Oral Nutrient Intake Research Articles

Enteral nutrition on discharge from intensive care and 30-day unplanned readmission: An exploratory, retrospective study of association

Individuals who survive critical illness are often malnourished with inadequate oral nutrient intake after leaving the intensive care unit (ICU). Enteral nutrition (EN) improves nutrient intake but there is limited evidence on the impact of maintaining EN after discharge from the ICU. The objective of this exploratory study was to understand the association between EN maintenance after ICU and 30-day unplanned hospital re-admission, to inform on future prospective research into the effects of post-ICU nutrition. This was a single-centre, retrospective study of ICU patients, requiring ventilation, who received EN for at least 3 days in ICU and were discharged to the ward. 102 patients met the inclusion criteria; 45 (44.1%) maintained EN and 57 (55.9%) discontinued EN after ICU discharge; there were no significant differences in demographics or clinical measures at ICU admission. Reason for EN discontinuation was documented in 38 (66.7%) patients, with 27 (71%) discontinuing EN due to a routine ward practice of feeding tube removal. Unplanned 30-day hospital re-admission occurred in 17 (16.7%) patients overall, 5 (11.1%) in the EN group and 12 (21.1%) in the non-EN group (crude odds ratio [OR] 0.47, 95% CI 0.15, 1.45, p=0.188). After adjusting for age, sex, BMI and length of stay, there was a persistent trend to lower re-admission rates in the EN group (OR 0.37, 95% CI 0.09, 1.57, p=0.176). EN maintenance after ICU discharge was associated with a trend to lower 30-day unplanned hospital re-admission rates. The clinically relevant reduction of about 50% in unplanned re-admission rates in this exploratory study warrants larger, prospective studies of post-ICU nutrition strategies based on clear discontinuation criteria to optimize nutrition and evaluate patient-centred outcomes.

Glycemic Excursion and Insulin Action Revealed in a Rare Case of Type 1 Diabetes Complicated with Short Bowel Syndrome.

We herein report a 52-year-old woman with a rare combination of short bowel syndrome due to massive resection of the small intestine and complete loss of endogenous insulin due to type 1 diabetes. To provide nutritional support, she was treated with total parenteral nutrition with co-administration of insulin, requiring careful matching of insulin and glucose levels. This case report provides insights on glycemic excursion and insulin action in type 1 diabetes, even when both insulin and glucose are administered directly into circulation, and the usual obstacles caused by subcutaneous injection of insulin and oral intake of nutrients are eliminated.

The behavior of lemon-based thickened fluids submitted to the IDDSI flow test as a strategy for dysphagia treatment

Dysphagia is a health condition that causes swallowing difficulty, which may be treated by many techniques. Feeding modified foods should be a usual protocol for these individuals, as it will rarely be a diet of choice but a diet necessary to maintain a safe oral intake of nutrients. All people who suffer from changes in swallowing have difficulty in oral feeding, which compromises their nutritional status, mainly due to dehydration. Thickening of fluids is a well-established management strategy for oropharyngeal dysphagia. Thus, this research aimed to evaluate commercial lemon-based beverages (juices and flavored waters) with the addition of thickeners through the gravity flow test, according to the protocol established by the International Dysphagia Diet Standardization Initiative (IDDSI). Eight commercial beverage samples, categorized as flavored carbonated water (L01, L02, L03, L04), isotonic beverage (L05), liquid soft drink (L06) and powdered soft drink (L07 and L08), in addition to two thickeners based on xanthan gum were used. A 10 mL slide-tip syringe with a barrel length of 61.5 mm was employed for the flow test. thickening agents to lemon-based beverages caused substantial changes in their rheological properties. Differences between samples and treatments were observed according to the type and amount of thickener. Samples L05 and L08 showed 8.55 and 8.05 mL retention in the syringe, respectively, classifying them as moderately thickened liquids, while the others samples were classified as slightly thickened liquids. The ideal treatment for the dysphagic patient aims to ensure a safe intake and a correct nutritional and water supply, in addition to the consequent improvement of the patient’s general clinical condition. According to their nutritional profile, the inclusion of these beverages may be interesting in increasing some micronutrients such as sodium, potassium, calcium, phosphorus and magnesium. The flow properties of lemon-based beverages can be a good option for patients with dysphagia when improved using low amounts of thickening agents to suit their diets.

Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults.

Several studies reported that impaired nutrition is associated with reduced muscle mass, muscle strength, and physical performance. Chewing ability is essential to maintain balanced oral nutrient intake. The study was designed to define the possible relationship between chewing ability and nutrition-related problems (malnutrition, sarcopenia, and frailty) in a holistic perspective. This cross-sectional study recruited adults aged ≥65 years. All patients were evaluated with comprehensive geriatric assessment. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criterion. Malnutrition was determined according to body mass index, calf circumference, and Mini Nutritional Assessment short form (MNA-SF). Frailty status was diagnosed with the Clinical Frailty Scale. Masseter and gastrocnemius muscle thicknesses (MTs) were measured via ultrasonography imaging. Oral examinations were carried out by a dentist, and chewing performance was examined with a color-changeable chewing gum. Overall, 135 older adults (76 females) were analyzed. Mean ± SD age was 75.7 ± 7.2 years; 37.0% of the patients were frail, 3.7% were malnourished, 12.6% were sarcopenic, and 20.0% had poor chewing function. In the poor chewing function group, age and frailty scores were increased and the MNA-SF scores, handgrip strength, skeletal muscle index, and masseter MT were reduced (all P < 0.05). After adjusting for confounders, regression analysis showed that low grip strength and low gastrocnemius MT were independently associated with poor chewing ability. Chewing ability was related to sarcopenia. Age and low grip strength in females and low cognitive scores and having low gastrocnemius MT in males were independent variables affecting chewing ability.

Computational Mechanisms of Osmoregulation: A Reinforcement Learning Model for Sodium Appetite.

Homeostatic control with oral nutrient intake is a vital complex system involving the orderly interactions between the external and internal senses, behavioral control, reward learning, and decision-making. Sodium appetite is a representative system and has been intensively investigated in animal models of homeostatic systems and oral nutrient intake. However, the system-level mechanisms for regulating sodium intake behavior and homeostatic control remain unclear. In the current study, we attempted to provide a mechanistic understanding of sodium appetite behavior by using a computational model, the homeostatic reinforcement learning model, in which homeostatic behaviors are interpreted as reinforcement learning processes. Through simulation experiments, we confirmed that our homeostatic reinforcement learning model successfully reproduced homeostatic behaviors by regulating sodium appetite. These behaviors include the approach and avoidance behaviors to sodium according to the internal states of individuals. In addition, based on the assumption that the sense of taste is a predictor of changes in the internal state, the homeostatic reinforcement learning model successfully reproduced the previous paradoxical observations of the intragastric infusion test, which cannot be explained by the classical drive reduction theory. Moreover, we extended the homeostatic reinforcement learning model to multimodal data, and successfully reproduced the behavioral tests in which water and sodium appetite were mediated by each other. Finally, through an experimental simulation of chemical manipulation in a specific neural population in the brain stem, we proposed a testable hypothesis for the function of neural circuits involving sodium appetite behavior. The study results support the idea that osmoregulation via sodium appetitive behavior can be understood as a reinforcement learning process, and provide a mechanistic explanation for the underlying neural mechanisms of decision-making related to sodium appetite and homeostatic behavior.

Vitamin C and Omega-3 Fatty Acid Intake Is Associated with Human Periodontitis-A Nested Case-Control Study.

Vitamins and omega-3 fatty acids (Ω3FA) modulate periodontitis-associated inflammatory processes. The aim of the current investigation was to evaluate associations of oral nutrient intake and corresponding serum metabolites with clinical severity of human periodontitis. Within the Food Chain Plus cohort, 373 periodontitis patients—245 without (POL) and 128 with tooth loss (PWL)—were matched to 373 controls based on sex, smoking habit, age and body mass index in a nested case-control design. The amount of oral intake of vitamins and Ω3FAs was assessed from nutritional data using a Food Frequency Questionnaire. Oral intake and circulatory bioavailability of vitamins and Ω3FA serum metabolomics were compared, using ultra-high-resolution mass spectrometry. Periodontitis patients exhibited a significantly higher oral intake of vitamin C and Ω3FA Docosapentaenoic acid (p < 0.05) compared to controls. Nutritional intake of vitamin C was higher in PWL, while the intake of Docosapentaenoic acid was increased in POL (p < 0.05) compared to controls. In accordance, serum levels of Docosapentaenoic acid were also increased in POL (p < 0.01) compared to controls. Vitamin C and the Ω3FA Docosapentaenoic acid might play a role in the pathophysiology of human periodontitis. Further studies on individualized nutritional intake and periodontitis progression and therapy are necessary.

Timing of Meals and Exercise Affects Hormonal Control of Glucoregulation, Insulin Resistance, Substrate Metabolism, and Gastrointestinal Hormones, but Has Little Effect on Appetite in Postmenopausal Women.

The current prevalence of obesity in the US is strongly associated with excessive food intake and insufficient physical activity. This study examined whether changing the timing of exercise before or after two daily meals could alter human appetite for food. Fifty-four healthy postmenopausal women were matched by body weight and assigned to two groups: (1) two bouts of 2-h moderate-intensity exercise ending one hour before each weight-maintenance meal (XM, n = 23), (2) two-hour moderate-intensity exercise starting 1 h after each weight-maintenance meal (MX, n = 23), and one sedentary control (SED) arm (n = 8). Measurements included appetite ratings, circulating glucose, free fatty acids (FFAs), a ketone body D-ß-hydroxybutyrate (BHB), glucoregulatory hormones insulin and glucagon, and gastrointestinal hormones associated with food digestion and absorption and implicated in appetite sensations. XM group increased concentrations of FFAs and BHB during exercise and increased insulin and homeostatic assessment of insulin resistance (HOMA-IR) during postprandial periods. MX group reduced postprandial insulin and HOMA-IR by about 50% without a major change in plasma glucose. There was brief suppression of hunger and an increase in satiation in both exercise groups near the end of the first postprandial period. The time course of hunger was unrelated to the perturbations in fuel metabolism, depletion of liver glycogen, and not correlated with concentration changes in hunger-stimulating hormone ghrelin during XM exercise before meals. Similarly, there was no correlation between the time course of fullness during exercise after meals with the postprandial secretion of gastrointestinal hormones including cholecystokinin (CCK) that has been linked to satiation. Hunger and satiation appear to depend on oral intake and gastrointestinal processing of nutrients and are not affected by metabolic and hormonal consequences of the timing of exercise with respect to meals. Moderate-intensity exercise performed shortly after meals induces a rapid and highly effective lowering of insulin resistance.

Serum Glucagon like peptide 1 Level and Peripheral Vascular Disease in Patients with Type 2 Diabetes

Abstract Background Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Incretins are hormones produced by the intestinal mucosa in response to oral intake of nutrients that enhance glucose-stimulated insulin secretion and lower blood glucose levels. GLP-1 is of particular interest for its glucoselowering effects, as well as its ability to slow gastric emptying and suppress secretion of glucagon. Objective To assess the level of glucagon like peptide-1 in type 2 diabetic patients with peripheral vascular disease. Patients and Methods Our study was conducted in the period from 1st of January to 1st of June 2017. Our subjects were collected from the diabetes clinics of Ain Shams university Hospitals. The study included eighty (80) patients divided into 40 type 2 diabetic patients without peripheral vascular disease (Group 1) and 40 type 2 diabetic patients with peripheral vascular disease (Group 2). Results Diabetic patients with peripheral vascular disease show statistically significant higher HbA1c levels than diabetic patients without peripheral vascular disease with P-value 0.005 (P-value &amp;lt;0.05). GLP 1 was highly significantly positively correlated with APSV with P-value&amp;lt; 0.001. GLP 1 correlated negatively with BMI, FBS, 2h PPBS and HbA1C; with statistically significant difference; P-value (0.031, 0.015, 0.033 and 0.010 respectively) but was not significantly negatively correlated with age, SBP and DBP; P-value (0.232, 0.654 and 0.335 respectively). Conclusion GLP-1 levels are lower in diabetic patients with peripheral vascular disease than diabetic patients without peripheral vascular disease. GLP-1 levels showed significantly lower levels with increasing degree of obesity, FBS, PPBS and HbA1c.

Zinc as a complementary treatment for cancer patients: a systematic review

Zinc is a trace element that plays an important role in the immune system and cell growth. The role of zinc in cancer treatment has been discussed for some time, however without reaching an evidenced-based consensus. Therefore, we aim to critically examine and review existing evidence on the role of zinc during cancer treatment. In January 2019, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychINFO, CINAHL and PubMed) to find studies concerning the use, effectiveness and potential harm of zinc therapy on cancer patients. Out of initial 5244 search results, 19 publications concerning 23 studies with 1230 patients were included in this systematic review. The patients treated with zinc were mainly diagnosed with head and neck cancer and underwent chemo-, radio- or concurrent radio-chemotherapy. Interventions included the intake of different amounts of zinc supplements and oral zinc rinses. Outcomes (primary endpoints) investigated were mucositis, xerostomia, dysgeusia, pain, weight, dermatitis and oral intake of nutrients. Secondary endpoints were survival data, quality of life assessments and aspects of fatigue, immune responses and toxicities of zinc. The studies were of moderate quality reporting heterogeneous results. Studies have shown a positive impact on the mucositis after radiotherapy. No protection was seen against mucositis after chemotherapy. There was a trend to reduced loss of taste, less dry mouth and oral pain after zinc substitution. No impact was seen on weight, QoL measurements, fatigue, and survival. The risk of side effects from zinc appears to be relatively small. Zinc could be useful in the prevention of oral toxicities during irradiation. It does not help in chemotherapy-induced side effects.

Nutrition and Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic eczematous disease characterized by T helper 2 (Th2) -shifted allergic immunity, skin barrier impairment, and pruritus. Oral intake of certain nutrients might help regulate AD. Serum 25-hydroxyvitamin D levels are often low in patients with AD, and oral vitamin D supplementation improves AD. Vitamin D increases regulatory T (Treg) cells, which promote tolerance to allergens and prevent allergic inflammation by inducing expression of filaggrin and cathelicidin in keratinocytes. Vitamin A strengthens Treg cells by inducing expression of forkhead box P3 and inhibits mediator release from mast cells and eosinophils. Serum levels of γ-linolenic acid and its metabolite, dihomo-γ-linolenic acid, are low in patients with AD, and oral γ-linolenic acid improves AD through anti-inflammatory prostaglandin D1 and E1 derived from dihomo-γ-linolenic acid. Eicosapentaenoic acid and docosahexaenoic acid ameliorate AD by suppressing production of leukotriene B4, increasing ceramides in the stratum corneum, and through their metabolites, resolvin E1 and D1, which resolve inflammation. The probiotics Lactobacillus and Bifidobacteria improve the intestinal permeability barrier and induce Treg cells. Zinc levels in serum, hair, and erythrocytes are diminished in patients with AD. Zinc induces forkhead box P3 expression and increases Treg cells, and zinc-finger protein A20 suppresses nuclear factor-κB-dependent expression of inflammatory cytokines and cell-adhesion molecules. Oral supplementation of the above nutrients might have therapeutic or preventive roles in AD.

Quality of life and regular diet in patients with chronic kidney disease

Introduction : Chronic kidney disease (CKD) is characterized by a reduced rate of glomerular filtration (GF), under 60 mL/min/1.73 m2, and/or laboratory data, and/or image data for kidney damage, present for more than 3 months. According to recent data, nearly 8.7% of the world population suffer from CKD with different etiology. CKD is a progressive health condition that can result in an end stage renal disease (ESRD). Materials and Methods : The quality of life (QoL) of these patients is of utmost importance and is related to their functional activity, well-being and overall perception of their health in a physical, psychological and social aspect. A direct link between QoL, morbidity rate and death rate exists. It has been established that patients with CKD have a significantly lower QoL compared to healthy people, which becomes clearer during the more advanced stages of the disease. Physical activity decreases progressively with the progression of kidney disease. Results : Sociodemographic, clinical and laboratory risk factors have been established in the population of dialysis patients, which definitely leads to a change in QoL. Malnutrition, which is observed in patients with CKD, can also contribute to a decline in their quality of life. Its occurrence results from a reduced food intake, increased protein consumption and altered endocrine function of the kidneys. Oral intake of nutrients raises the chances of treating protein-energy wasting (PEW) in patients with ESRD. Conclusion : Conducting dietary consultations, as well as preparing individual diets to meet a patient’s specific needs, will increase their quality of life.

Medical Nutrition Therapy for a Critically Ill Patient With Spinal Cord Injury: A Case Report

Spinal cord injury causing chronic paralysis affects the body’s energy and protein requirements. Central nervous system injuries require long-term healing, and its complications can lead to prolonged bed rest, decreased life expectancy, and reduced quality of life. The risk of malnutrition due to chronic inactivity can lead to a loss of muscle mass, which affects nutritional status. Medical nutrition therapy aims to decrease the metabolic response, maintain fat-free mass, and prevent complications. We report a 58-year-old critically ill man with a spinal cord injury who had a normal weight initially; his medical nutrition therapy was based on nutrition guidelines for critically ill patients and gradually increased as per his clinical and gastrointestinal tolerance. He was given vitamin B supplementation and treated for 69 days. On discharge, he had optimal oral nutrient intake and normal weight. Adequate nutrition supported his recovery, increased his functional capacity, and maintained his nutritional status.

Current Evidence for the Use of Smoflipid® Emulsion in Critical Care Patients for Parenteral Nutrition.

There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20–50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient's physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function. However, these patients also require a mixture of essential and nonessential fatty acids (SMOF emulsions) to supply not only energy needs but also restore immunological, anti-inflammatory, and proregenerative functions. A revision of the safety and efficacy of Smoflipid® in patients requiring long-term parenteral nutrition was discussed here. Although controversial data are available indicating the contraindications or effectiveness of its use, most of studies presented indicate favorable benefits associated with improved clinical outcomes. The reported roles of this supplementation include positive immunomodulatory and anti-inflammatory effects, positive impact in liver function, reduction of hospital stay, and nosocomial infections as additional contributions to its energetic role, which in many cases results in reduced total costs per patient. Finally, many authors propose that the use of Smoflipid® should become a gold standard of parenteral nutrition in intensive unit care patients and that the costs associated with this supplement should not be limiting for its use, not only to improve the clinical outcome but also to reduce the treatment costs.

Patient and family management of mucositis in children and adolescents with Acute Lymphoblastic Leukemia undergoing chemotherapy in Qatar: A narrative review

Objective: Currently oral mucositis in children and adolescents is a growing concern and requires emphasis on dental care, initial and ongoing assessment of the oral cavity, oral care, tooth brushing and oral rinses, as well as pain management. The purpose of this narrative review is to highlight the need and to outline the importance of assessment, treatment and care of children and adolescents while they go through chemotherapy treatments. It is during this treatment that oral mucositis is most prevalent due to the breakdown of rapidly dividing cells.Methods: Narrative review.Results: Providing planned mouth care education to patients and parents is useful in preventing and managing oral mucositis.Conclusions: Oral mucositis affects more than 75% of children and adolescents undergoing chemotherapy and places a significant burden on patients and caregivers. Severity of oral mucositis can range from mild, painless tissue changes to bleeding ulcerations that may prevent oral intake of nutrients and require narcotic analgesics to control associated pain. Oral mucositis also leads to an increased risk of infection and often delays further chemotherapy regimens. The peer reviewed literature supports structured patient and family education.

The Effects of a Normal Rate versus a Slow Intervalled Rate of Oral Nutrient Intake and Intravenous Low Rate Macronutrient Application on Psychophysical Function - Two Pilot Studies.

Stomach distension and energy per time are factors influencing satiety. Moreover, different rates of nutrient intake induce different stomach distension. The goal of our studies was to elucidate the influence of different oral rates of nutrient intake (normal rate versus slow intervalled rate; study I) and intravenous low rate macronutrient application (protein, carbohydrate, fat) or placebo (study II) on psychophysical function. The pilot studies investigated the effects of 1) study I: a mixed nutrient solution (1/3 protein, 1/3 fat, 1/3 carbohydrates) 2) study II: intravenous macronutrient infusions (protein, carbohydrate, fat) or placebo on psychophysical function (mood, hunger, food craving, alertness, smell intensity ratings and hedonic ratings) in human subjects. In study I 10 male subjects (age range: 21–30 years) completed the study protocol participating in both test conditions and in study II 20 male subjects (age range: 19–41 years) completed the study protocol participating in all test conditions. Additionally, metabolic function was analyzed and cognitive and olfactory tests were conducted twice starting 100 min before the beginning of the intervention and 240 min after. Psychophysical (mood, hunger, fat-, protein-, carbohydrate-, sweets- and vegetable-craving), alertness and metabolic function tests were performed seven times on each examination day. Greater effects on hunger and food cravings were observed for normal rate of intake compared to slow intervalled rate of intake and intravenous low rate macronutrient application. Our findings potentially confirm that volume of the food ingested and a higher rate of energy per time contribute to satiety during normal rate of food intake, while slow intervalled rate of food intake and intravenous low rate macronutrient application showed no effects on satiation. Our results motivate the view that a certain amount of volume of the food ingested and a certain energy per time ratio are necessary to reduce hunger and food craving.

The oncologist as coordinator of the nutritional approach

Although the nutritional approach, especially when delivered through a gastric or jejunal tube or in a central vein, is handled by the nutritional support team or a specialist in nutrition, it is the responsibility of the oncologist, who knows the natural history of the disease and the impact of the oncologic therapy, to identify the potential candidates for the nutritional support, to recommend the nutritional strategy and to integrate it within the oncologic program. If gastrointestinal function is preserved, the initial nutritional approach should be through oral supplementation, followed by tube feeding if previous attempts are unsuccessful or upper gastrointestinal tract is not accessible. Parenteral nutrition is the obligatory resort when patients are (sub)obstructed but it may also be a practical way to integrate an insufficient oral nutrient intake (so called “supplemental” parenteral nutrition). Depending on the patient's condition and the disease's stage, artificial nutrition may have a “permissive” role in patients receiving aggressive oncologic therapy or represent just a supportive treatment in patients likely to succumb from starvation sooner than from tumor progression.

The Governor has a sweet tooth – Mouth sensing of nutrients to enhance sports performance

The oral–pharyngeal cavity and the gastrointestinal tract are richly endowed with receptors that respond to taste, temperature and to a wide range of specific nutrient and non-nutritive food components. Ingestion of carbohydrate-containing drinks has been shown to enhance endurance exercise performance, and these responses have been attributed to post-absorptive effects. It is increasingly recognised, though, that the response to ingested carbohydrate begins in the mouth via specific carbohydrate receptors and continues in the gut via the release of a range of hormones that influence substrate metabolism. Cold drinks can also enhance performance, especially in conditions of thermal stress, and part of the mechanism underlying this effect may be the response to cold fluids in the mouth. There is also some, albeit not entirely consistent, evidence for effects of caffeine, quinine, menthol and acetic acid on performance or other relevant effects. This review summarises current knowledge of responses to mouth sensing of temperature, carbohydrate and other food components, with the goal of assisting athletes to implement practical strategies that make best use of its effects. It also examines the evidence that oral intake of other nutrients or characteristics associated with food/fluid intake during exercise can enhance performance via communication between the mouth/gut and the brain.

Características y tipos de agonistas del receptor de GLP-1. Una oportunidad más para la individualización terapéutica

Glucagon-like peptide 1 (GLP-1) is secreted from enteroendocrine L-cells in response to oral nutrient intake and elicits glucose-stimulated insulin secretion while suppressing glucagon secretion. Moreover slows gastric emptying –reducing postprandial glycemic excursions–, reduces body weight, systolic blood pressure and has beneficial effects in the cardiovascular and central nervous systems.Since the 1990s, the efficacy of GLP-1 in reducing blood glucose levels in type 2 diabetes (DM2) was well known. However, GLP-1 should be administered by chronic subcutaneous infusion because of the rapid cleavage by the enzyme dipeptidyl peptidase 4 (DPP-4). Hence, DPP-4 inhibitors –which increase pseudo-physiologically endogenous GLP-1 levels– were developed. In addition, several GLP-1 receptor agonists have been designed to avoid DPP-4-breakdown and/or rapid renal elimination and, therefore, induce a pharmacologic effect in the GLP-1 receptor: short-acting, long-acting, and prolonged-acting GLP-1 analogs. Each class has different structural, pharmacodynamic and clinical properties and could be administered in different therapeutical regimens giving us the opportunity to individualize the therapy of DM2.

Nutritional status and dysphagia risk among community-dwelling frail older adults.

Although the presence of dysphagia is a key determinant of nutritional status among older adults, few studies have focused on the association between malnutrition and dysphagia risk in community-dwelling frail older adults. This study estimated the prevalence of malnutrition and quantified the association between malnutrition and dysphagia risk among community-dwelling older Japanese adults requiring long-term care. Cross-sectional study. This study was conducted with the cooperation of the Japan Dental Association and local dental associations in all 47 prefectures from January to February 2012. Individuals aged ≥65 years capable of oral nutrient intake who were living at home and receiving home dental care and treatment. Individual demographic characteristics and factors associated with health loss-related functional decline were obtained through interviews by home-visit dentists and self-administered questionnaires. Nutritional status and dysphagia risk were evaluated using the Mini Nutritional Assessment Short Form and the Dysphagia Risk Assessment for the Community-dwelling Elderly. Among 874 respondents (345 men and 529 women), 24.6% were malnourished, 67.4% were at risk of malnutrition, and 8.0% were well nourished. Dysphagia risk was related to an increased likelihood of malnutrition at an old age, even after adjusting for covariates (PR = 1.30, 95% CI = 1.01-1.67). Malnutrition is highly prevalent among community-dwelling frail older adults, and dysphagia risk is independently associated with malnutrition. Dysphagia may be an important predictor of malnutrition progression in aged populations.

Effects of glucagon-like peptide-1 receptor agonists on non-alcoholic fatty liver disease and inflammation.

Glucagon-like peptide1 (GLP-1) is secreted from Langerhans cells in response to oral nutrient intake. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new class of incretin-based anti-diabetic drugs. They function to stimulate insulin secretion while suppressing glucagon secretion. GLP-1-based therapies are now well established in the management of type 2 diabetes mellitus (T2DM), and recent literature has suggested potential applications of these drugs in the treatment of obesity and for protection against cardiovascular and neurological diseases. As we know, along with change in lifestyles, the prevalence of non-alcoholic fatty liver disease (NAFLD) in China is rising more than that of viral hepatitis and alcoholic fatty liver disease, and NAFLD has become the most common chronic liver disease in recent years. Recent studies further suggest that GLP-1RAs can reduce transaminase levels to improve NAFLD by improving blood lipid levels, cutting down the fat content to promote fat redistribution, directly decreasing fatty degeneration of the liver, reducing the degree of liver fibrosis and improving inflammation. This review shows the NAFLD-associated effects of GLP-1RAs in animal models and in patients with T2DM or obesity who are participants in clinical trials.