Dietary Protein Intake Research Articles

A transmural intensive dietetic care-pathway for optimal protein intake and physical functioning in malnourished older patients: A protocol for the randomised ProIntens trial

Background Disease-related malnutrition is common among hospitalised and recently discharged older adults. Consequences of malnutrition are physical limitations, negative health outcomes, decreased quality of life and increased healthcare costs. Dietetic care can counteract the effects of malnutrition by increasing protein and energy intake. The ProIntens study aims to evaluate the impact of an intensive dietetic care pathway on dietary protein intake and physical functioning in older adults during hospitalisation and after discharge. Process and economic evaluations will be performed. Methods The ProIntens study is a multicentre two-armed parallel individually randomised trial in five hospitals in the Amsterdam region. In total, 250 hospitalised older adults, aged ≥55 years and at risk of malnutrition will be randomised to receive regular care (control) or intensive dietetic care (intervention). The intervention consists of intensive personalised care which involves transmural guidance by trained dietitians, supportive materials on protein intake in a social context and a mobilization program during hospitalisation until three months after discharge. Controls will receive regular care. The primary outcome will be the between-groups difference in the mean change on the Short Physical Performance Battery three months after discharge. Secondary outcomes include dietary protein intake, body composition, physical activity, activities of daily living, quality of life and healthcare costs. Discussion The ProIntens trial will study the effects and costs of an intensive dietetic treatment on recovery outcomes in hospitalised older adults at risk of malnutrition. The intervention will result in practical tools for care professionals which aim to improve malnutrition treatment for older patients. Trial registration Landelijk Trial Register (NL8041; NL72069.029.19); registered 2019-09-23; covering all WHO Trial Registration Data Set items.

Investigating how eating behavior shapes mental health: A cross-sectional study.

This study aimed to examine the relationship between eating behavior, nutritional status and mental health. It is a cross-sectional study conducted on a sample of 360 healthy individuals aged 19-64 years. The General Health Questionnaire (GHQ-12) was used to evaluate mental health and the Three-Factor Eating Scale (TFEQ-R21) was used to assess eating behavior. The Healthy Eating Index-2015 (HEI-2015) score was calculated from participants' 24 h food recalls as an indicator of diet quality. The mean age of the participants was 26.0 ± 8.40 years, and 50.6 % were female. Multivariate logistic regression model was performed. A statistically significant relationship was found between the participants' GHQ-12 score and both their emotional eating and uncontrolled eating scores (p < 0.001 for each). It was determined that individuals who had high levels of emotional eating and uncontrolled eating behaviors, along with higher dietary protein and lipid intake, and lower intake of long-chain fatty acids, were at a higher risk of mental health deterioration, according to the established model (R2 = 0.214). Dietary energy and nutrient intakes such as niacin, vitamin B12, folic acid, phosphorus, iron, sodium and carotene, as well as diet quality and BMI were not associated with mental health according to the model in this study. Eating behavior is associated with mental well-being, and nutritional status may be one of the underlying factors contributing to this association.

Novel Insights Into Gyrate Atrophy of the Choroid and Retina (GACR): A Cohort Study.

Gyrate atrophy of the choroid and retina (GACR, OMIM #258870) is a rare inherited metabolic disorder characterized by progressive chorioretinal degeneration and hyperornithinemia. Current therapeutic modalities potentially slow disease progression but are not successful in preventing blindness. To allow for trial development, increased knowledge of the clinical phenotype and current therapeutic outcomes is required. In this study, we analyzed 27 patients with GACR. The median age at inclusion was 24 years (range 8-58), with a median age at diagnosis of 14 years (range 0-42). Symptoms began at a mean age of 9 years (range 0-21). Mixed-models analysis showed a significant association between dietary natural protein intake and plasma ornithine levels. Ornithine increased significantly with age, independent of dietary natural protein intake. We found no statistically significant association between ornithine levels and best-corrected visual acuity over time. Patients who started a natural protein-restricted diet below 10 years of age had better VF outcomes compared to patients that started at a later age. MR spectroscopy was used to asses cerebral creatine deficiency, which was present in 15/20 patients, of whom 10 were supplemented with creatine at the time. Finally, using the Michigan Retinal Degeneration Questionnaire, we provided a first insight into the vision-related disability reported by patients with GACR and showed that higher foveal sensitivity was associated with less perceived disability. To conclude, this study provides insights into the phenotype, genotype, biochemistry, and treatment effects of GACR, which can be used for care pathways and clinical trial design.

Association of protein intake with discordance between cystatin C- and creatinine-based eGFR in community-dwelling Japanese adults.

Recent studies have reported the prognostic implications of the discordance between creatinine-based and cystatin C-based estimated glomerular filtration rates (eGFRcr and eGFRcys, respectively); however, the associations of protein intake with the eGFR discordance have not been investigated. The present study investigated whether protein intake was associated with the discordance between eGFRcr and eGFRcys. We cross-sectionally analyzed data from a Japanese community-based cohort including 6,143 participants (50.7% women; age range, 40-97 years). Protein intake was estimated by food groups derived from a validated food frequency questionnaire. As a measure of discordance, we modeled the ratio of eGFRcys and eGFRcr (eGFRcys divided by eGFRcr) continuously in multivariable linear regression models and categorically (<0.8, 0.8-1.1, and ≥1.2) in multinomial logistic regression models. We analyzed men and women separately given their distinct dietary patterns. The mean eGFR ratio was 1.15 in men and 1.19 in women. In multivariable linear regression analysis, total protein was positively associated with the eGFR ratio in men (regression coefficient, 0.005 [95% CI, 0.003, 0.007]). When animal and plant proteins were analyzed separately, a significant positive association was seen for animal protein only in men (0.005 [0.003, 0.007]). The results were similar when we modeled protein intake categorically by multinomial logistic regression. This study suggests intake of dietary protein, especially animal protein in men, as a determinant of eGFR discordance. Future studies exploring eGFR discordance and health outcomes should consider simultaneously assessing dietary protein intake.

The relationship between temperament with nutritional status and anthropometric measurements in adult individuals.

Interest in studies examining the effect of temperament types on nutrition has recently increased. The aim of this study was to evaluate the relationship between nine types of temperament, anthropometric measurements, and nutrition in adults. This study was conducted on 1317 individuals aged between 18 and 55 years. Descriptive information, dietary habits and anthropometric measurements of the participants were questioned. The Nine Types of Temperament Scale was administered to the individuals and food consumption records were obtained with a 24-hour retrospective reminder method. Type 2 scores of obese participants were higher than those of underweight and normal body weight; Type 8 scores of overweight participants were higher than those of normal body weight. Daily dietary intake of protein, riboflavin, folate, vitamins K, C, calcium, iron, and cholesterol were negatively associated with Type 1 score; protein, magnesium, iron, zinc intake, and water consumption were negatively associated with Type 2 score. Type 3 score was negatively associated with dietary CHO (%), dietary magnesium, iron, and zinc intake and positively associated with water consumption. The results of the study indicate significant relationships between temperament types, dietary habits, and anthropometric measures. In this context, considering temperament types when planning dietary patterns of individuals may be a new approach.

Unraveling the complexity: A rare case of urea cycle defect and its clinical implications

Background: Argininosuccinate lyase deficiency is a rare urea cycle disorder that leads to severe hyperammonemia, particularly in neonates. Early identification and intervention are crucial to prevent neurological damage and improve long-term outcomes. Case Presentation: This case presentation describes the clinical course of an 18-year-old male from South Africa, who was referred to the Adult Endocrine Unit for further management after being diagnosed with life-threatening hyperammonemia in the neonatal period. Presenting on the fourth day of life, the patient was ventilator-dependent and required peritoneal dialysis. Analytical results obtained during the hyperammonemia crisis showed considerable perturbements of metabolic parameters; potassium was 6.6 mmol/L, urea was &lt;1 mmol/L and the peak ammonia level was 2590 μmol/L. The change in amino acid level showed that glutamine, alanine, and argininosuccinic acid were increased. Molecular genetic testing finally led to the diagnosis of argininosuccinate lyase deficiency, a urea cycle disorder. Mostly, dietary protein intake was restricted to about 1 g/kg/day, and the use of ammonia precursors such as sodium phenylbutyrate and sodium benzoate, L-arginine, and branched-chain amino acid supplementation. The patient was treated and developed normally up to puberty, but he had mild neurocognitive delay that affected his school attendance in the mainstream schools. He ended up experiencing multiple hyperammonemia crises in his lifespan and the last admission with crisis in September 2024 ammonia increased to 228 umol/L (11-35umol/L), treated with Dextrose 10%infusion and ammonia scavengers, and protein restriction, ammonia dropped to 93 umol/L within 24 hours. Conclusion: This case shows that urea cycle defect requires early diagnosis and continuing treatment to prevent episodes of hyperammonemia crisis. Our patient had normal physical growth but had neurocognitive dysfunction, which is why the management of this rare urea cycle disorder is challenging.

Individual and Joint Associations Between Animal and Plant Protein Intakes with Impaired Fasting Glucose and Type 2 Diabetes in the Framingham Offspring Study.

Given the considerable discrepancy in the literature regarding dietary protein and glucose homeostasis, we examined the prospective association between protein intake (total, animal, plant) and risk of type 2 diabetes mellitus or impaired fasting glucose (IFG). We also examined whether these associations differed by sex, body weight, or other risk factors. We included 1423 subjects, aged ≥ 30 years, in the Framingham Offspring Study cohort. Three-day dietary records at exams 3 and 5 were used to average protein intake and then adjusted for body weight residuals. Cox proportional hazard models were used to estimate hazard ratios (HR), adjusting for anthropometric, demographic, and lifestyle factors over ~16 years of follow-up. Subjects with the highest total protein intakes (≥100 g men; ≥85 g women) had a 31% lower risk of type 2 diabetes/IFG (95% CI: 0.54, 0.87). The highest (vs. lowest) category of intake of animal protein was associated with a 32% lower risk of diabetes/IFG (95% CI: 0.55, 0.83), whereas plant protein was not. Beneficial trends of total protein, especially animal, were stronger for women (HR: 0.61; 95% CI: 0.42, 0.87) than for men (HR: 0.82; 95% CI 0.58, 1.15). Subjects with lower BMI who consumed more protein had the lowest risks of diabetes/IFG. Overall, in this prospective study, higher intake of total dietary protein, including the consumption of animal protein, particularly among individuals with lower BMI and higher physical activity levels, was inversely associated with risk of incident type 2 diabetes and IFG.

The association between animal protein, plant protein, and their substitution with bladder cancer risk: a pooled analysis of 10 cohort studies.

Although total dietary protein intake has been associated with bladder cancer (BC) risk, the effect of the origin (plant or animal) and the substitutions remain to be understood. This study aimed to investigate the effect of total dietary protein, animal-based protein, plant-based protein, and their substitutions with each other on the risk of BC using a pooled analysis of 10 cohort studies. The study was conducted within the "BLadder cancer Epidemiology and Nutritional Determinants" (BLEND) study, including 10 prospective cohort studies from several European countries, the United Kingdom, and the United States. Individual data from 10 prospective cohorts containing 434,412 participants (overall male/female ratio was almost 3:1) with a total of 4,224,643.8 person-years of follow-up was analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) for BC risk for animal and plant-based protein substitutions of 30gram (g) per day (g/day) were estimated by multivariable adjusted HRs using Cox proportional hazards models. During 11.4 years of follow-up, among 434,412 participants (73.28% female), 1,440 new cases of BC were identified. After multivariable adjustment, no association was observed between the intake of total, animal-based protein, and plant-based protein and BC risk. Replacement of every 30g/day of animal-based protein intake by the same amount of plant-based protein intake or vice versa was not associated with the risk of BC. In conclusion, our study found no association between protein intake-whether from animal or plant sources-and the risk of BC. Substituting animal-based protein with plant-based protein, or the reverse, did not influence BC risk. Future studies are required to provide information on the link between animal- and plant-based proteins and BC risk.

Relationship between multi-nutrient intake and bone loss and osteoporosis in U.S. adults: Findings from NHANES.

The relationship between dietary nutrient intake and bone mineral density (BMD) has not been clarified. In the U.S. population, we have demonstrated that dietary intake of multiple nutrients (potassium, magnesium, and sodium) is positively associated with BMD and negatively associated with the prevalence of osteopenia. This study examined whether there is an association between dietary potassium, magnesium, and sodium intake and BMD, osteopenia, and osteoporosis, using data from the National Health and Nutrition Examination Surveys from 2005 to 2010, 2013 to 2014, and 2017 to 2018. We assessed the association of dietary potassium, magnesium, and sodium intake with BMD in 10,355 National Health and Nutrition Examination Survey participants during 2005 to 2010, 2013 to 2014, and 2017 to 2018. BMD of the whole femur was estimated by dual-energy X-ray absorptiometry. We utilized multiple linear regression models to examine the associations of dietary potassium, magnesium, and sodium intake with femoral BMD, osteopenia, and osteoporosis, after adjusting for various confounders. Dietary potassium, magnesium, and sodium intake are positively correlated with femur BMD when corrected for the confounders of age, sex, race/ethnicity, smoking behavior, education level, body mass index, poverty income ratio, serum uric acid, serum cholesterol, potential renal acid load, dietary calcium intake, dietary protein intake, and dietary vitamin D intake. Dietary intake of potassium, magnesium, and sodium was adversely correlated with the development of osteopenia and osteoporosis. Our study showed that intake of dietary nutrients (potassium, magnesium, and sodium) was correlated positively to femur BMD and adversely to osteopenia and osteoporosis in the U.S. population. Further research is needed on the association of dietary elemental intake with BMD.

Digging deep for nutrients and metabolites derived from high dietary protein intake and their potential functions in metabolic health.

Intake of high quantities of dietary proteins sourced from dairy, meat or plants can affect body weight and metabolic health in humans. To improve our understanding of how this may be achieved, we reviewed the data related to the availability of nutrients and metabolites in the faeces, circulation and urine. All protein sources (≥20% by energy) increased faecal levels of branched chain fatty acids and ammonia, and decreased the levels of butyrate. There were metabolites responding to dairy and meat proteins (branch chain amino acids) as well as dairy and plant proteins (p-cresol), which were increased in faecal matter. Specific to dairy protein intake, the faecal levels of acetate, indole and phenol were increased, whereas plant protein intake specifically increased the levels of kynurenine and tyramine. Meat protein intake increased the faecal levels of methionine, cysteine and alanine, and decreased the levels of propionate and acetate. The metabolite profile in the faecal matter following dairy protein intake mirrored availability in circulation or urine. These findings provide an understanding of the contrasting gut versus systemic effects of different dietary proteins, which we know to show different physiological effects. In this regard, we provide directions to determining the mechanisms for the effects of different dietary proteins.

Effects of Nutritional Support with a Leucine-Enriched Essential Amino Acid Supplement on Body Composition, Muscle Strength, and Physical Function in Stroke Patients Undergoing Rehabilitation.

Dietary protein intake can potentially influence renal function. This study aimed to elucidate the association between dietary protein supplementation and a decrease in the estimated glomerular filtration rate (eGFR) in Japanese stroke patients undergoing rehabilitation. From July 2017 to June 2021, 60 patients undergoing post-stroke rehabilitation were randomly assigned to a rehabilitation alone or rehabilitation nutrition group, which received 120 g Reha-Time Jelly® after each session. Both groups were followed up for 3 months. Serum nutritional markers (prealbumin and retinol-binding protein), muscle strength, body composition, renal function markers (eGFR based on creatinine [eGFR-Cr] and cystatin C [eGFR-Cys]), urinary protein-to-creatinine ratio (UPCR), and motor function (walking speed, 2-min walk distance, and chair stand test) were assessed at baseline and post-intervention. Of the 60 participants (mean age: 70.2 ± 10.0 years), 39 were men (65.0%) and 19 (31.7%) had chronic kidney disease. Initial eGFR-Cr and eGFR-Cys values were 70.5 ± 17.2 and 66.6 ± 14.8 mL/min/1.73 m2, respectively. After the intervention, the rehabilitation nutrition group demonstrated a significantly greater increase in body mass index (BMI) and a smaller decrease in bone mineral content than the rehabilitation alone group. However, no significant between-group differences were noted in serum marker levels or motor function, including grip strength and knee extensor strength, on the paralyzed and non-paralyzed sides. The change in chair stand test performance indicated a trend toward improvement in the rehabilitation nutrition group. No significant differences were observed in the changes in renal function. A 3-month nutritional supplementation intervention may help increase BMI, preserve bone mineral content, and support physical activity levels in patients undergoing post-stroke rehabilitation without negatively affecting renal function.

Plasma Metabolite Profiles Between In-Center Daytime Extended-Hours and Conventional Hemodialysis.

Protein-energy wasting, characterized by disordered body protein catabolism resulting from metabolic and nutritional derangements, is associated with adverse clinical outcomes in patients undergoing hemodialysis. Extended-hours hemodialysis (≥6 h per treatment session) offers both enhanced removal of uremic solutes and better fluid management, generally allowing more liberalized dietary protein and calorie intake. This study aimed to evaluate the difference in plasma metabolite profiles among patients receiving in-center daytime extended-hours hemodialysis and those receiving conventional hemodialysis. Pre-dialysis plasma samples were obtained from 188 patients on extended-hours hemodialysis (21.9 h/week) and 286 patients on conventional hemodialysis (12.1 h/week) in Japan in 2020 using capillary electrophoresis-mass spectrometry. Group differences were compared for 117 metabolites using Wilcoxon rank-sum tests with multiple comparisons and partial least squares discriminant analysis. Additionally, propensity score-adjusted multiple regression analyses were performed to evaluate group differences for known uremic toxins, branched-chain amino acids, and lactate-to-pyruvate ratio (a possible surrogate marker of mitochondrial dysfunction). Significant differences were observed in 39 metabolites, largely consistent with the high variable importance for prediction in partial least squares discriminant analysis. Among known uremic toxins, uridine and hypoxanthine levels were significantly higher in the conventional hemodialysis group than in the extended-hours hemodialysis group, whereas trimethylamine N-oxide levels were higher in the extended-hours hemodialysis group than in the conventional hemodialysis group. Patients on extended-hours hemodialysis had higher levels of all branched-chain amino acids and a lower lactate-to-pyruvate ratio than those on conventional hemodialysis (significant difference of -8.6 [95% confidence interval, -9.8 to -7.4]). Extended-hours hemodialysis was associated with a more favorable plasma metabolic and amino acid profile; however, concentrations of most uremic toxins did not significantly differ from those of conventional hemodialysis.

Physical Activity Level and Dietary Intake Associated with Fat-Free Muscle Mass Changes During Intentional Weight Loss in Overweight and Obese Subjects.

The prevalence of obesity and related complications is increasing relentlessly worldwide. The effect of intentional weight loss strategies for obese individuals on fat-free muscle mass (FFMM) and metabolic and general health is not well known. The aim of this research is to measure the effects of dietary intake and physical activity level on FFMM change during intentional weight loss in obese subjects. Nine hundred and sixty-five overweight and obese community free-living subjects had the effects of physical activity level and dietary intake on FFMM change during intentional weight loss assessed in a prospective longitudinal study. Anthropometric, physical activity, dietary intake, inflammatory markers, and oxidative damage were assessed at baseline and follow-up. Validated questionnaires were used to measure dietary intake and physical activity. We compared FFMM loss or gain between subjects stratified by calorie, protein, and fruit and vegetable intake and physical activity levels. The Cox proportional hazards analysis was used to determine the independent effects of dietary intake and physical activity on FFMM changes. A total of 965 subjects [(mean (SD) age 39 ± 12 years, 801 (83%)] females] were assessed at baseline with follow-up for a period of 427 ± 223 days. Using the WHO criteria for body mass index (BMI), 284 (30%) subjects were found to be overweight and 584 (62%) were obese. We found significant correlations between fat-muscle mass ratio (FMR) and inflammatory and oxidative damage markers. After adjusting for important prognostic indicators, age, gender, occupation, physical activity, and fruit and vegetable consumption were found to be significantly associated with FFMM at baseline (p < 0.05). We found no statistically significant difference in dietary protein or amino acids intake in subjects who gained FFMM compared to those who lost FFMM both at baseline and follow-up. By contrast, high consumption of fruits and vegetable and increased calorie intake were associated with increased odds of FFMM gain (p < 0.05). Increased physical activity was independently associated with significant FFMM gain after adjusting for other important indicators ([hazard ratio (95% CI): 0.49 (0.25, 0.97); p = 0.039]. Increased physical activity and high calorie, fruit and vegetable intake are associated with FFMM preservation or gains during intentional weight loss in obese subjects.

Secular trends in dietary energy, carbohydrate, protein and fat intake among Korean children and adolescents.

We aimed to analyse the evolving trends in macronutrient intake and dietary composition among Korean children and adolescents over a 10-year period. We utilised cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) spanning the years 2010-2020. Overall, the study included 11 861 participants aged 6-18 years who completed the 24-h dietary recall survey. Subsequently, we assessed trends in energy consumption and macronutrient intake across population subgroups, including age, sex and obesity status. Survey-weighted linear regression was employed to determine the β coefficient and P-value for trends in dietary nutrient consumption, treating the survey year as a continuous variable. KNHANES from 2010 to 2020. 11 861 children and adolescents aged 6-18 years. Total energy intake significantly decreased across the 10-year survey period, with a corresponding decline in the percentage of energy intake from carbohydrates. Conversely, the proportion of energy intake from fat increased during the same period. Subgroup analysis revealed changes in the composition of energy intake across age, sex and obesity status, with a consistent increase in total fat intake observed across all subgroups. Upon analysing data on dietary fibres, total sugars and fat subtypes intake, we found insufficient dietary fibre intake and increased intake of all fat subtypes. This study underscores the gradually changing dietary intake patterns among Korean children and adolescents. Our findings revealed that these transitions in dietary nutrient consumption may pose potential risks of diet-related diseases in the future.

Impact of resistance training and chicken intake on vascular and muscle health in elderly women.

Resistance training is a well-known exercise therapy for preventing and improving lacks of muscle mass, strength, and quality with advances in age; however, its effects on arterial stiffness are not beneficial. Additionally, a higher intake of protein, which is an effective nutrient for muscle health, results in lower arterial stiffness. Whether the combination of moderate to high-intensity resistance training and high-protein intake would improve muscle mass, strength, and quality and cancel the resistance training-induced increase in arterial stiffness in elderly women remains unclear. Ninety-three elderly women (67.2±5.3years) were randomly divided into four groups; sedentary control (CON), higher dietary animal protein intake (HP), resistance training (RT), and combination of RT and HP (RT+HP) groups. Participants in the RT and RT+HP groups completed 12weeks of resistance training (exercise intensity at 70% of one-repetition maximum (1-RM), three sets with 10 repetitions of leg extension and curls, 3days/week). In addition to the daily diet, the HP and RT+HP groups consumed steamed chicken breast as a high-protein diet. Percent changes in thickness (indices of muscle mass) and echo intensity (index of muscle quality) in the quadriceps muscle, 1-RM of leg extension and curls (index of muscle strength), and circulating C1q levels (a potential biomarker of muscle fibrosis) in the RT and RT+HP groups significantly improved after both RT and RT+HP interventions (P<0.05). Percent changes in carotid-femoral pulse wave velocity (cfPWV) and carotid β-stiffness (indices of arterial stiffness), and circulating angiotensin II (a vasoconstrictor peptide hormone) levels via each intervention were significantly higher in the RT group (4.9±12.7%, 13.8±13.5%, 94.9±132.7%, respectively), as compared with the CON group (-2.5±5.9%, 0.2±8.1%, 21.2±79.3%, respectively) (P<0.05). Of note, no significant differences in the cfPWV, carotid β-stiffness, and circulating angiotensin II levels between the RT+HP (-2.4±9.3%, 2.4±10.3%, -5.7±29.6%, respectively) and CON groups were observed. Furthermore, significant positive relationships between the percent changes in circulating angiotensin II levels, and cfPWV (r=0.438, P<0.01) and carotid β-stiffness (r=0.328, P<0.01) were observed. The combination of moderate to high-intensity resistance training and regular intake of steamed chicken breast as a high-protein food could increase muscle mass, strength, and quality and could cancel resistance training-induced increases in arterial stiffness in elderly women.

The Effects of Omega-3 Fatty Acids and Vitamin D Supplementation on the Nutritional Status of Women with Breast Cancer in Palestine: An Open-Label Randomized Controlled Trial.

This study emphasizes the critical role of early nutritional interventions in addressing cancer-related malnutrition. It aimed to assess the effects of omega-3 fatty acids (ω3) and vitamin D3 (VitD) supplementation on the nutritional status of newly diagnosed women with breast cancer (BC) in the Gaza Strip, Palestine. A total of 88 newly diagnosed women with BC were randomly assigned into four groups: (i) Omega-3 fatty acid (ω3) group; (ii) Vitamin D (VitD) group; (iii) ω3+VitD group; and (iv) the controls. The patients took two daily 300 mg ω3 capsules and/or one weekly 50,000 IU VitD tablet for nine weeks. Nutritional status of the participants was assessed by several measurement tools, namely, the Patient-Generated Subjective Global Assessment (PG-SGA)-derived scores, anthropometric measurements, blood albumin status and dietary intakes between the baseline and after 9 weeks post-intervention. The procedures of the present study were registered on ClinicalTrial.gov with the identifier NCT05331807. At the end of trial, there was a significant increase in the PG-SGA-derived nutritional risk scores (p < 0.01), body weight and body mass index (BMI) (both p < 0.05) among participants in ω3+VitD group compared to other groups. Additionally, there was a significant rise in blood albumin levels (p < 0.05), daily energy and protein intake in the ω3+VitD group (p < 0.05) compared to baseline. Participants with supplementation of daily ω3 and weekly VitD had improved nutritional status, assessed by the PG-SGA scores and anthropometric measures, blood albumin and dietary energy and protein intake among women with BC who were undergoing active treatment.

Why protein-energy wasting leads to faster progression of chronic kidney disease.

Protein-energy wasting (PEW) is increasingly more prevalent as chronic kidney disease (CKD) progresses to more advanced stages. There is a global recognition of the importance of preventing and mitigating PEW in the CKD population not on dialysis given the goal of extending dialysis-free time and delaying dialysis initiation and growing evidence of the clinical consequences of PEW which include the risk of death, hospitalization and clinical conditions such as infections. We reviewed the association of PEW and the malnutrition characteristics indicative of PEW on CKD progression. Studies show the association between low serum albumin levels, low BMI, and diets with inadequate dietary energy and protein intake and CKD progression. Limited studies suggest low muscle mass impacts CKD progression. Optimizing nutrition by dietary management, including a moderately low protein (0.6-0.8 g/kg/day) and plant-based (>50% of protein source, known as PLADO) diet and as needed with supplementation [e.g. during acute kidney injury (AKI) event] administrated orally, enterally, or parenterally are the basis for the prevention and treatment of PEW in CKD and delaying CKD progression. Furthermore, other therapeutic methods such as treating or avoiding comorbidities and AKI, ensuring appropriate exercise and incremental transition to dialysis treatment may help ameliorate and prevent PEW development in CKD patients. Using tailored precision nutrition approaches and nutritional supplementation with or without other beneficial strategies may help prevent and treat PEW and its consequent occurrence of CKD progression.

Alterations in Glucagon Levels and the Glucagon-to-Insulin Ratio in Response to High Dietary Fat or Protein Intake in Healthy Lean Adult Twins: A Post Hoc Analysis.

Background/Objectives: Emerging data support evidence of the essential role of glucagon for lipid metabolism. However, data on the role of dietary fat intake for glucagon secretion is limited. This analysis investigated whether altering nutritional fat intake affects glucagon levels in healthy subjects. Methods: A total of 92 twins (age: 31 ± 14 years, BMI: 23 ± 3 kg/m2) consumed two 6-week diets: first a low-fat, high-carbohydrate diet (LFD) followed by an isocaloric high-fat, low-carbohydrate diet (HFD). In total, 24 twins (age: 39 ± 15 years, BMI: 24 ± 2 kg/m2) continued with a high-protein diet (HPD). Clinical investigations were performed after 6 weeks of the LFD, after 1 and 6 weeks of the HFD and after 6 weeks of the HPD. Results: The LFD caused a significant decrease in fasting glucagon (-27%, p < 0.001) compared to baseline. After 6 weeks of the HFD, glucagon increased (117%, p < 0.001 vs. LFD), while free fatty acids decreased. Six weeks of the HPD further increased glucagon levels (72%, p = 0.502 vs. HFD), although fasting amino acid levels remained constant. Fasting insulin and HOMA-IR moderately increased after one week of the HFD, while six weeks of the HPD significantly decreased both. The fasting glucagon-to-insulin ratio decreased during the LFD (p < 0.001) but increased after the HFD (p < 0.001) and even further increased after the HPD (p = 0.018). Liver fat, triglycerides and blood glucose did not increase during the HFD. The heritability of glucagon levels was 45% with the LFD. Conclusions: An HFD increases glucagon levels and the glucagon-to-insulin ratio under isocaloric conditions compared to an LFD in healthy lean subjects. This rise in glucagon may represent a metabolic response to prevent hepatic steatosis, as glucagon increases have been previously shown to induce hepatic fat oxidation.

Effects of dietary proteins on cognitive performance and brain vascular function in adults: a systematic review of randomised controlled trials.

The incidence of cognitive decline is rising, leading to increased attention on the preventive role of healthy foods on brain function. Previous reviews including primarily observational studies suggested that dietary proteins may improve cognitive performance, but evidence from individual randomised controlled trials (RCT) is less consistent. Therefore, this systematic review examined the long-term effects of dietary proteins from RCT, considering both their amount and type, on cognitive performance (psychomotor speed and attention, executive function, memory and global cognition). Alterations in cerebral blood flow (CBF) - a validated brain vascular function marker - were also considered. A total of 4747 studies were identified through a systematic search, resulting in twenty-three included papers reporting effects on cognitive performance (n = 23) and CBF (n = 3). Improvements were observed in three out of the nine studies that evaluated psychomotor speed which compared a dietary protein intervention with a non-protein or lower-protein control. Of the six beneficial observations on working memory (n = 12), declarative memory (n = 10) and visuospatial memory (n = 10), five were nut interventions from three different trials. Limited studies focusing on global cognition suggested that specific target populations, namely subacute stroke or dementia, may benefit more than healthy individuals from increased dietary protein intake. From the three studies involving CBF, improvements in regional blood flow were associated with most cognitive performance outcomes. The comparative effects of different protein types warrant further investigation. Overall, this review encourages additional research into protein-rich foods or supplements which could potentially prevent or mitigate cognitive decline.

Validity of dietary intake methods in cancer cachexia.

Accurate assessment of dietary intake, especially energy and protein intake, is crucial for optimizing nutritional care and outcomes in patients with cancer. Validation of dietary assessment methods is necessary to ensure accuracy, but the validity of these methods in patients with cancer, and especially in those with cancer cachexia, is uncertain. Validating nutritional intake is complex because of the variety of dietary methods, lack of a gold standard method, and diverse validation measures. Here, we review the literature on validations of dietary intake methods in patients with cancer, including those with cachexia, and highlight the gap between current validation efforts and the need for accurate dietary assessment methods in this population. We analyzed eight studies involving 1479 patients with cancer to evaluate the accuracy and reliability of 24-hour recalls, food records, and food frequency questionnaires in estimating energy and protein intake. We discuss validation methods, including comparison with biomarkers, indirect calorimetry, and relative validation of dietary intake methods. Few have validated dietary intake methods against objective markers in patients with cancer. While food records and 24-hour recalls show potential accuracy for energy and protein intake, this may be compromised in hypermetabolic patients. Additionally, under- and overreporting of intake may be less frequent, and the reliability of urinary nitrogen as a protein intake marker in patients with cachexia needs further investigation. Accurate dietary assessment is important for enhancing nutritional care outcomes in cachexia trials, requiring validation at multiple time points throughout the cancer trajectory.