dietary therapies, mainly the ketogenic diet and its variants, can have positive effects on pediatric migraine. Several recent studies have revealed that dietary therapies, such as the classic ketogenic diet, modified Atkins diet, and low glycemic index diet, improve various neurological diseases by improving dysbiosis of microbiota, reducing proinflammatory cytokines, and increasing mitochondrial function. Nonetheless, the mechanism through which active dietary therapy affects pediatric migraine requires further research. To achieve this, an important role is played by the neuro-nutritional team, which can develop and manage tolerable diets for pediatric migraine patients through mutual collaboration among pediatric neurologists, nurses, and nutritionists.

Ketogenic Diet in the Treatment of Epilepsy.

Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.

Ketogenic Diet Interventions in Inborn Errors of Metabolism: A Review Article

Objective: The ketogenic diet, which has been used in the treatment of epilepsy since the 1920s, is a diet containing high fat, sufficient protein, and low carbohydrate. The ketogenic diet mimics the metabolic effects of fasting by shifting metabolism towards fat utilization. The ketogenic diet, which has different variants, such as the classical ketogenic diet, modified Atkins diet, and medium-chain triglyceride diet, is used in inborn errors of metabolism to target the underlying metabolic state by bypassing the damaged metabolic pathway or to treat the clinical symptoms of inborn errors of metabolism, such as epileptic seizures. In this review, we assessed the evidence for ketogenic diet interventions in the treatment of inborn errors of metabolism.
 Methods: The Google Scholar search engine, PubMed, Scopus, and Science Direct databases were used to find studies on the use of ketogenic diet interventions in the treatment of inborn errors of metabolism.
 Results: The beneficial effects of different variants of the ketogenic diet on glucose transport type 1 deficiency syndrome and pyruvate dehydrogenase complex deficiency have long been recognized. There are also favorable data on its use in myopathic glycogen storage diseases, mitochondrial diseases, and nonketotic hyperglycinemia accompanied by epilepsy.
 Conclusion: The evidence is mostly based on individual case reports, case series, and clinical trials with small sample sizes and is insufficient to make recommendations.

A randomized feasibility trial of the modified Atkins diet in older adults with mild cognitive impairment due to Alzheimer's disease.

Alzheimer's disease (AD) is increasing in prevalence, but effective treatments for its cognitive impairment remain severely limited. This study investigates the impact of ketone body production through dietary manipulation on memory in persons with mild cognitive impairment due to early AD and explores potential mechanisms of action. We conducted a 12-week, parallel-group, controlled feasibility trial of a ketogenic diet, the modified Atkins diet (MAD), compared to a control diet in patients with cognitive impairments attributed to AD. We administered neuropsychological assessments, including memory tests, and collected blood samples at baseline and after 12 weeks of intervention. We performed untargeted lipidomic and targeted metabolomic analyses on plasma samples to detect changes over time. A total of 839 individuals were screened to yield 38 randomized participants, with 20 assigned to receive MAD and 18 assigned to receive a control diet. Due to attrition, only 13 in the MAD arm and nine in the control arm were assessed for the primary endpoint, with two participants meeting ketosis levels used to define MAD adherence criteria. The average change from baseline in the Memory Composite Score was 1.37 (95% CI: -0.87, 4.90) points higher in the MAD group compared to the control group. The effect size of the intervention on baseline MAD change was moderate (Cohen's D = 0.57, 95% CI: -0.67, 1.33). In the 15 participants (nine MAD, six control) assessed for lipidomic and metabolomic-lipidomics and metabolomics, 13 metabolites and 10 lipids showed significant changes from baseline to 12 weeks, including triacylglycerols (TAGs, 50:5, 52:5, and 52:6), sphingomyelins (SM, 44:3, 46:0, 46:3, and 48:1), acetoacetate, fatty acylcarnitines, glycerol-3-phosphate, and hydroxy fatty acids. Attrition was greatest between baseline and week 6. All participants retained at week 6 completed the study. Despite low rates of adherence by criteria defined a priori, lipidomic and metabolomic analyses indicate significant changes from baseline in circulating lipids and metabolites between MAD and control participants at 12-week postrandomization, and MAD participants showed greater, albeit nonsignificant, improvement in memory.

Efficacy and cognitive impact of modified Atkins diet in adults with drug-resistant epilepsy

This study aims to explore the efficacy and cognitive impact of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy, as well as to analyze changes in epileptiform activity during ketogenic diet (KD) intervention. We performed a prospective, open-label study with patients aged 16 – 60 years who met the International League Against Epilepsy (ILAE) criteria for drug-resistant epilepsy. Sixteen patients were enrolled in this study, and baseline clinical and electroencephalography (EEG) characteristics, along with neuropsychological tests, were collected before and after 3 months of KD. Patients were divided into responders (≥50% seizure reduction) and non-responders (<50% seizure reduction) according to the clinical efficacy of the KD. Results indicate that 37.5% of patients reported a ≥50% seizure reduction after 3 months. In terms of safety, 37.5% of patients reported adverse effects, including constipation, abdominal pain, and nausea. In addition, a statistically significant increase in the level of total cholesterol was observed (P = 0.037) after diet treatment. Regarding cognitive impact, there was a significant improvement in auditory verbal learning test (AVLT) instant recall scale scores (P = 0.017). In terms of EEG characteristics, MAD significantly reduces interictal epileptic discharge (IED) index in non-rapid eye movement 2 (NREM2) after 3 months. No clinical predictors or EEG characteristics of MAD efficacy were identified. In conclusion, MAD can be safely and effectively practiced by adults with drug-resistant epilepsy. KD treatment has a significant impact on AVLT instant recall and can reduce the IED index in NREM2.

Estimating milk production and energy-use efficiency of pasture-grazed Holstein and Jersey cows using mathematical models

The efficiency of feed use for milk production is critical for sustainable and profitable pasture-based dairy systems. The aim of this study was to estimate milk production and energy-use efficiencies of pasture-grazed Holstein and Jersey cows. Lactation records of 122 Holstein and 99 Jersey cows varying from parities 1 to 6 that were managed under similar feeding and environmental conditions were collected from 2005 to 2014. Feed intake and nutrient requirements of the cows were calculated using the National Research Council and the Cornell Net Carbohydrate and Protein System equations. Holsteins had a higher milk yield/kg dry matter intake (1.36±0.01 vs. 1.27±0.01 kg), whereas Jerseys had higher efficiencies in milk fat (52.4±0.3 vs. 58.4±0.4 g), milk protein (42.7±0.3 vs. 45.1±0.3 g), and energy-corrected milk (1.30±0.01 vs. 1.36±0.01 kg) per kg dry matter intake. Jersey cows also had a higher dry matter intake/kg body weight (3.13±0.02 vs. 3.51±0.02%). During transition and early lactation stages, Holstein and Jersey cows were in negative energy balance for 102.4±2.3 vs. 74.2±2.3 days, with the lowest energy reserves (-53.9 MJ vs. -39.7 MJ) reached at 22.3±0.9 vs. 24.6±0.9 days post-calving, respectively. Compared to Holsteins, Jersey cows used proportionally less net energy intake to produce 100 g milk fat (13.7±0.10 vs. 12.5±0.10), 100 g milk protein (16.7±0.14 vs.16.2±0.15) and a 1-kg energy-corrected milk (5.52±0.04 vs. 5.35±0.04), making them a better breed for pasture-based dairy systems as they possess more production and feed-use efficiency traits, which are desirable in pasture-based production systems.

The impact of ketogenic diet on drug-resistant epilepsy in children: A comprehensive review and meta-analysis.

The ketogenic diet (KD), characterized by high-fat and low-carbohydrate intake, is currently gaining widespread popularity as a treatment for drug-resistant epilepsy (DRE). In addition to the traditional ketogenic diet, several variants have been introduced to enhance compliance and flexibility, such as the modified Atkins diet (MAD) and the low glycemic index diet (LGID). These adaptations aim to provide patients with more manageable and sustainable options while harnessing the potential therapeutic benefits of DRE. The objective of this study is to evaluate the efficacy and safety of the KD in pediatric patients who exhibit DRE. In this study, we conducted a thorough review of existing literature by searching Cochrane, Embase, Medline, and PubMed. Our approach involved predefined criteria for data extraction and the assessment of study quality. Eleven RCTs with 788 participants were included in this study. The pooled effect estimates revealed a significant association between dietary interventions and seizure frequency reduction of > 50% (OR 6.68, 96% CI 3.52, 12.67) and > 90% (OR 4.37, 95% CI 2.04, 9.37). Dietary interventions also increased the odds of achieving seizure freedom (OR 4.13, 95% CI 1.61, 10.60). The common adverse effects included constipation (39.07%) and vomiting (10%). In conclusion, dietary interventions, notably the KD, hold promise for pediatric DRE, reducing seizures and achieving freedom. These non-pharmacological options improve the quality of life of non-responsive and non-surgical patients. The KD has emerged as a potential therapeutic approach. Further research is needed to address the limitations and investigate their long-term effects.

Protein and Carbohydrate Fractionation to Evaluate Perennial Ryegrass (Lolium perenne L.) Accessions

Precise information about carbohydrates and proteins in relation to their utilization in the rumen is useful for the breeding purposes of perennial ryegrass cultivars used for animal nutrition. The objective of the current study was to evaluate 20 diploid perennial ryegrass accessions from the intermediary heading stage. The ruminal kinetics of different carbohydrate and protein fractions of grasses and legumes are important for forage breeding programs. The Cornell Net Carbohydrate and Protein System (CNCPS) was used to provide such information. Accession-based variation can be observed after considering dynamic degradation processes. Variation among the 20 accessions was observed. Ruminally digested (RDC) and undigested (UDC) carbohydrate and ruminally degraded (RDP) and undegraded (UDP) protein contents, total carbohydrate and total protein contents, and carbohydrate and protein fractions for the first cut and annual averages show significant differences. Although the variation was smaller for the protein fractions, the calculated usable protein content (uCP, sum of UDP and amount of synthesized microbial protein in the rumen) in the small intestine is mainly influenced by decreasing the neutral detergent fiber (NDF) and increasing the sugar content among cultivars. Carbohydrate and protein fractionation is suitable for characterizing perennial grass accessions as it uses parameters relevant to ruminant nutrition, allowing a step forward in forage plant breeding for forage quality. To conclude, using parameters related to ruminal degradation kinetics should favor the selection of accessions with higher amounts of ruminally digested carbohydrates (RDC). The selection of accessions based on protein quality (proportion of UDP) is less favorable for achieving a higher usable protein content.

Effect of growing regions on morphological characteristics, protein subfractions, rumen degradation and molecular structures of various whole-plant silage corn cultivars.

Little information exists on the variation in morphological characteristics, nutritional value, ruminal degradability, and molecular structural makeup of diverse whole-plant silage corn (WPSC) cultivars among different growing regions. This study investigated the between-regions (Beijing, Urumchi, Cangzhou, Liaoyuan, Tianjin) discrepancies in five widely used WPSC cultivars in China (FKBN, YQ889, YQ23, DK301 and ZD958), in terms of 1) morphological characteristics; 2) crude protein (CP) chemical profile; 3) Cornell Net Carbohydrate and Protein System (CNCPS) CP subfractions; 4) in situ CP degradation kinetics; and 5) CP molecular structures. Our results revealed significant growing region and WPSC cultivar interaction for all estimated morphological characteristics (P < 0.001), CP chemical profile (P < 0.001), CNCPS subfractions (P < 0.001) and CP molecular structural features (P < 0.05). Except ear weight (P = 0.18), all measured morphological characteristics varied among different growing regions (P < 0.001). Besides, WPSC cultivars planted in different areas had remarkably different CP chemical profiles and CNCPS subfractions (P < 0.001). All spectral parameters of protein primary structure of WPSC differed (P < 0.05) due to the growing regions, except amide II area (P = 0.28). Finally, the area ratio of amide I to II was negatively correlated with the contents of soluble CP (δ = -0.66; P = 0.002), CP (δ = -0.61; P = 0.006), non-protein nitrogen (δ = -0.56; P = 0.004) and acid detergent insoluble CP (δ = -0.43; P = 0.008), in conjunction with a positive correlation with moderately degradable CP (PB1; δ = 0.58; P = 0.01). In conclusion, the cultivar of DK301 exhibited high and stable CP content. The WPSC planted in Beijing showed high CP, SCP and NPN. The low rumen degradable protein of WPSC was observed in Urumchi. Meanwhile, above changes in protein profiles and digestibility were strongly connected with the ratio of amide I and amide II.

Hypocarnitinemia and its effect on seizure control in adult patients with intractable epilepsy on the modified Atkins diet.

Previous studies have demonstrated the safety and efficacy of the modified Atkins diet (MAD) in attenuating seizures in patients with intractable epilepsy. MAD works by achieving ketosis, which is heavily dependent on the metabolic compound, carnitine, to facilitate the transport of long-chain fatty acids across the mitochondria for beta-oxidation. The effect of carnitine on ketogenic diet therapy is not well-defined in the current literature. Thus, the purpose of our study is to investigate the effects of hypocarnitinemia on the efficacy of MAD. A retrospective chart review was conducted, and 58 adults with epilepsy undergoing MAD were evaluated. Generalized linear mixed effects models were used to compare the low carnitine status with normal carnitine group in patient measures of body mass index, seizure frequency and severity, number of anti-seizure medications, beta-hydroxybutyrate, triglyceride, and carnitine levels across baseline, 3-9-month follow-up (timepoint 1), 1-2-year follow-up (timepoint 2), and 2+ year follow-up (timepoint 3). Our study revealed that 38.3% of adult patients with epilepsy following MAD experienced low free carnitine at some point through the course of diet therapy. Patients with hypocarnitinemia at timepoint 2 showed a significant percent seizure increase while seizures continued to decrease in the normal carnitine group. Fasting triglyceride levels at timepoint 1 were significantly increased in the low carnitine group compared to normal carnitine group. Change in BHB, BMI, seizure severity, and number of ASMs showcased no significant differences between the low and normal carnitine groups. It may be important for clinicians to monitor for hypocarnitinemia in adults on MAD and provide carnitine supplementation when low. Further investigations into carnitine and MAD may inform clinical decisions on carnitine supplementation to maximize the efficacy of MAD therapy.

Bazı popüler diyetlerin besin ögesi içeriklerinin, diyet antioksidan kapasitelerinin, diyet kalitelerinin ve diyet inflamatuar yükünün incelenmesi

This study aimed to examine some popular diets' nutrient content, dietary antioxidant capacity, diet quality, and dietary inflammatory load. Materials and Method: Literature was reviewed to identify popular diets, and Atkins, vegan, Zone, Dukan, Mediterranean, alkaline, ketogenic, and Paleo diets were included in the study. Nutrient contents, antioxidant capacity, and oxygen radical absorbance capacity (ORAC) values of popular diets were determined using the Ebispro for Windows (BeBIS) program. Diet Quality Index-I (DQI-I) and Dietary Inflammatory Index were calculated. Results: When the antioxidant amounts of all dietary models were compared, the diet with the highest antioxidant content was the Paleo diet (6.0 mmol), and the lowest was the classic ketogenic diet (1.9 mmol). When the ORAC values of the dietary patterns were compared, the diet with the highest antioxidant capacity was the Paleo diet (23670), and the diet with the lowest antioxidant capacity was the Dukan cruise diet (1828). The diet with the lowest DII score was the vegan diet (-1.5), and the diet with the highest DII score was the classic ketogenic diet (5.9). According to the DII scores, vegan, Dukan, and Mediterranean diets have anti-inflammatory properties. Vegan diet had the highest DQI-I score (74). Zone (73) and Mediterranean (68) had the highest scoring diets. The diets with the lowest DQI-I scores were the Dukan (attack phase) (43) and the classic ketogenic diet (46). Conclusion: These findings provide valuable information on the nutritional adequacy of popular diets. Plant-based and balanced diets have better quality and nutrient profiles than low-carbohydrate diets.

Nutrient analysis of three low-carbohydrate diets differing in carbohydrate content.

Low-carbohydrate diets are increasing in popularity. Despite clinical evidence demonstrating their safety and efficacy, concerns regarding the nutrient adequacy of low-carbohydrate diets persist. The aims of this study were to assess the nutrient adequacy of three 7-day meal plans that delivered 20 (VLCD20), 40 (VLCD40), and 100 (LCD100) grams of net carbohydrate per day respectively. Nutrient analyses were conducted using USDA Food Data Central. All three low-carbohydrate meal plans exceeded recommendations for vitamins A, C, D, E, K, thiamin, riboflavin, niacin, B6, folate and B12 in males and females 31-70 years and exceeded calcium recommendations for adults 31-50 years but remained below the Tolerable Upper Intake Level. VLCD40 and LCD100 met or exceeded fiber recommendations for females ages 31-70 years and were adequate for males 51-70 years. None of the meal plans contributed meaningful amounts of added sugar. The plans exceeded the Recommended Dietary Allowance for protein for adults ages 31-70 years of age but were within the Acceptable Macronutrient Distribution Range of 10-35% of energy. The plans slightly exceeded recommendations for saturated fat and sodium but were lower in these nutrients than the average American diet and had more favorable omega-6 to omega-3 and sodium to potassium ratios than is typical. All three meals plans met or exceeded the Estimated Average Requirement for micronutrients in females ages 31-50 years, the population group most likely to consume low-carbohydrate diets. Well-constructed low-carbohydrate meal plans can be nutritionally adequate in adults.

The Effectiveness of Modified Atkins Ketogenic Diet on Children with Intractable Epilepsy: A Pilot Study from Indonesia.

The ketogenic diet has recently been explored as a potential treatment approach for intractable epilepsy in children and has been applied in various parts of the world. The ketogenic diet is also effective for the treatment of mood disorders, especially for adolescent and young adults with epilepsy. The Modified Atkins Diet (MAD) is the less restrictive type of ketogenic diet with similar principles as the classic type. However, no study has been conducted to evaluate the use of MAD in children with severe epilepsy in Indonesia. This study aims to assess the effectiveness, tolerance, compliance, and the adverse effects of MAD in children with intractable epilepsy during a 6-month monitoring period. This is a pilot experimental study involving children aged 2-18 years old with intractable epilepsy at the Pediatric Neurology and the Pediatric Nutrition & Metabolic Diseases Clinics at the Dr. Cipto Mangunkusumo Hospital Jakarta between November 2021 and June 2022. A total of 31 subjects met the inclusion criteria and received the MAD in the first month, followed by 13 (41.9%) subjects in the third month, and 9 (29%) subjects in the sixth month. The MAD reduced the seizure frequency by 50% (p = 0.144), 62% (p = 0.221), and 83.3% (p = 0.028) in the first, third, and sixth months, respectively. The most frequent adverse effects are vomiting and diarrhea. Noncompliance was observed in 18 (58.1%) subjects. A sample of the MAD food menu guidebook was developed to make it easier for parents to adhere to the diet. The MAD reduces the mean seizure frequency in children with intractable epilepsy in the first, third, and sixth months, with a statistical significance in the sixth month. A further randomized, controlled, and multicenter clinical trial with a larger sample size and longer observation period is required. This trial is registered with Protocol ID 20-10-1323.

Efficacy and safety of modified Atkins diet therapy for drug‐resistant epilepsy in children and adults: A systematic review and meta‐analysis

AbstractIntroductionDiet‐based treatments have been proposed for drug‐resistant epilepsy (DRE), and the Modified Atkins Diet (MAD) is an alternative. This study aimed to assess the efficacy and safety of MAD as an adjunctive therapy for reducing seizures in patients with drug‐resistant epilepsy.MethodsA literature search was done on six databases. Randomized controlled trial (RCT) studies were included, comparing DRE patients of all ages on standard antiseizure medications (ASD) who received MAD compared to no‐dietary or other dietary interventions. The outcomes are the seizure frequency reduction and the adverse events. Cochrane risk‐of‐bias tool and GRADE were used to assess study quality and the overall certainty of evidence. The effect size of the efficacy of MAD was computed as risk ratio (95% CI). Subgroup analysis based on each type of comparator was done.ResultsTen RCT studies (905 participants) were included, comparing MAD to no dietary intervention, ketogenic diet (KD), and low glycemic index treatment (LGIT). Overall, MAD is constantly and significantly more efficacious than no dietary intervention in reducing seizures ≥50% (RR 7.90, 95% CI 4.59–13.62), ≥90% (RR 4.61, 95% CI 2.05–10.36), and inducing complete seizure‐free (RR 7.79, 95% 2.61–23.22) with high certainty. Other dietary therapies and MAD did not differ significantly from one another in terms of efficacy. The risk of adverse events in MAD is insignificantly higher than in others (RR 1.19, 95% 0.92–1.55).ConclusionThe Modified Atkins Diet has better seizure reduction than no diet intervention but is comparable to other dietary interventions with a negligible increased risk of adverse events.

Optimizing corn silage quality during hot summer conditions of the tropics: investigating the effect of additives on in-silo fermentation characteristics, nutrient profiles, digestibility and post-ensiling stability

Corn crop grown and ensiled at high temperature have lower water soluble carbohydrates (WSC), epiphytic lactic acid bacteria (LAB) population, lactic acid concentration, fermentation quality and aerobic stability. This study systematically investigated the effects of heterofermentative LAB (hetLAB), homofermentative LAB (homLAB), molasses and their mixture (MIX) on in-silo fermentation characteristics, chemical profiles, Cornell Net Carbohydrate and Protein System (CNCPS) carbohydrate subfractions, in vitro digestibility (DMD), microbial count, and post-ensiling aerobic stability of whole crop corn silage during hot summer (30 to 45°C) condition. Corn hybrids (P30K08 and DK6789) were ensiled at targeted dry matter (DM) of 330 g/kg for 0, 3, 7, 21, and 150 days in 3 L silos, without additive (CCS) or treated with hetLAB (4×106 cfu/g Lactobacillus buchneri), homLAB (1×106 cfu/g of L. plantarum), molasses (3% of fresh forage) or MIX (half of individual doses of homLAB, hetLAB and molasses) additives. The CCS, homLAB, hetLAB, molasses, or MIX treated chopped material of each hybrid were ensiled in 16 replicate silos at a density of 260 kg of DM/m3. Compared to CCS, the additives significantly improved silage nutritional and fermentation quality, DM digestibility (in vitro), count of LAB, DM recovery and aerobic stability, and decreased counts of yeast and mold. Among the inoculants, the homLAB and MIX inoculated silages had greatest improvement in fermentation quality and nutritional value. The homLAB produced corn silage with the highest (P &amp;lt; 0.05) content of lactic acid, and soluble carbohydrates, and lowest contents of acetic acid, NH3-N and pH, demonstrating desirable and restricted in silo fermentation. On the other hand, the hetLAB inoculated silages had the greatest (P &amp;lt; 0.05) value of acetic acids, highlighting greater aerobic stability. Interestingly, the MIX silages followed the hetLAB in acetic acid value and homLAB in lactic acid value. Notably, without additive stable pH was not achieved during 21 days, with application of molasses, hetLAB and the MIX inoculants stable pH was achieved during 7 days, and with homLAB stable pH was achieved during the first 3 days of ensiling. The greatest numbers of viable LAB were recorded in homLAB (8.13 log cfu/g) and MIX (7.89 log cfu/g) inoculated silages, while the lowest for CCS (6.29 log cfu/g). The lowest yeast (1.48 log cfu/g) and mold (0.22 log cfu/g) were recorded for hetLAB inoculated silage. The greatest (P &amp;lt; 0.05) DM recovery was recorded for hetLAB (97.3%) and MIX (96.9%), and the lowest for the control silage (92.9%). All additives significantly improved the aerobic stability of corn silage, and the greatest value of &amp;gt;72 h was recorded for hetLAB and MIX inoculats, and the lowest for CSC (25 h). In conclusion, additives application can improve fermentation quality, nutritional value, DM recovery and aerobic stability of whole crop corn silage under hot summer conditions of the tropics. The MIX inoculant showed potential to improve in-silo fermentation, and aerobic stability at the same time, however, further investigation are required, particularly with respect of dose rate.

Predictors of elevations in fasting lipid levels in adults with epilepsy on a modified Atkins diet

BackgroundKetogenic diet therapies can improve seizure control in patients with drug-resistant epilepsy (DRE). The current study investigated whether dietary fat composition is associated with elevations in serum lipid levels in adults with epilepsy who began a modified Atkins diet (MAD). MethodsAdults with DRE were instructed to follow the MAD. Food records collected at baseline and follow-up were analyzed to extract median daily macro- and micronutrient composition. Total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, triglyceride (TG), high-density lipoprotein (HDL) cholesterol, non-HDL and TC/HDL ratio were measured at baseline and follow-up. ResultsStudy participants initiating MAD showed higher fat intake at 1 month (p<0.001) and 2 months (p<0.001) and lower carbohydrate intake at 1 month (p<0.001) and 2 months (p<0.001) compared to baseline. Study participants also showed higher intake of cholesterol (p<0.001), saturated fatty acid (p<0.001) and monounsaturated fatty acid (p<0.001) over time. Following MAD initiation, study participants showed significant increases in levels of TC (p = 0.007), LDL (p<0.001), and non-HDL (p = 0.009) over time. Dietary intake variables, including cholesterol and fat subtypes, were significantly associated with difference in 1 month TC and LDL levels from baseline but not absolute 1 month lipid values. In a sub-analysis, participants with baseline dyslipidemia showed smaller changes in lipid values during diet use. ConclusionsAdults with DRE starting MAD increased fat intake, particularly saturated and monounsaturated fat subtypes, and reduced carbohydrate intake. Changes in TC and LDL levels 1 month after MAD initiation are associated with dietary intake of cholesterol and fat.

Gut microbiota response to in vitro transit time variation is mediated by microbial growth rates, nutrient use efficiency and adaptation to in vivo transit time

BackgroundTransit time is an important modulator of the human gut microbiome. The inability to modify transit time as the sole variable hampers mechanistic in vivo microbiome research. We singled out gut transit time in an unprecedented in vitro approach by subjecting faecal microbial communities from six individuals with either short, medium or long in vivo transit times, to three different colonic transit times of 21, 32 and 63 h in the validated human gut in vitro model, SHIME.ResultsTransit time was identified as the single most important driver of microbial cell concentrations (52%), metabolic activity (45%) and quantitative (24%) and proportional (22%) community composition. Deceleration of transit was characterised by a significant decrease of specific Bifidobacterium and Veillonella spp. and increase of specific fibre degrading bacteria and nutrient specialists, such as Bacteroides, Prevotella, Ruminococcus, Bilophila and Akkermansia spp. These microbial communities reached a higher population density and net carbohydrate fermentation, leading to an increased SCFA production at longer transit times. In contrast, the carbohydrate-to-biomass production efficiency was increased at shorter transits, particularly in well-adapted faecal microbiomes from donors with short in vivo transit. Said adaptation was also reflected in the carbohydrate-to-SCFA conversion efficiency which varied with donor, but also colon region and SCFA chain length. A long transit time promoted propionate production, whereas butyrate production and butyrate producers were selectively enriched in the proximal colon at medium transit time.ConclusionMicrobial growth rates and nutrient utilisation efficiency mediate the species-specific gut microbiota response to in vitro transit time variation, which is the main driver of in vitro microbial load, metabolism and community composition. Given the in vivo transit time variation within and between individuals, the personalisation of in vitro transit time based on in vivo data is required to accurately study intra- and inter-individual differences in gut microbiome structure, functionality and interactions with host and environmental modulators.1MQXL3e8MgVLC8CZ9wex6EVideo

Association of dietary adherence and dietary quality with weight loss success among those following low-carbohydrate and low-fat diets: a secondary analysis of the DIETFITS randomized clinical trial

BackgroundEating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets. ObjectiveTo determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet. DesignGenerally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF. ResultsFor HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m2 (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m2 (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup. ConclusionWithin both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss. Clinical Trial Registryclinicaltrials.gov (Identifier: NCT01826591).

In vitro protein fractionation methods for ruminant feeds

Estimating protein fractions and their degradation rate are vital to ensure optimum protein supply and degradation in the digestive system of ruminants. This study investigated the possibility of using the ANKOM gas production system and preserved rumen fluid to estimate the protein fractions and in vitro degradability of protein-rich feeds. Three in vitro methods: (1) gas production method (2) Cornell Net Carbohydrate and Protein System (CNCPS), and (3) the unavailable nitrogen assay of Ross (uNRoss) were used to quantify protein fractions of four feeds (lupin meal, vetch grain, Desmanthus hay, and soybean meal). Rumen fluid mixed with 5% dimethyl sulfoxide and frozen at −20 °C was also compared against fresh rumen fluid in the gas production and uNRoss methods. All three methods ranked the feeds identically in the proportions of available (degradable or ‘a + b’) protein fractions as vetch grain, soybean meal, lupin meal, and Desmanthus hay in decreasing order. The use of fresh rumen fluid produced greater available protein fractions than preserved rumen fluid in all feeds. However, there was no difference between total gas production from lupin meal and vetch grain fermented for 16 h in either rumen fluid source. The in vitro degradable CP (IVDP) was higher for vetch grain (46 and 70%) at the 4th and 8th hours of incubation than other feeds, whereas soybean meal (85%) exceeded the other feeds after the 16th hour of incubation (P < 0.001). The greatest ammonia-N concentration was from soybean meal (1.27 mg/g) and lupin meal (0.87 mg/g) fermented for four hours using fresh rumen fluid. The proportion of fraction 'b' for soybean (82.1% CP) and lupin meals (39.4% CP) from the CNCPS method were not different (P = 0.001) from the fraction 'b' estimation of the gas production method for the same feeds (r = 0.99). Regardless of the methods, a greater water-soluble protein fraction was found from vetch grain (39.6–46.6% CP), and the proportion of fraction ‘c’ or unavailable protein in Desmanthus hay (39.1–41.5% CP) exceeded other substrates (P < 0.001). The strong positive correlation between fractions across different methods and identical ranking of feeds suggests the possibility of using ANKOM gas production apparatus for protein fractionation.

Nutritional treatment with the ketogenic diet in children with refractory epilepsy: a narrative review

The two mainstays of therapy for refractory epilepsy are medication and surgery. Child behavioral and cognitive aspects of epilepsy can be improved by using a specialized dietary regimen such as the ketogenic diet (KD). The purpose of this review is to expand our understanding of KD as a nutritional therapy for children with refractory epilepsy and to provide insight into the physiological aspects of its efficacy as an alternative to anti-seizure medication. Either directly or indirectly, ketones, glucose restriction, and polyunsaturated fatty acids regulate epileptic seizures. For KD to be effective, all three of these components must be present, even though the exact mechanism is unknown. Increasing gamma-aminobutyric acid, mitochondrial biogenesis, and oxidative phosphorylation levels can also serve as a means of promoting stable synaptic function while also decreasing neural activity and excitability. Most side effects of KD are caused by mild metabolic abnormalities such as acidosis, hyperuricemia, hypercholesterolemia, hypocalcemia, and hypomagnesemia. Since medium-chain triglycerides (MCTs) produce more ketones per calorie than long-chain triglycerides, individuals who consume MCTs can consume more carbohydrates and protein. This review demonstrated that KD therapy led to positive outcomes for patients with refractory epilepsy. Further study is needed to evaluate whether less restrictive and easier-to-follow diets, such as the modified Atkins diet and MCT diets, have a similar effect on seizure treatment as the standard KD.