Dietary Measures Research Articles

National school food standards in England: a cross-sectional study to explore compliance in secondary schools and impact on pupil nutritional intake.

Many countries have introduced school food standards to improve the dietary intakes of school-aged children. England has school food standards (SFS) legislation in place but little is known about how well secondary schools comply with this. We aimed to assess compliance with the SFS legislation in English secondary schools and explore the impact of the SFS on pupils' nutritional intake. We conducted a cross-sectional study with English secondary schools from 2019 to 2022. We compared SFS compliance and pupil nutritional intake in schools mandated or not mandated to comply with the SFS legislation, and explored the association between school compliance and pupil nutritional intake. We assessed the percentage of SFS (%SFS) complied with by reviewing school food menus and observing food served in school canteens. We assessed pupil nutritional intake using a 24-hour dietary recall measure (Intake24) and estimated intakes of free sugar (primary outcome) and other nutrients/foods. We used adjusted multilevel models to compare pupil intakes in the SFS-mandated and SFS-non-mandated schools, and to explore the association between school SFS compliance and pupil intakes. 36 schools (23 not mandated and 13 mandated to comply with the SFS) and 2,273 pupils participated. The median %SFS complied with was 63.9% (interquartile range 60.0-70.0%). This was similar for SFS-non-mandated (64.5%) and SFS-mandated schools (63.3%). Compliance was highest for standards applying to lunchtime (median = 81.3%) and lowest for those applying across the whole school day (median = 41.7%). It was also lower for standards restricting high fat, sugar and energy-dense items (median = 26.1%) than for standards aiming to increase dietary variety (median = 92.3%). Pupils from SFS-mandated schools had a lower mean lunchtime intake of free sugar (g) (adjusted mean difference: -2.78g; 95% CI: -4.66g to -0.90g). There were few significant associations between %SFS complied with and pupil nutritional intake. English secondary schools do not fully comply with SFS legislation regardless of whether they are mandated to comply. Schools and caterers may require monitoring and support to fully comply. There is little evidence that SFS compliance is associated with better pupil nutritional intake. Food environments outside of school also need to be considered. ISRCTN68757496 (17-10-2019).

Duodenal compressions from non-SMA structures in the same patient causing SMA-like syndrome: a rare case report

Abstract SMA-like syndrome is an increasingly used term to describe vascular compression of the third duodenal portion between structures other than superior mesenteric artery and aorta. Although rare, this clinical condition is as serious as true SMA syndrome and requires similar management. However, the diagnostic criteria are not well-established yet and require a case-by-case analysis, including a review of various clinical symptoms, especially evolving ones, as well as radiological imaging and effectiveness of conservative therapeutic maneuvers. The presented case involves a double vascular compression, in a 50-year-old woman with no medical history, one of which is between two venous structures. The patient had been experiencing recurrent abdominal pain, vomiting and distension for a long time. Laboratory tests were normal, and gastroesophageal endoscopy revealed Barrett’s esophagus. CT- enterography revealed two duodenal vascular compressions. Dietary measures were initiated with close follow-up. To the best of our knowledge, this is the first reported case in the world literature and adds to the existing body of SMA-like syndromes.

Dietary strategies and nutritional supplements in the management of heart failure: a systematic review.

Heart failure (HF) is a syndrome of increased intracardiac pressure or decreased cardiac output. There is a lack of conclusive evidence to recommend the regular use of any dietary supplement in patients with HF. However, certain studies have shown nutritional interventions to be beneficial for patients with HF. Therefore, the purpose of this systematic review was to understand and map the updates of dietary interventions and nutritional supplementation measures related to patients with HF over the past 5 years. A systematic review. The PubMed, Web of Science, Scopus, and Cochrane Library databases were searched for randomized clinical trials on the association between dietary interventions and nutritional supplements and HF published between 2018 and 2023. A total of 1755 documents were retrieved, of which 19 were finalized for inclusion. The findings suggest that individualized nutritional support reduces mortality and risk of major cardiovascular events in chronic heart failure inpatients at high nutritional risk. The Mediterranean diet improves functionality, quality of life, and cardiac function. Additionally, supplementation with thiamine, ubiquinol, D-ribose, and L-arginine enhances left ventricular ejection fraction. Probiotic yogurt may effectively improve the inflammatory and antioxidative status of chronic heart failure. Whey protein and melatonin have a positive effect on improving endothelial function in HF patients. Certain dietary interventions and nutritional supplements may provide some benefit to patients with HF. However, there is no relevant definitive evidence on the impact of nutritional interventions on the prognosis of HF, and more high-quality clinical trials are needed for further in-depth studies. Identifier, CRD42024510847.

Medical practice in classical Greece : The neurological and psychiatric case reports of the Hippocratic Corpus

Which theoretical and practical competences do the neurological and psychiatric case histories of the Hippocratic Corpus convey? The 431 Hippocratic case histories have been studied for reports and communication on the diagnostics, treatment and prognosis of single persons and groups of patients suffering from neurological and psychiatric diseases. In the 7books of the Hippocratic Epidemics, atotal of 128 patients with neurological and psychiatric symptoms are described. Epidemic fever and its variants were the leading predisposing conditions and the main symptoms were delirium, coma, insomnia, headache, speech disorders and convulsions. Anumber of patients with phrenitis and opisthotonos are also reported. The majority of the sick persons were male, were teenagers or adults and 47of them are mentioned by name. The patient's information about the course is often just as informative as the doctor's observations. Treatment was limited to physical and dietary measures. The Hippocratic physician diagnosed and attempted to treat alarge number of neurological and psychiatric diseases. The often almost continuous observations of the patients led to astonishingly precise predictions of the course and the prospects of recovery. Numerous symptoms described in the case studies, including carphologia and opisthotonus, have entered the neurological vocabulary. The retrospective etiological analysis of the reports leads to the almost explicit identification of neurosyphilis and encephalitis lethargica. The therapeutic measures described by the author were, as the changeable course of the diseases shows, only of limited effectiveness despite a very differentiated application over time, both against the underlying diseases and the neurological and psychiatric complications.

Antibiogram Pattern of Bacterial Isolates from Sputum Sample

Antibiotics are frequently used for various infectious disease example; acute lower respiratory tract infection. But, injudicious use of antibiotic resistance is an emerging problem. The objective of this study was taken up to analyze the antibiogram pattern of bacterial isolated from the sputum samples of patient in Manmohan Memorial Medical College and Teaching Hospital. Initially, 250 sputum specimens of patients were collected and opted for the isolation and identification of isolates which detected 56.097% Klebsiella spp. 17.073 %, Pseudomonas aeruginosa 4.878 %, Burkholderia spp. 9.756 % Enterobacter spp. 12.195% Escherichia coli respectively. Conducting AST following Kirby Bauer disc diffusion method (CLSI 2020), it was determined that Klebsiella spp. (56.097 %) exhibited sensitive to Gentamycin and exhibited resistance to Cefixime. It was observed that 9 (39.130 %) Klebsiella spp. isolates exhibited multi-drug resistance character. Likewise, out of 23 isolated Klebsiella spp. only 5 (21.739 %) was found to be ESBL producers. The presence of multi drug-resistant strains and Extended Spectrum Beta-Lactamase (ESBL) producing Klebsiella spp. is of major concern worldwide. The improper and excessive utilization of antibiotics, encompassing unauthorized practices might be the reason in the rise to the development and proliferation of antimicrobial resistance (AMR) and multidrug resistance (MDR)in microorganisms. This study highlights the importance of implementing appropriate hygiene and dietary measures for human to prevent the transmission of diverse pathogenic microorganisms. Int. J. Appl. Sci. Biotechnol. Vol 12(3): 151-157.

Changes in unhealthy food consumption among vulnerable elementary-aged children in the United States during the COVID-19 pandemic: a serial cross-sectional analysis.

Several studies suggest that during the early pandemic, amidst socioeconomic instability, children from underserved families were more likely to resort to consuming cheaper, lower-quality foods with longer shelf lives. This study investigated the change in unhealthy food consumption across different phases (pre, early, mid) of the COVID-19 pandemic, and whether the strength of association between unhealthy food consumption and household socioeconomic disadvantage (HSED) varied across phases of the pandemic. This study utilized serial cross-sectional data collected from low-income families enrolled in a school-based food co-op, Brighter Bites. Secondary data analysis included 5,384 surveys from families who had complete data: 3422 pre-pandemic, 944 from the early pandemic, and 1,018 mid-pandemic. Outcome measures included sugary food intake and convenience/fast food intake, each of which was operationalized as a scale using pre-validated items from the surveys. HSED was operationalized as a composite of parent employment, parent education, food insecurity, and participation in government programs; responses were categorized into low, medium, and high HSED groups for analysis. We examined the interaction between HSED and time period to explore how HSED and its association with dietary measures changed over the course of the pandemic. A significant linear negative trend, i.e., a decrease in consumption from pre-to-mid-pandemic period was seen in sugary food intake (p < 0.001), but not in convenience food intake. In data pooled across time-periods, both sugary food and convenience/fast food consumption were inversely associated with HSED, and low unhealthy food consumption was observed among high-disadvantage groups. No significant interaction between time period and HSED was observed on either scale. However, the post-regression estimates from the adjusted interaction model showed a significant association between convenience/fast food consumption and HSED in pre- and mid-pandemic periods. The study highlights the nuances of socioeconomic dynamics on the diet behaviors of children from low-income families during a natural disaster.

Metabolic adverse drug reactions related to psychotropic drugs

Metabolic adverse drug reactions (mADR) related to psychotropic drugs have significant health-related effects including weight gain, impaired glucose tolerance, diabetes mellitus and dyslipidemia as well as economic relevance. Nearly all antipsychotics (AP) and many antidepressants (AD) and mood stabilisers may induce weight gain. Weight development in the first weeks or months after the beginning of the therapy is the strongest predictor for weight gain related to AP and AD. The most important risk factors for mADR are antagonistic effects at H1-, 5-HT2C- und M3-receptors and antidopaminergic effects. However, several other systems are also relevant. Systematic monitoring of metabolic parameters is recommended in all patients treated with substances that are associated with an increased risk of mADR. Lifestyle modification, dietary measures, exercise therapy, dose reduction, change and discontinuation of the substance, and additional treatment with metformin and topiramate are evidence-based treatment options for AP-associated weight gain. GLP-1 receptor agonists such as liraglutide are also promising.

Erectile dysfunction in the hypertensive patient

Hypertensive patients are frequently affected by erectile dysfunction (20-25%). This is often a manifestation of atherosclerosis, a systemic disease that itself requires management. Dietary measures and physical activity are beneficial for these patients. Regarding pharmacological options, these include modifying the antihypertensive treatment or using a phosphodiesterase type 5 inhibitor (PDE5 inhibitor) in males. The preferred antihypertensive treatments are angiotensin 2 receptor antagonists, ACE inhibitors, calcium channel blockers, and if necessary, a vasodilating beta-blocker (nébivolol). Thiazide and thiazide-like diuretics (with the exception of indapamide), traditional beta-blockers, and central antihypertensive agents should be avoided.

Effects of SLC34A3 or SLC34A1 variants on calcium and phosphorus homeostasis.

Variants in SLC34A1 and SLC34A2 genes, which encode co-transporters NaPi2a and NaPi2c, respectively, can lead to hypophosphatemia due to renal phosphate loss. This condition results in hypercalcitriolemia and hypercalciuria, leading to formation of kidney stones and nephrocalcinosis. Phenotype is highly variable. Management includes hyperhydration, dietary modifications, and/or phosphate supplementation. Thiazides and azoles may be used, but randomized studies are needed to confirm their clinical efficacy. We conducted a retrospective study in the pediatric nephrology unit at Grenoble University Hospital from January 2010 to December 2023. The study aimed to describe clinical and biological symptoms of patients with confirmed SLC34A1 and SLC34A3 gene variants and their outcomes. A total of 11 patients (9 females) from 6 different families had variants in the SLC34A1 (5 patients) and SLC34A3 (6 patients) genes. Median age at diagnosis was 72 [1-108] months. Average follow-up duration was 8.1 ± 4.5years. Presenting symptom was nephrocalcinosis (4 cases), followed by renal colic (3 cases). At diagnosis, 90% of patients had hypercalciuria and 45% had hypercalcitriolemia. Management included hyperhydration and dietary advice. All patients showed favorable outcomes with normal growth and school attendance. One patient with an SLC34A3 variant showed regression of nephrocalcinosis. Kidney function remained normal. Clinical and biological manifestations of SLC34 gene variants are highly variable, even among siblings; therefore, management must be personalized. Hygienic and dietary measures (such as hyperhydration, a low sodium diet, and age-appropriate calcium intake) result in favorable outcomes in most cases. Use of azoles (e.g., fluconazole) appears to be a promising therapeutic option.

Multiphase optimization strategy to establish optimal delivery of nutrition-related services in healthcare settings: A step towards clinical trial

BackgroundMinorities living in the Southern US generally have greater incidence and prevalence of cardiometabolic diseases compared to other groups. Cardiometabolic disease prevalence and risk can be reduced by focusing on diet and lifestyle modifications. There is need for holistic and integrated care models for community-based healthcare organizations who are already working with minorities. This research aimed to select and optimize essential psychosocial and structural components to address diet behaviors among racial/ethnic minorities, and/or disadvantaged background young to middle aged adult populations in Mississippi. MethodsNutrition360 was guided by a community-academic team using a participatory approach and included a preparation and two optimization phases to examine different approaches to dietary interventions utilizing the multiphase optimization strategy. Each intervention arm included three different modalities to identify the most feasible delivery method. The intervention was conducted at a community-based, outpatient healthcare center located in Jackson, MS. Eligible participants were between 25 and 50 years old, residents of Jackson metropolitan area, at risk for cardiovascular disease-related premature mortality, and had internet access. Individuals who completed baseline surveys were randomly assigned to an intervention group and then to modality order. Co-primary outcomes were research participant burden and cost-effectiveness and secondary outcomes were attendance, and dietary measures. ResultsThirty-one, African American individuals with a mean age of 40.5 years completed baseline surveys and were randomized to an intervention program. ConclusionThe two most feasible and cost-effective interventions will be combined to further test this model's delivery in the real-world setting as part of the next optimization phase. RegistrationClinicalTrials.gov, NCT06286618. https://clinicaltrials.gov/study/NCT06286618

Ultra-processed foods, allergy outcomes and underlying mechanisms in children: An EAACI task force report.

Consumption of ultra-processed foods [UPFs] may be associated with negative health outcomes. Limited data exist regarding the potential role of UPFs in the occurrence of allergic diseases. The underlying mechanisms underpinning any such associations are also poorly elucidated. We performed a systematic review and narrative evidence synthesis of the available literature to assess associations between UPF consumption and pediatric allergy outcomes (n = 26 papers), including data on the association seen with the gut microbiome (n = 16 papers) or immune system (n = 3 papers) structure and function following PRISMA guidelines. Dietary exposure to fructose, carbonated soft drinks, and sugar intake was associated with an increased risk of asthma, allergic rhinitis, and food allergies in children. Commercial baby food intake was associated with childhood food allergy. Childhood intake of fructose, fruit juices, sugar-sweetened beverages, high carbohydrate UPFs, monosodium glutamate, UPFs, and advanced glycated end-products (AGEs) was associated with the occurrence of allergic diseases. Exposure to UPFs and common ingredients in UPFs seem to be associated with increased occurrence of allergic diseases such as asthma, wheezing, food allergies, atopic dermatitis, and allergic rhinitis, in many, but not all studies. More preclinical and clinical studies are required to better define the link between UPF consumption and the risk of allergies and asthma. These observational studies ideally require supporting data with clearly defined UPF consumption, validated dietary measures, and mechanistic assessments to definitively link UPFs with the risk of allergies and asthma.

Study of Nutritional Anemia in Children Admitted to Pediatric Department in Rural Teaching Hospital of Telangana

Abstract Background: Globally, around 600 million preschool and school aged children are affected by anemia. According to World Health Organization, 65.5% of preschool children in southeast asia are anemic. Nutritional anemia is the commonest cause of anemia resulting from deficiencies of nutrients essential for red blood cell formation. Iron deficiency anemia is the most common nutritional deficiency amounting to 50%, followed by vitamin B12 and folate deficiency. This study is conducted to study the incidence of nutritional anemia among hospitalised children in a territory care teaching hospital in rural Telangana, in the age group of 6 months to 18 years and to bring awareness regarding the diet requirements in children in order to prevent deficiencies thereby the consequences of nutritional deficiencies. Method: This was a prospective hospital-based study conducted to study the incidence of Nutritional anemia along with clinical and hematological profile of nutritional anemia amongst children admitted to the Department of pediatrics in the age group of 6 months to 18 years at Mediciti Institute of Medical Sciences, Ghanpur, Telangana, from January 1st 2020 to June 30th 2021. All the children who had satisfied the inclusion criteria after taking consent from their parents were included in the study. Result: The incidence of nutritional anemia in the present study was found to be 52.08%, with both males and females equally affected. The age group of 6–12 years was particularly impacted, accounting for 49.3% of the cases. A significant 94% of the cases were associated with inadequate protein intake as per ICMR guidelines. Children from socio-economic classes 2 and 3, as per the Kuppuswamy scale, were more frequently affected. Severe anemia was observed in 8.7% of the cases. Peripheral smear analysis revealed microcytic, hypochromic red blood cells in 64.4% of the cases, with 94% of the children showing decreased serum iron levels. Conclusion: Nutritional anemia is the major cause of anemia in hospitalised children affecting majorly children in the age group of 6-12 years. Inadequate protein intake is the major contributor accounting to 94%, which can be prevented with proper dietary measures

Iodine supply and thyroid function in women with gestational diabetes mellitus: a cohort study.

Maternal urinary iodine concentration and blood neonatal thyroid-stimulating hormone (TSH) concentration reflect iodine status in pregnancy and serve as markers of iodine deficiency. As dietary measures in gestational diabetes mellitus (GDM) could affect iodine intake, our study aimed to investigate iodine supply in women with GDM compared to healthy pregnant women and to evaluate its relationship to maternal and neonatal thyroid function. Urinary iodine concentration (UIC) and serum TSH, free thyroxine (FT4), and autoantibodies against thyroid peroxidase (TPOAb) were analyzed in 195 women with GDM and 88 healthy pregnant women in the second trimester. Subsequently, neonatal TSH concentrations measured 72 h after delivery in a subgroup of 154 newborns (115 of mothers with GDM and 39 controls) from the national register were analyzed. Median UIC was significantly lower in women with GDM compared to controls (89.50 µg/L vs. 150.05 µg/L; P < 0.001). Optimal iodine intake was found only in nine women with GDM (4.6%) and 33 healthy pregnant women (37.5%) (P < 0.001). Most pregnant women with GDM (88.7%) compared to one half of controls (50%) had iodine deficiency (P < 0.001). Although serum TSH and the prevalence of hypothyroidism (TSH > 4.0 mIU/L) were not different in both groups, hypothyroxinaemia was more prevalent in GDM compared to controls (12.3% vs 3.4%, P = 0.032). Consistently, neonatal TSH > 5.0 mIU/L indicating iodine deficiency, was found in 6 (5.2%) newborns of women with GDM as compared to none in controls. In women with GDM, the prevalence of perinatal complications was significantly lower in those who were taking dietary iodine supplements compared to those who were not (3/39 (7.69%) vs 46/156 (28.85%), P <0.001). In the multiple logistic and linear regression models in women with GDM, hypothyroxinaemia was associated with preterm births, and a negative association of serum FT4 and HbA1c was found. Iodine deficiency in pregnancy was more prevalent among women with GDM compared to healthy pregnant controls. Serum FT4 negatively correlated with HbA1c, and hypothyroxinaemia was associated with preterm births in women with GDM. Conversely, women with GDM who used dietary iodine supplements had a lower risk of perinatal complications.

Examining the effectiveness of food literacy interventions in improving food literacy behavior and healthy eating among adults belonging to different socioeconomic groups- a systematic scoping review

BackgroundIn high-income countries, significant diet-related health inequalities exist between people of different socioeconomic backgrounds. Individuals who face socioeconomic challenges are less likely to meet dietary guidelines, leading to increased incidence and prevalence of morbidity and mortality associated with dietary risk factors. To promote healthy eating, strategies may focus on individual-level factors (e.g., knowledge, skills, and behavior) along with broader societal factors (e.g., social determinants of health). The concept of food literacy is considered an individual-level factor and has been framed as a skill set that individuals must possess to effectively navigate the complexities of the modern food system. Food literacy interventions can be a complementary but effective tool for encouraging healthy eating behavior among diverse populations, including those facing socioeconomic disadvantage. However, there is limited evidence to guide the design of food literacy intervention for vulnerable population groups. In the process of developing an ideal portfolio of solutions and strategies to promote food literacy and healthy eating for people experiencing socioeconomic disadvantage, this systematic scoping review aims to comprehensively examine the effects of food literacy interventions on promoting food literacy behavior and healthy eating in adults (18 years and above) from various socioeconomic groups (SEGs) in high-income countries.MethodsThe review includes both qualitative and quantitative papers obtained from academic databases, including MEDLINE (via EBSCOhost), Embase, Web of Science, and Google Scholar. In addition to the electronic search, manual forward and backward citation searching will be conducted to identify additional relevant papers. Food literacy interventions will be evaluated across four domains: planning and management, selection, preparation, and consumption. Papers included in the review will be analyzed for process, impact, and outcome evaluation. The main outcome of a food literacy intervention is the modification in eating behavior, while the mechanism for this action will be through impact measure of food literacy behaviors. Implementation factors will be extracted for process evaluation. This review will also include a range of dietary behavior measures, such as diet quality index and dietary intake indicator. The screening process for all citations, full-text articles, and abstract data will be carried out by two reviewers independently. In case of any potential conflicts, they will be resolved through discussion. The quality of quantitative studies will be reviewed using the JBI critical appraisal checklist for analytical cross-sectional studies. The “Consolidated Criteria for Reporting Qualitative Studies (COREQ)” will be used to report on the quality of qualitative papers. Systematic review registration: https://doi.org/10.17605/OSF.IO/TPNKU

Hair mercury isotopes, a noninvasive biomarker for dietary methylmercury exposure and biological uptake.

Background. Fish and rice are the main dietary sources of methylmercury (MeHg); however, rice does not contain the same beneficial nutrients as fish, and these differences can impact the observed health effects of MeHg. Hence, it is important to validate a biomarker, which can distinguish among dietary MeHg sources. Methods. Mercury (Hg) stable isotopes were analyzed in hair samples from peripartum mothers in China (n = 265). Associations between mass dependent fractionation (MDF) (δ202Hg) and mass independent fractionation (MIF) (Δ199Hg) (dependent variables) and dietary MeHg intake (independent variable) were investigated using multivariable regression models. Results. In adjusted models, hair Δ199Hg was positively correlated with serum omega-3 fatty acids (a biomarker for fish consumption) and negatively correlated with maternal rice MeHg intake, indicating MIF recorded in hair can be used to distinguish MeHg intake predominantly from fish versus rice. Conversely, in adjusted models, hair δ202Hg was not correlated with measures of dietary measures of MeHg intake. Instead, hair δ202Hg was strongly, negatively correlated with hair Hg, which explained 27-29% of the variability in hair δ202Hg. Conclusions. Our results indicated that hair Δ199Hg can be used to distinguish MeHg intake from fish versus rice. Results also suggested that lighter isotopes were preferentially accumulated in hair, potentially reflecting Hg binding to thiols (i.e., cysteine); however, more research is needed to elucidate this hypothesis. Broader impacts include 1) validation of a non-invasive biomarker to distinguish MeHg intake from rice versus fish, and 2) the potential to use Hg isotopes to investigate Hg binding in tissues.

Socioeconomic adversity, maternal nutrition, and the prenatal programming of offspring cognition and language at two years of age through maternal inflammation

Increasing rates of child neurodevelopmental vulnerability are a significant public health challenge. The adverse effect of socioeconomic adversity on offspring cognition may be mediated through elevated prenatal maternal systemic inflammation, but the role of modifiable antecedents such as maternal nutrition has not yet been clarified. This study aimed to examine (1) whether prenatal factors, with an emphasis on maternal nutrition, were associated with prenatal maternal systemic inflammation at 28 weeks’ gestation, including the metabolomic marker glycoprotein acetyls (GlycA); (2) the extent to which the association between prenatal maternal nutrition and child cognition and language at age two years was mediated by elevated maternal inflammation in pregnancy; (3) the extent to which the associations between prenatal socioeconomic adversity and child neurodevelopment were mediated through prenatal maternal nutrition and GlycA levels. We used a prospective population-derived pre-birth longitudinal cohort study, the Barwon Infant Study (Barwon region of Victoria, Australia), where 1074 mother–child pairs were recruited by 28 weeks’ gestation using an unselected sampling frame. Exposures included prenatal factors such as maternal diet measured by a validated food frequency questionnaire at 28 weeks’ gestation and dietary patterns determined by principal component analysis. The main outcome measures were maternal inflammatory biomarkers (GlycA and hsCRP levels) at 28 weeks’ gestation, and offspring Bayley-III cognition and language scores at age two years. Results showed that the ‘modern wholefoods’ and ‘processed’ maternal dietary patterns were independently associated with reduced and elevated maternal inflammation respectively (GlycA or hsCRP p < 0.001), and also with higher and reduced offspring Bayley-III scores respectively (cognition p ≤ 0.004, language p ≤ 0.009). Associations between dietary patterns and offspring cognition and language were partially mediated by higher maternal GlycA (indirect effect: cognition p ≤ 0.036, language p ≤ 0.05), but were less evident for hsCRP. The maternal dietary patterns mediated 22 % of the association between socioeconomic adversity (lower maternal education and/or lower household income vs otherwise) and poorer offspring cognition (indirect effect p = 0.001). Variation in prenatal GlycA levels that were independent of these dietary measures appeared less important. In conclusion, modifiable prenatal maternal dietary patterns were associated with adverse child neurocognitive outcomes through their effect on maternal inflammation (GlycA). Maternal diet may partially explain the association between socioeconomic adversity and child neurocognitive vulnerability. Maternal diet-by-inflammation pathways are an attractive target for future intervention studies.

Nutritional Management of Patients with Fatty Acid Oxidation Disorders.

Treatment of fatty acid oxidation disorders is based on dietary, pharmacological and metabolic decompensation measures. It is essential to provide the patient with sufficient glucose to prevent lipolysis and to avoid the use of fatty acids as fuel as far as possible. Dietary management consists of preventing periods of fasting and restricting fat intake by increasing carbohydrate intake, while maintaining an adequate and uninterrupted caloric intake. In long-chain deficits, long-chain triglyceride restriction should be 10% of total energy, with linoleic acid and linolenic acid intake of 3-4% and 0.5-1% (5/1-10/1 ratio), with medium-chain triglyceride supplementation at 10-25% of total energy (total MCT+LCT ratio = 20-35%). Trihepatnoin is a new therapeutic option with a good safety and efficacy profile. Patients at risk of rhabdomyolysis should ingest MCT or carbohydrates or a combination of both 20 min before exercise. In medium- and short-chain deficits, dietary modifications are not advised (except during exacerbations), with MCT contraindicated and slow sugars recommended 20 min before any significant physical exertion. Parents should be alerted to the need to increase the amount and frequency of carbohydrate intake in stressful situations. The main measure in emergency hospital treatment is the administration of IV glucose. The use of carnitine remains controversial and new therapeutic options are under investigation.

Fruit and vegetable intake modifies the association between ultra-processed food and metabolic syndrome

BackgroundThis prospective cohort study aimed to investigate the association between ultra-processed food (UPF) and the risk of metabolic syndrome (MetS), as well as to assess whether fruit and vegetable intake and weight change modify this association.MethodsWe included 1915 healthy participants who participated in the Tehran Lipid and Glucose Study (TLGS), all of whom had complete demographic, anthropometric, and dietary measurements. A validated food frequency questionnaire was used to assess UPF consumption based on the NOVA classification system. MetS was defined according to the Joint Interim Statement. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of UPF. The effect of fruit and vegetable consumption and weight change on this association was assessed using joint classification by Cox regression.ResultsUFP consumption showed no association with MetS risk after adjusting for confounders. However, after adjustment for dietary fiber, fruits, and vegetables, the highest tertile of UPF consumption was positively linked to MetS risk, compared to the lowest tertile. There was a significant interaction between fruit, vegetable, and dietary fiber intake and UPF consumption concerning the risk of MetS (All P values < 0.05). Among individuals consuming less than 248 g/day of fruit, the risk of MetS increased by 54% (confidence interval: 1.13–2.10) in the highest UPF tertile. Consuming vegetables and dietary fiber below the median (258 g/day and 42.2 g/day, respectively) increased the risk of MetS in the third tertile of UPF. However, consuming vegetables and fiber ≥ median intake, reduced the risk of MetS among those with the lowest UPF consumption. Furthermore, the risk of MetS was observed in the third tertile of UPF consumption among individuals with fruit and vegetable consumption < 537 g/day. UPF consumption was not associated with the risk of MetS in different weight change statuses.ConclusionsConsuming more fruits and vegetables mitigated the adverse effect of UPF on the risk of developing MetS.

The Role of the Nephrologist in the Treatment and Prevention of Nephrolithiasis

Abstract Nephrolithiasis is a disease with a high risk of recurrence: 50% within five years and up to 80–90 % within 10 years after the first episode. Often, with this diagnosis, there is only symptomatic treatment with the aim of expelling the kidney stone and removing the pain. In such patients, however, initial stratification of the risk of recurrence based on the risk factors present is essential. Every patient with nephrolithiasis, whether it is a single episode or recurrent, should follow general measures to prevent kidney stones. Depending on the results of the kidney stone analysis and the risk of recurrence, it is necessary to carry out a specialised nephrological metabolic examination which is performed by a nephrologist in Slovakia, with subsequent personalised recommendations depending on the cause of recurrent nephrolithiasis. These include dietary and regimen measures, as well as pharmacological treatment. In the following article we summarize specific measures for individual types of nephrolithiasis, as well as basic preventive measures for the recurrence of kidney stones, with a focus on dietary risk and protective factors.

Depression and anxiety in multiple sclerosis. Review of a fatal combination.

Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.