Dietary Restriction Research Articles

Non-pharmacological interventions to prevent return of gastric ulcers: A systematic review

Recurrence of gastric ulcers is a significant concern, and non-pharmacological interventions play an important role in their prevention. This systematic review aims to evaluate the effectiveness of nonpharmacological interventions in preventing gastric ulcer recurrence. The aim of this research is Non-Pharmacological Interventions to Prevent Recurrence of Gastric Ulcers: A Systematic Review". The research method in this study was the literature method. The literature method was carried out by means of a comprehensive search carried out in several databases, including PubMed, Medline, Scopus, and the Cochrane Library, using predefined search terms. Studies published from (start date) to (end date) were included. Two independent reviewers screened articles, extracted data, and assessed the quality of included studies using standard tools. The results show that non-pharmacological interventions are quite promising in preventing recurrence of gastric ulcers. Dietary modifications, such as avoiding spicy and acidic foods, and adopting a balanced diet rich in fruits and vegetables, are associated with a reduced risk of relapse. Lifestyle changes, particularly smoking cessation and reducing alcohol consumption, have shown a positive impact on healing ulcers and preventing recurrence. Stress management techniques, such as relaxation exercises and cognitive behavioral therapy, show potential benefits in reducing ulcer recurrence rates. Complementary therapies, such as acupuncture and herbal remedies, have shown mixed results, with some studies showing positive effects in preventing recurrence. Non-pharmacological interventions offer a valuable approach to preventing gastric ulcer recurrence. Dietary modifications, lifestyle changes, stress management techniques, and complementary therapies show promising results in reducing relapse rates. These findings highlight the importance of integrating non-pharmacological interventions into gastric ulcer management and prevention strategies. Further research is needed to validate these findings and explore optimal implementation methods.

Study on Wellness Programs Offered by the Health Insurance Companies

Introduction: Wellness is the act of ensuring a healthy lifestyle regularly. It is a multidimensional phenomenon. There are wellness providers such as hospitals, insurance companies, diagnostics, and wellness firms. It focuses on the wellness programs offered by Indian and International health insurance companies. Method: Descriptive and cross-sectional study on the wellness programs delivered by health insurance companies. The survey was conducted on the outlook of customers for the wellness programs offered by insurance companies. Result: List of wellness programs offered by various health insurance companies. The determination of the interest of consumers in wellness programs and rewards related to it. Discussion: Wellness programs include fitness challenges, modifications in diet and lifestyle, goal-based exercises, and healthy living. This paper discusses wellness initiatives, benefits, and regulations of wellness programs for insurance companies. Application: A comprehensive wellness plan for health insurance companies to increase the well-being of their customers. Conclusion: Both the insured and the insurer get benefit from the wellness initiatives. Wellness programs keep individuals healthy and therefore reduce the possibility of future claims. This increases the revenue of insurance companies.

Levothyroxine management in Hashimoto’s thyroiditis: A comprehensive revie

Hashimoto thyroiditis and hypothyroidism are related thyroid conditions with different aetiologies and clinical manifestations. Insufficient synthesis of thyroid hormones causes hypothyroidism, which may lead to systemic symptoms that impact energy, metabolism, and overall wellness. Thyroid tissue damage mediated by the immune system is the hallmark of the autoimmune thyroid condition known as Hashimoto thyroiditis, which is the most prevalent cause of hypothyroidism. A wide range of symptoms, such as fatigue, weight gain, cold sensitivity, constipation, dry skin, and cognitive impairment, are clinical indications of hypothyroidism and Hashimoto thyroiditis. Thyroid function tests, which measure serum levels of free thyroxine, thyroid-stimulating hormone, and thyroid autoantibodies, must be performed for the diagnosis. Imaging techniques, such ultrasonography, may aid with nodular changes detection and thyroid morphology assessment. The goals of management plans for Hashimoto thyroiditis and hypothyroidism are to stop complications, relieve symptoms, and return the body to normal. The cornerstone of treatment is levothyroxine-based thyroid hormone replacement medication, which is customized for each patient depending on their clinical presentation and thyroid function testing. Dietary restrictions, patient education, and lifestyle changes are essential components of illness management.

Fatigue: Pharmacological and non-pharmacological management in patients with multiple sclerosis

Multiple sclerosis (MS) is a neurological disease that causes inflammation and demyelination of the central nervous system. It progresses with episodic attacks and is particularly disabling in young adults. Among the many symptoms experienced by MS patients, fatigue is one of the most commonly reported. Approximately 75 – 90% of patients experience fatigue, with the vast majority reporting it as one of their top three symptoms. Over half of MS patients find fatigue to be a debilitating symptom that interferes with their work, family, and social life, significantly affecting their overall quality of life. Despite its prevalence, fatigue is often overlooked due to its subjective nature. Although the pathophysiology of fatigue is not fully understood, it has been associated with various variables such as stress, vigorous exercise, anxiety, depression, insomnia, pain, spasticity, medication side effects, anemia, and temperature elevation. Effective management of multifactorial fatigue requires a multidisciplinary approach, incorporating both pharmacological and non-pharmacological modalities. An analysis of studies conducted over the last decade indicates that the efficacy of pharmacological methods is controversial, with a high side effect profile. Among non-pharmacological methods, exercise has proven to be one of the most effective interventions. In addition, dietary modifications and vitamin supplementation have demonstrated effectiveness. Cognitive behavioral therapy, acupressure, acupuncture, the application of cooling garments, transcranial stimulation, web-based education and counseling, and guided imagery have also reported positive results. However, further studies with larger sample sizes are necessary to objectively evaluate their effectiveness. In conclusion, fatigue is a prevalent symptom among MS patients. While the management of fatigue through pharmacological methods remains controversial, non-pharmacological methods have demonstrated effectiveness, are low-cost, and have no side effects.

The prevalence of orthorexia nervosa in patients with selected chronic diseases

Introduction and aim. Orthorexia nervosa is described as an obsession with consuming solely healthy foods accompanied by restrictive behaviors. Patients with chronic conditions frequently require dietary interventions alongside medication to manage symptoms and slow down disease progression. However, when dietary restrictions are taken to extremes, individuals may develop orthorexia nervosa, resulting in malnutrition and weight loss. This poses risks during treatment, where maintaining a balanced diet is vital. In this review we aim to display the prevalence of orthorexia nervosa in patients suffering from selected chronic diseases.Material and methods. A literature review was performed to investigate the prevalence of orthorexia nervosa in individuals with type 1 diabetes, inflammatory bowel disease, celiac disease, rheumatoid arthritis, and cancer.Description of the State of Knowledge. The occurrence of orthorexia reaches up to 7% in the general population, 72% in patients with type 1 diabetes mellitus, 77% in case of inflammatory bowel disease, 71% among individuals suffering from celiac disease, 75% in those with rheumatoid arthritis, and 50% in case of cancer. Orthorexia nervosa mostly affects females who are younger, have higher education levels, select organic foods, prepare their own meals, and have concurrent chronic illnesses. Distress associated with diagnosis is the primary factor contributing to the development of this condition. Orthorexia ultimately leads to malnutrition, weight loss, impaired social functioning, and poses a risk of complications in chronically ill patients.Conclusion. The prevalence of orthorexia nervosa in patients suffering from chronic illnesses is significantly higher compared to the general population. Therefore, early detection of this condition and intervention are necessary to improve patient management. Further research is needed to assess the frequency of orthorexia among individuals suffering from other chronic diseases.

LunchByte: A Facial Recognition-Based Payment System for Health-Conscious Elementary Student Meals

A significant number of elementary school students experience challenges related to lunch, including forgetting lunch money, lacking awareness of their individual dietary needs, and the importance of balanced nutritional choices for their overall health. Numerous parents and guardians struggle to monitor their children at school, control their purchasing behaviors, and maintain their health. Therefore, this research aims to enhance the efficiency and monitoring of elementary school students' lunch choices. LunchByte, a face recognition system developed in this study assists elementary in monitoring lunch expenses concerning their dietary restrictions. The main feature of LunchByte is using a student’s face print to generate a custom menu tailored to their allergies/diet restrictions and allowing them to pay with a prepaid balance added by their guardians. The evaluation of this system involves conducting model testing to assess the accuracy of facial recognition, integration testing to examine the interaction between different components of the system, and usability testing with end-users to evaluate the user experience. The results of these tests indicate that the system achieves high levels of accuracy and user satisfaction. The study is important because it has the potential to improve the overall health of young children.

Information-seeking behaviors, attitudes and beliefs about pregnancy-related nutrition and supplementation in different communities of Pakistan

Purpose This study aims to assess the information-seeking behaviors, attitudes and beliefs about pregnancy-related nutrition, food-related myths and taboos and supplementation among pregnant women in different communities of Pakistan. Design/methodology/approach A cross-sectional quantitative survey method was used in this study, which included 150 pregnant women from various locations in Lahore and Faisalabad. Findings Most participants were between the ages of 25 and 29, having 14 years of education. Regardless of age or number of children, all selected women had the same dietary awareness. Regarding myths and taboos, highly significant values (p = 0.001) were found in various studied variables. No significant difference was observed in knowledge level between age and number of children. It was observed that food myths and taboos significantly (p = 0.001) impact pregnant women’s dietary choices. Research limitations/implications This survey experienced limited representativeness; many participants provided incomplete food and nutritional information. This research was conducted in two major districts of Pakistan, i.e. Lahore and Faisalabad; therefore, the results can be generalized for a population of pregnant women living in the northeastern region of Pakistan. Practical implications This study can provide helpful insight for health-care professionals to improve pregnant women’s nutritional status and knowledge. Social implications The outcomes of this study can help guide how pregnant women might be educated and have better nutritional awareness at domestic and professional levels. Originality/value In Pakistan, there is a lack of research on pregnant women’s nutritional knowledge, and this research can assist health-care professionals in providing diversified knowledge to promote maternal health.

The Future of Obesity Management through Precision Nutrition: Putting the Individual at the Center.

PURPOSEOF REVIEW: The prevalence of obesity continues to rise steadily. While obesity management typically relies on dietary and lifestyle modifications, individual responses to these interventions vary widely. Clinical guidelines for overweight and obesity stress the importance of personalized approaches to care. This review aims to underscore the role of precision nutrition in delivering tailored interventions for obesity management. RECENT FINDINGS: Recent technological strides have expanded our ability to detect obesity-related genetic polymorphisms, with machine learning algorithms proving pivotal in analyzing intricate genomic data. Machine learning algorithms can also predict postprandial glucose, triglyceride, and insulin levels, facilitating customized dietary interventions and ultimately leading to successful weight loss. Additionally, given that adherence to dietary recommendations is one of the key predictors of weight loss success, employing more objective methods for dietary assessment and monitoring can enhance sustained long-term compliance. Biomarkers of food intake hold promise for a more objective dietary assessment. Acknowledging the multifaceted nature of obesity, precision nutrition stands poised to transform obesity management by tailoring dietary interventions to individuals' genetic backgrounds, gut microbiota, metabolic profiles, and behavioral patterns. However, there is insufficient evidence demonstrating the superiority of precision nutrition over traditional dietary recommendations. The integration of precision nutrition into routine clinical practice requires further validation through randomized controlled trials and the accumulation of a larger body of evidence to strengthen itsfoundation.

Effect of emotional priming on eating willingness of women with restrictive diet.

There is controversy regarding whether negative or positive emotions have a greater impact on the eating behavior of restrictive dieters. Moreover, it is unclear whether unconscious emotional processing can predict the eating behavior of restrictive dieters. This study investigated the effects of conscious and unconscious emotional processing on the dietary behavior of women with restrictive diet. Female student participants (N = 600) completed the Dutch Eating Behavior Questionnaire to screen 60 each of successful, unsuccessful restrictive and unrestricted eaters. They were randomly and equally divided into two groups for supra-threshold and subliminal emotional priming and carried out a behavioral task to index eating intentions. The restrictive dieters increase their willingness to eat when they are in a positive mood, even if they are not consciously aware of their happiness. Furthermore, the unsuccessful restrictive dieters are more intense. This study presents empirical evidence on the impact of positive emotions on the eating intention of restrictive dieters and the cognitive characteristics of unsuccessful restrictive dieters. Additionally, it offers guidance for unsuccessful restrictive dieters to personalize their treatment goals.

Latent profile analysis reveals overlapping ARFID and shape/weight motivations for restriction in eating disorders.

DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations. We applied latent profile analysis to 202 treatment-seeking individuals (ages 10-79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators. A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations. The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.

Enteral Nutrition in Operated-On Gastric Cancer Patients: An Update.

It is well established that the preoperative nutritional status of gastric cancer (GC) patients significantly affects the prognosis of the operated patients, their overall survival, as well as the disease-specific survival. Existing data support that preoperative assessment of nutritional status and early correction of nutritional deficiencies exert a favorable effect on early postoperative outcomes. A variety of relevant indices are used to assess the nutritional status of GC patients who are candidates for surgery. The guidelines of almost all international organizations recommend the use of oral enteral nutrition (EN). Oncologically acceptable types of gastrectomy and methods of patient rehabilitation should take into account the expected postoperative nutritional status. The majority of data support that perioperative EN reduces complications and hospital stay, but not mortality. Oral EN in the postoperative period, albeit in small amounts, helps to reduce the weight loss that is a consequence of gastrectomy. Iron deficiency with or without anemia and low serum levels of vitamin B12 are common metabolic sequelae after gastrectomy and should be restored. EN also significantly helps patients undergoing neoadjuvant or adjuvant antineoplastic therapy. The occurrence of the so-called "postgastrectomy syndromes" requires dietary modifications and drug support. This review attempts to highlight the benefits of EN in GC patients undergoing gastrectomy and to emphasize the type of necessary nutritional management, based on current literature data.

Current Advances and Material Innovations in the Search for Novel Treatments of Phenylketonuria.

Phenylketonuria (PKU) is a genetically inherited disease caused by a mutation of the gene encoding phenylalanine hydroxylase (PAH) and is the most common inborn error of amino acid metabolism. A deficiency of PAH leads to increased blood and brain levels of phenylalanine (Phe), which may cause permanent neurocognitive symptoms and developmental delays if untreated. Current management strategies for PKU consist of early detection through neonatal screening and implementation of a restrictive diet with minimal amounts of natural protein in combination with Phe-free supplements and low-protein foods to meet nutritional requirements. For milder forms of PKU, oral treatment with synthetic sapropterin (BH4), the cofactor of PAH, may improve metabolic control of Phe and allow for more natural protein to be included in the patient's diet. For more severe forms, daily injections of pegvaliase, a PEGylated variant of phenylalanine ammonia-lyase (PAL), may allow for normalization of blood Phe levels. However, the latter treatment has considerable drawbacks, notably a strong immunogenicity of the exogenous enzyme and the attached polymeric chains. Research for novel therapies of PKU makes use of innovative materials for drug delivery and state-of-the-art protein engineering techniques to develop treatments which are safer, more effective, and potentially permanent.

Prevalence of Dietary Modification and Supplement Use in Patients with Metastatic Renal Cell Carcinoma Receiving Systemic Therapy.

Many patients diagnosed with cancer adopt dietary changes and supplement use, and a growing body of evidence suggests that such modifications can affect outcomes to cancer therapy. We sought to assess the prevalence of these practices and the surrounding physician-patient dialogue among patients with metastatic renal cell carcinoma. An online survey was administered by Kidney Cancer Research Alliance (KCCure), interrogating dietary modification patterns, supplement usage, out-of-pocket expenditure related to supplements, and patients' views toward alternative medicine practices. Patients with metastatic renal cell carcinoma receiving combination therapy were actively solicited. In total, 289 unique responses were collected. The most common first-line treatments were nivolumab/ipilimumab (32.4%) and axitinib/pembrolizumab (13.1%). Within the cohort, 147 (50.9%) started using supplements following diagnosis of renal cell carcinoma; the most utilized supplements were probiotics, cannabidiol (CBD) oil/marijuana, and Vitamin C, reported by 70 (47.6%), 61 (41.4%), and 54 (36.7%), respectively. Dietary modifications following cancer diagnosis were reported by 101 (34.9%) respondents, of which 19.8% followed the Mediterranean diet and 18.8% adopted a ketogenic diet. Most respondents (71.3%) noted that they consistently report supplement usage to their physicians. A substantial proportion of patients with metastatic renal cell carcinoma utilize dietary modification and supplements as an adjunct to antineoplastic therapy. Considering the widespread adoption of these practices and the reported effects on cancer treatment, it is crucial for healthcare providers to engage in discussions with patients regarding supplement use.

Evaluating the sources and types of dietary and nutritional advice for patients with alopecia areata.

Although there are now two Food and Drug Administration (FDA)-approved treatments for severe alopecia areata (AA), many patients still resort to non-medical therapies and lifestyle modifications such as diet and nutrition. The goal of this study was to evaluate the sources and types of dietary and nutritional advice for patients with AA. We distributed a cross-sectional national survey using the National Alopecia Areata Foundation's email list-serv between August 2022 and January 2023. Most respondents were White (76.3%), employed (58.3%) females (84.4%) with a mean age of 52 years. 163 (19.1%) respondents reported receiving diet and/or nutritional advice and 418 (49.5%) respondents reported searching for diet and/or nutritional advice to help with their AA; the most common source of advice was online. The most common dietary changes were the use of vitamins or supplements (30.6%), adherence to diets (23.2%), and the addition of specific foods (21.4%). 209 (50.2%) respondents reported no change in their disease and 197 (47.4%) respondents reported no change in how they felt about their disease compared to before they tried the change. Many AA patients search for or receive unsolicited dietary and nutritional advice and subsequently modify their behavior to manage their disease. However, the efficacy of these changes is unclear. Providers should be mindful of the sources through which patients obtain treatment information as well as the lifestyle changes patients make to counsel patients with evidence-based information. Further investigation is needed to better characterize the direct and indirect costs of dietary and nutritional modification in the treatment of AA.

Patient-reported treatment burden: comparison between vitamin-K antagonist and non-vitamin K antagonist oral anticoagulants

Abstract Introduction Treatment burden (TB) is defined as the overall workload that maintenance or improvement of their functioning and well-being poses on patients with chronic medical conditions. A high patient-reported TB has been associated with lower adherence to treatment and increased risk of major adverse events including death. We explored the differences in patient-reported TB value and prevalence of unacceptably high TB score (≥59 points) between patients receiving vitamin K antagonist oral anticoagulants (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC). Furthermore, we explored contributory factors associated with TB and the relationship between TB and quality of life (QoL) in these patients. Methods A single-centre study included consecutive adult in- and outpatients on long-term oral anticoagulation, seen at a university clinical centre a from April to June 2019, who were willing to complete the Treatment Burden Questionnaire encompassing 13 items assessing the TB associated with taking medicine, self-monitoring, laboratory assessments, medical consultations, organisational and administrative requirements, adherence to dietary and physical activity recommendations, as well as the social repercussions of the treatment. Results Of 320 enroled patients, 206 (64.4%) were taking a VKA. Atrial fibrillation was the most common indication for long-term oral anticoagulation (n=299, 93.4%). The mean TB score was significantly higher in patients on VKA versus those taking a NOAC (48.8 ±26.5 vs. 41.8 ±19.7, P= 0.014), mostly owing to significantly higher TB values for questions related to self-monitoring, including the International Normalized Ratio (INR) control (3.85±3.32 vs. 1.62±1.38, P<0.001) and diet restrictions (3.98±3.43 vs. 2.48±2.49, P<0.001) in patients taking VKA (Figure 1). In addition, these patients significantly more often reported an unacceptably high TB of ≥59 points compared with those taking NOAC (30.1% vs 18.4%, P= 0.024). Multivariable regression analysis of predictors of TB in patients taking a VKA or NOAC are presented in Table 1. Conclusion In our study, patients receiving a VKA reported significantly higher TB compared to those using NOAC, especially regarding the questions about self-monitoring (including INR control) and diet restrictions. An unacceptably high TB was also more prevalent among patients receiving a VKA. Our findings suggest that prescribing NOACs in preference to VKAs could help in decreasing the self-reported TB in patients who need oral anticoagulant therapy.

Fmo induction as a tool to screen for pro-longevity drugs.

Dietary restriction (DR) and hypoxia (low oxygen) extend lifespan in Caenorhabditis elegans through the induction of a convergent downstream longevity gene, fmo-2. Flavin-containing monooxygenases (FMOs) are highly conserved xenobiotic-metabolizing enzymes with a clear role in promoting longevity in nematodes and a plausible similar role in mammals. This makes them an attractive potential target of small molecule drugs to stimulate the health-promoting effects of longevity pathways. Here, we utilize an fmo-2 fluorescent transcriptional reporter in C. elegans to screen a set of 80 compounds previously shown to improve stress resistance in mouse fibroblasts. Our data show that 19 compounds significantly induce fmo-2, and 10 of the compounds induce fmo-2 more than twofold. Interestingly, 9 of the 10 high fmo-2 inducers also extend lifespan in C. elegans. Two of these drugs, mitochondrial respiration chain complex inhibitors, interact with the hypoxia pathway to induce fmo-2, whereas two dopamine receptor type 2 (DRD2) antagonists interact with the DR pathway to induce fmo-2, indicating that dopamine signaling is involved in DR-mediated fmo-2 induction. Together, our data identify nine drugs that each (1) increase stress resistance in mouse fibroblasts, (2) induce fmo-2 in C. elegans, and (3) extend nematode lifespan, some through known longevity pathways. These results define fmo-2 induction as a viable approach to identifying and understanding mechanisms of putative longevity compounds.

Using ChatGPT-4 to Analyze 24-Hour Urine Results and Generate Custom Dietary Recommendations for Nephrolithiasis.

Purpose: The increasing incidence of nephrolithiasis underscores the need for effective, accessible tools to aid urologists in preventing recurrence. Despite dietary modification's crucial role in prevention, targeted dietary counseling using 24-hour urine collections is underutilized. This study evaluates ChatGPT-4, a multimodal large language model, in analyzing urine collection results and providing custom dietary advice, exploring the potential for artificial intelligence-assisted analysis and counseling. Materials and Methods: Eleven unique prompts with synthesized 24-hour urine collection results were submitted to ChatGPT-4. The model was instructed to provide five dietary recommendations in response to the results. One prompt contained all "normal" values, with subsequent prompts introducing one abnormality each. Generated responses were assessed for accuracy, completeness, and appropriateness by two urologists, a nephrologist, and a clinical dietitian. Results: ChatGPT-4 achieved average scores of 5.2/6 for accuracy, 2.4/3 for completeness, and 2.6/3 for appropriateness. It correctly identified all "normal" values but had difficulty consistently detecting abnormalities and formulating appropriate recommendations. The model performed particularly poorly in response to calcium and citrate abnormalities and failed to address 3/10 abnormalities entirely. Conclusions: ChatGPT-4 exhibits potential in the dietary management of nephrolithiasis but requires further refinement for dependable performance. The model demonstrated the ability to generate personalized recommendations that were often accurate and complete but displayed inconsistencies in identifying and addressing urine abnormalities. Despite these limitations, with precise prompt design, physician oversight, and continued training, ChatGPT-4 can serve as a foundation for personalized medicine while also reducing administrative burden, indicating its promising role in improving the management of conditions such as nephrolithiasis.

Semaglutide and weight loss – a concern for diabetics and pharmaceuticals

Madam, On 4 June 2021, the FDA approved intravenous Wegovy (semaglutide) for weight-loss management in chronically obese individuals [1]. However, Wegovy, also sold under the name Ozempic, has long been a shortcut for rapid weight loss and gained a reputation as “the worst kept secret in Hollywood” [2]. A recent rise in the popularity of these drugs has led manufacturers struggle to meet the increased demands, resulting in shortages of the medication—even for critical diabetic patients for whom they were initially recommended [2]. In this letter, we scrutinise the possible adverse effects of the rising usage of semaglutide for weight loss. A Semaglutide Treatment Effect in People with Obesity (STEP) trial of 3613 participants showed that 2.4 mg of semaglutide can cause clinically significant weight loss of 14.9% [95% CI] and improve cardiovascular function when used over 68 weeks [3]. The primary reported contraindications were gastrointestinal disturbances such as nausea, vomiting, and diarrhoea [3]. However, another STEP 1 trial the following year found that this weight loss was not sustainable as 1961 participants regained 11.6% (SD: 7.7) of the lost weight after discontinuation [4]. The increasing usage of semaglutide medication for purely aesthetic weight loss without diet and lifestyle modifications has become a pressing problem. The use of semaglutide by non-obese and non-diabetic individuals poses a public health threat as there is limited literature available on its contraindications in this population. Similarly, the original aim of drug development was to achieve sustained, clinically significant weight loss and seek to improve associated comorbidities, including cardiovascular diseases. These benefits are lost when the primary focus of semaglutide use becomes weight loss alone and other health parameters are ignored. Trials show that discontinuation can lead to regain of two-thirds of the lost weight and a reversal of cardio-metabolic improvements [5]. Moreover, this misinformed usage of semaglutide fuelled by media influence contributes to the age-old perception of ‘miracle drugs’ that allow quick fixes. Such erroneous beliefs can cause an unhealthy lifestyle and binging behaviours, highlighting the need for patient counselling at the time of prescription and stricter regulations on the distribution of semaglutide. Stricter regulations should also be implemented until the long-term effects and safety of using Wegovy, which contains a higher dose of medication (2.4 mg) as compared to antidiabetic semaglutide formulations, are extensively explored. ---Continue

#885 Combination of medium cut-off dialyzer membrane and diet modification to reduce serum concentrations of p-cresyl sulfate and indoxyl sulfate

Abstract Background and Aims Online hemodiafiltration (ol-HDF) may be considered currently as the best choice for chronic hemodialysis (HD) treatment, but medium cut-off (MCO) membranes may provide similar efficiency for larger and protein-bound toxin removal. P-cresyl sulfate (PCS) and indoxyl-sulfate (IS) concentration depends mainly on residual renal function and diet. Increased dietary fiber intake and short-chain fatty acid (SCFA) supplementation were associated with decreased production of PCS and IS. The aim of this study was to pragmatically combine MCO use with diet modification in an attempt to reduce serum concentration of PCS and IS and compare this strategy to online HDF use. Method We report preliminary results from a subset of a study sample with 42 chronic prevalent HD patients in a prospective randomized controlled interventional study. Two weeks after standard bicarbonate HD (BHD), patients were randomized to hemodialysis with MCO membrane (EXP group) or ol-HDF with a standard "high-flux" (HF) dialyzer membrane (CON group). After 4 weeks, both groups were supplemented by a change in the diet with increase of the daily intake of dietary fiber to 30g and addition of a SCFA propionate in the dose of 1g daily for 8 weeks. Two main outcomes were serum concentrations of PCS and IS. Measurements were taken at baseline (after 2 week wash-in period), after 4 weeks of the first intervention phase (MCO vs. ol-HDF; T1), after 8 weeks of the second intervention phase (fiber and SCFA supplementation; T2) and finally, after 4 weeks of wash-out period with BHD (T3). Results From 42 participants, 38 completed the study (63.2% men, 66.4±10.9 years, Charlson comorbidity index 5.7±2.3). In the CON group, serum concentrations of PCS (in μg/ml) were 36.8±19.6 (baseline), 36.9±20.8 (T1), 32.4±17.4 (T2) and 38.6±22.1 (T3). Serum concentrations of IS (in μg/ml) were 31.8±13.0 (baseline), 32.9±14.7 (T1), 29.5±9.1 (T2) and 35.5±16.8 (T3). In the EXP group, serum concentrations of PCS were 33.5± 16.6 (baseline), 35.9±17.8 (T1), 34.0±16.1 (T2) and 37.4±21.5 (T3). Serum concentrations for IS were 39.6±12.6 (baseline), 37.3±12.9 (T1), 42.3±13.5 (T2) and 41.0±12.8 (T3). Repeated measures ANOVA revealed no significant time*group interaction for PCS (F(1,33)=0.479, p=0.698, ŋ2=0.014) and IS (F(1,33)=2.392, p=0.073, ŋ2=0.068). There was a significant within-group increase in serum IS concentration between T2 and T3 in CON group (p=0.042). There was a trend towards a decrease in PCS concentration between T1 and T2 and increase between T2 and T3 in CON group. Conclusion The results of the study suggest both hemodialysis methods are equivalent in eliminating PCS and IS. Additional fiber and SCFA propionate supplementation did not decrease serum PCS and IS concentrations significantly, although there was a trend towards lower serums concentration of PCS after diet modification in CON group.

Dietary restriction rescues 5-fluorouracil-induced lethal intestinal toxicity in old mice by blocking translocation of opportunistic pathogens

ABSTRACT Chemotherapy remains a major treatment for malignant tumors, yet the application of standard dose intensity chemotherapy is limited due to the side effects of cytotoxic drugs, especially in old populations. The underlying mechanisms of cytotoxicity and strategies to increase the safety and tolerance of chemotherapy remain to be explored. Using 5-fluorouracil (5-FU), a cornerstone chemotherapeutic drug, we demonstrate that the main cause of death in ad libitum (AL) fed mice after 5-FU chemotherapy was infection caused by translocation of intestinal opportunistic pathogens. We show that these opportunistic pathogens greatly increase in the intestine after chemotherapy, which was closely related to loss of intestinal lysozyme. Of note, two weeks of dietary restriction (DR) prior to chemotherapy significantly protected the loss of lysozyme and increased the content of the beneficial Lactobacillus genera, resulting in a substantial inhibition of intestinal opportunistic pathogens and their translocation. The rescue effect of DR could be mimicked by Lysozyme or Lactobacillus gavage. Our study provides the first evidence that DR achieved a comprehensive protection of the intestinal physical, biological and chemical barriers, which significantly improved the overall survival of 5-FU-treated mice. Importantly, the above findings were more prominent in old mice. Furthermore, we show that patients over 65 years old have enriched opportunistic pathogens in their gut microbiota, especially after 5-FU based chemotherapy. Our study reveals important mechanisms for the poor chemotherapy tolerance of the elderly population, which can be significantly improved by short-term DR. This study generates new insights into methods for improving the chemotherapeutic prognosis by increasing the chemotherapy tolerance and safety of patients with malignant tumors.