Oral Supplementation Research Articles

EFFECTIVENESS AND SAFETY OF ORAL CALCIUM SUPPLEMENTATION DURING PREGNANCY FOR PREVENTION OF PREECLAMPSIA: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Calcium supplementation is a promising intervention in preventing preeclampsia, a major global health concern. Clinical trials and meta-analyses show its protective effect in reducing hypertensive complications. However, the exact effectiveness and safety profile require further evaluation to guide clinical practice. This systematic review aims to enhance evidence-based decision-making in maternal health.Methods: This systematic review adhered to PRISMA 2020 guidelines and focused exclusively on full-text articles published in English between 2015 and 2025. Editorials and review articles without a DOI were excluded to preserve the integrity of high-quality sources. A literature review was conducted utilizing reputable databases, including ScienceDirect, PubMed, and SagePub, to identify relevant studies.Result: The initial database search yielded over 30 relevant publications on the topic. Following a comprehensive three-stage screening process, eight studies met the specified inclusion criteria and were selected for in-depth analysis. A comprehensive critical evaluation was conducted for each study, enabling an in-depth analysis of the effectiveness and safety of oral calcium supplementation during pregnancy for the prevention of preeclampsia. This systematic approach ensured that the analysis was grounded in high-quality evidence, aligned with the study's objectives, and capable of providing significant insights into this complex association.Conclusion: Calcium supplementation is an effective measure to reduce preeclampsia risk, especially in those with insufficient dietary intake. The WHO recommends 1.5-2 grams daily, enhancing vascular stability and hypertension. However, individual reactions may vary, necessitating personalized strategies. Future studies should optimize dosage recommendations.

European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption.

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. A patient's medical and pharmacological history is essential for identifying risk factors. Several examinations such as endoscopy with small intestinal biopsies, non-invasive functional tests and radiological imaging are useful in diagnosing malabsorption. Because of its high prevalence, CD should always be looked for in cases of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in the management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians play a central role in the early detection of malabsorption and should be involved in multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving ten scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

The effect of oral nutritional supplementation combined with probiotics on the liver function and intestinal microflora in lung cancer chemotherapy patients through the gut-liver axis

The role of gut microbiota in cancer treatment research is receiving increasing attention. This study aims to evaluate the oral nutritional supplementation combined with probiotics on the liver function and intestinal microflora of lung cancer chemotherapy patients. An evaluation was conducted involving 113 patients with lung cancer, who were given routine hospitalization diet and oral nutrition supplement (ONS). The intervention group received probiotic supplementation, while the control group received placebo. It lasted for 21 days. The primary endpoint was the changes in liver function and intestinal microflora. Secondary endpoints included nutrition and immune status, and blood lipids. Compared with the control group, there were differences in the serum levels of ALT, AST, endotoxin and the amount of gut microbiota in the intervention group (P < 0.05). However, no significant changes were found in nutrition, immune, and the blood lipids status. ONS combined with probiotics could improve the liver function and gut microbiota status of lung cancer chemotherapy patients. We speculate that this may be due to the role of supplementing probiotics in regulating the gut-liver axis.

Effect of Probiotic Product Containing Heyndrickxia coagulans TBC169 on Hyperuricemia in Rats.

Hyperuricemia (HUA) is a metabolic disease characterized by elevated serum uric acid, which is closely related to the gut microbiota. Probiotics have great potential in improving HUA. The purpose of this study was to evaluate the effect and mechanism of probiotic product (SQK) containing Heyndrickxia coagulans TBC169 on HUA rats. Forty SD rats (6weeks old, 200 ± 20g) were randomly divided into four groups (Ctrl group, HUA group, SQK1 group, and SQK2 group) of 10 rats each. Rats were given potassium oxonate (100mg potassium oxonate/100g BW/day) for 12weeks to establish HUA model and simultaneously administered with sterile saline (HUA group) or different dose of SQK (SQK1 group, 20.48mg SQK/100g BW/day; SQK2 group, 40.95mg SQK/100g BW/day) throughout the 12weeks. The results showed that SQK could degrade uric acid precursors and inhibit the xanthine oxidase (XOD) activity in vitro. Oral supplementation of SQK can reverse the increase of serum uric acid, the increase of the liver and serum XOD activity, and the decrease of ABCG2 expression in the ileum induced by HUA. In addition, SQK could restore the changes in α and β diversity of the ileal microbiota and prevent the increase in pathogenic Helicobacter and Staphylococcus caused by HUA. 16S rRNA sequencing and correlation analysis showed that the chondroitin sulfate (CS) degradation pathway of the gut microbiota played a key role in the prevention of HUA in the SQK group. These findings suggest that SQK may improve HUA by reducing uric acid synthesis and increasing uric acid excretion and provide a basis for its development into a probiotic product to improve HUA.

Population Pharmacokinetic Modeling of TV-46000, a Risperidone Long-Acting Subcutaneous Antipsychotic for the Treatment of Patients with Schizophrenia.

TV-46000 is a long-acting subcutaneous antipsychotic (LASCA) agent that combines risperidone and an innovative, copolymer-based drug delivery technology in a suspension suitable for subcutaneous administration from a prefilled syringe. The objective of the current analysis was to characterize the pharmacokinetics (PK) of TV-46000 based on pooled data from phase1 and phase3 studies, and to further support clinical use aspects of TV-46000. A population PK (popPK) model was developed using TV-46000 PK data obtained from three phase1 studies (n = 267) and two phase3 trials (n = 425). A sequential parent-metabolite model structure was used, and the total active moiety (TAM) concentration-time profiles were simulated for TV-46000 once monthly (q1m) and once every 2months (q2m) across the range of available doses and different administration sites. The popPK model adequately characterized the PK of risperidone and its active metabolite. TV-46000 reaches therapeutic plasma TAM concentrations (≥ 10ng/mL) within 24h following first dose administration. Three months after initiation of TV-46000, 86% and 88% of steady-state TAM exposure were achieved for q1m and q2m, respectively, and steady state was fully attained by 6months (i.e., > 90% of steady-state TAM exposure). In addition, simulated D2 receptor occupancy for TV-46000 was generally within the therapeutic window of 60-80% during both dosing intervals. The developed popPK model, together with corresponding simulations, supports TV-46000 as a LASCA that offers flexible dosing intervals (q1m or q2m) and administration sites (abdomen or upper arm) and does not require oral supplementation or loading dose(s).

Impact of SGLT2 Inhibitors on Magnesium in Kidney Transplant Patients with and Without Diabetes

Magnesium (Mg2+) is essential for cardiovascular and metabolic health, yet hypomagnesemia is common in kidney transplant recipients (KTRs) due to immunosuppressive therapy and renal dysfunction. Oral Mg2+ supplementation is often ineffective due to poor absorption and side effects. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to increase serum Mg2+ in chronic kidney disease, but their effects in KTRs, particularly patients without diabetes, remain unclear. This observational study assessed 63 KTRs treated with dapagliflozin, analyzing the serum Mg2+ levels at baseline and after 3 and 6 months. The hypomagnesemia prevalence, associations with oral supplementation, diabetes status, and diuretic use were evaluated. The results showed a significant Mg2+ increase with SGLT2i therapy, reducing hypomagnesemia regardless of the diabetes status. Oral supplementation did not correlate with improved Mg2+ levels, reinforcing its limited efficacy. Additional benefits included reductions in the body weight, blood pressure, and serum urate without compromising graft function. SGLT2i may offer a novel approach to managing hypomagnesemia in KTRs, potentially reducing the reliance on ineffective supplements while providing renal and cardiovascular benefits. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

Effect of oral nutritional supplements administration on the management of children with picky eating and underweight: a systematic review and meta-analysis.

Effect of oral nutritional supplements administration on the management of children with picky eating and underweight: a systematic review and meta-analysis.

Malnutrition and perioperative nutritional rehabilitation in major operations

Summary Background Malnutrition is a potentially preventable risk factor for surgery. This systematic review examines nutritional management strategies aiming to enhance surgical outcomes. Methods A systematic search was conducted in PubMed for English-language studies published between July 1, 2004, and July 1, 2024, involving adult surgical patients. Study selection focused on four key themes: (1) nutritional screening and assessment, (2) preoperative nutritional therapy, (3) nutritional support in critically ill surgical patients, and (4) postoperative nutritional rehabilitation. Studies in non-surgical cohorts, letters, and case reports were excluded. Reference lists of relevant studies were manually screened for additional sources. Results Of 2763 studies identified, 251 met the inclusion criteria and 85 were added after manual screening, contributing to a total of 341 papers for the review. The prevalence of malnutrition varied widely by procedure, with the highest rates observed in pancreatic and esophagogastric operations. Preoperative malnutrition was strongly associated with increased postoperative complications, infections, prolonged hospital stay, and higher mortality. The Malnutrition Universal Screening Tool (MUST) was effective in identifying at-risk patients. Preoperative nutritional interventions, including dietitian-led counseling, oral supplementation, and enteral or parenteral nutrition, may reduce complications and improve outcomes. Critically ill patients benefited from structured enteral and parenteral strategies. Early postoperative nutrition within enhanced recovery after surgery (ERAS) protocols are linked to less complications and shorter hospital stay. Conclusion Malnutrition significantly impacts surgical outcomes, necessitating early identification and intervention. Standardized management is key to improving recovery and reducing complications. Future research should focus on refining diagnostic tools, assessing nutritional requirements, optimizing perioperative nutritional strategies, and establishing long-term nutritional follow-up guidelines for surgical patients.

Impacts of particles' aspect ratio on the efficacy of β-FeOOH nanorods as nano-based oral iron supplements.

Nano-iron oral supplements emerged as efficient supplements with reduced gastrointestinal side effects. Very recently, nanorods of β-FeOOH was introduced as the most efficient shape of nano-iron to be employed as oral supplement. Developed technologies in the fabrication of nanostructures provides the ability to synthesize β-FeOOH nanorods in various lengths while the other features are constant. As we all know, particles' length has an immense impact on the biologic properties of nanorods. But there are no in vivo data about the impacts of particles length on the bioavailability and possible toxicity of β-FeOOH nanorods. So, in this study, different lengths of β-FeOOH nanorods were fabricated and employed as oral iron supplements. In this order, β-FeOOH nanorods with two lengths (mean length 50 nm and 100 nm) were successfully synthesized via hydrolysis reaction. Oral supplementation of Sprague-Dawley rats with the synthesized nanorods and FeSO4 was performed in two dosages, 10 and 20 mg/Kg. After 1-month daily treatment, blood and tissue samples were collected for hematologic, toxicologic, and pathologic analyses. Compared to FeSO4, β-FeOOH nanorods demonstrated greater efficiency to improve serum iron levels (~ threefold increase) and also hematological parameters. Similar to FeSO4, nanorods exhibited any adverse effect on liver and spleen tissues. With the same level of biocompatibility, short nanorods provided better bioavailability than the long nanorods. These data approved the short β-FeOOH nanorods as efficient and safe nanostructures to be employed in nano-based formulation of iron supplements.

Multicenter phase II study on the efficacy of an oral nutritional supplement containing eicosapentaenoic acid in advanced gastric cancer patients with cachexia.

Cachexia is a common complication in advanced gastric cancer (AGC). Eicosapentaenoic acid (EPA) may ameliorate cachexia. This single-arm, phase II study assessed the potential benefit of an oral nutritional supplement containing EPA (ONS-EPA) for cachexia in AGC patients. Chemotherapy-naive AGC patients with cachexia, defined by serum albumin < 3.5g/dl and C-reactive protein ≥ 0.5mg/dl, were included. Patients received an EPA-enriched supplement (Prosure®, 1.056g EPA/pack) twice daily during first-line chemotherapy. The primary endpoint was time to treatment failure (TTF) in patients adhering to ≥ 25% of the planned ONS-EPA dose in the first two weeks (per-protocol set, PPS). Secondary analyses evaluated adherence impact on treatment outcomes. Of 72 enrolled patients, 65 were evaluated. Median adherence was 42.8%. Median TTF in the PPS group was 4.8months (95% CI 3.6-5.5), below the pre-set 4-month threshold. The PPS group had a higher proportion of patients who improved their nutritional and inflammatory status during treatment, along with better TTF and overall survival (OS) compared to those with poor adherence. Adjusted median TTF was 4.6 vs. 2.5months (hazard ratio: 0.56; 95% CI 0.28-1.12, p = 0.105). Although the primary endpoint was not achieved, the study suggests that ONS-EPA may benefit AGC patients with cachexia.

Lacticaseibacillus rhamnosus OF44 with Potent Antimicrobial Activity: Evidence from the Complete Genome and Phenotypic Analysis.

Lacticaseibacillus rhamnosus is extensively studied, with some strains widely applied for enhancing human health. Complete genome analysis is crucial for the functional exploration of probiotics. This study aimed to investigate the potential of L. rhamnosus OF44 (OF44) to promote human health through complete genome and phenotypic analysis. The complete genome sequence of OF44 was 2,978,769bp, with 2791 CDSs and an average GC content of 47%. In vitro experiments demonstrated that OF44 had a broad carbon source fermentation capacity. Resistance gene analysis and simulated digestion tests confirmed the favorable tolerance of OF44 under harsh conditions, suggesting its potential as an oral supplement. OF44 possessed various potential genes related to bioactive substances with antimicrobial activity, such as antimicrobial peptides, lactic acid, hydrogen peroxide, and exopolysaccharides, most of which were detected in vitro. Further, OF44 exhibited significant growth inhibition capacities against pathogens from the gut, vagina, skin, and mouth, likely due to high co-aggregation with pathogens, multiple antimicrobial peptide clusters, and adhesin gene clusters. Additionally, oral administration of OF44 was found to reduce the pH and inflammation levels in the vaginal microenvironment of rats with bacterial vaginosis. Therefore, OF44 exhibited probiotic properties in improving reproductive tract bacterial infections by modulating vaginal microbiota balance and inhibiting pathogen growth. In summary, this study provided a new perspective on the application of OF44 as a supplement in the food and pharmaceutical fields.

Effectiveness of an oral supplement containing Polypodium leucotomos in enhancing sun protection: a clinical evaluation of minimal erythema dose pre- and post-consumption.

Ultraviolet (UV) radiation contributes to skin erythema, photoaging, and an increased risk of skin cancer. Although topical sunscreens and protective clothing remain standard photoprotection measures, poor adherence often limits their efficacy. Oral supplements containing Polypodium leucotomos extract (PLE) have gained attention as convenient adjuncts that may bolster the skin's defenses against UV-induced damage. This study aimed to evaluate the photoprotective effects of a novel oral supplement, Sol Defense Gummies containing PLE, on the minimal erythema dose (MED) and erythema intensity in individuals with Fitzpatrick skin types I-III. Twenty-seven participants were enrolled; 25 completed the study. After baseline MED assessments without supplementation on Day 1, participants consumed 240mg of PLE bid for five days. MED was reassessed on Day 5 to determine any changes attributable to supplementation. Erythema intensity was further evaluated via colorimetry, visual grading, and standardized photography. Participant compliance and adverse events were monitored through daily diaries and staff reviews. By blinded visual grading following a five-day supplementation period, 64% of subjects showed improvement in MED. When evaluated by colorimeter 80% of subjects demonstrated some degree of enhanced photoprotection. 20% of participants demonstrated no improvement. The mean MED increased from approximately 223J/cm² to 234J/cm², and 44% of participants showed a quantifiable rise in MED. Short-term oral supplementation with Sol Defense Gummies containing PLE was associated with measurable improvements in photoprotection as evidenced by increases in MED and reductions in erythema. These findings support the potential of this novel PLE delivery method as a convenient adjunct to conventional photoprotection strategies.

Oral nutritional supplement combined with an online resistance training programme to improve physical function and nutritional status in older adults receiving home care and at risk of sarcopenia: protocol for the randomised controlled POWER trial

Background The aim of the POWER trial is to investigate the effects of a whey protein oral nutritional supplement (ONS) combined with an online resistance training (RT) programme compared to RT alone on physical function, nutritional status and health-related outcomes in community-dwelling older adults receiving supportive home care who are at risk of sarcopenia. Methods This home-based, randomised controlled trial will include older adults aged ≥70 years, receiving supportive home care (professional and/or informal), who will be screened for sarcopenia via telephone. Forty-six participants will be randomised into either (i) ONS + RT or (ii) RT only trial arms. Participants in the ONS + RT group will be provided with a whey protein ONS enriched with leucine and vitamin D to consume twice a day for 12 weeks. All participants will be provided with an online RT programme twice a week via Zoom. The primary outcomes are physical function, measured using the Timed Up and Go test and nutritional status, measured using the Mini-Nutritional Assessment-Full Form. Secondary outcomes include body composition, dietary intake, gait speed, muscle strength, cognitive function, depression risk, activities of daily living, quality of life and feasibility of intervention implementation. All outcomes will be measured at baseline, after and 12 weeks post-intervention. Conclusion This study will provide data on the effectiveness of a whey protein ONS enriched with leucine and vitamin D combined with an online RT programme delivered via Zoom, compared to the RT programme alone, for older adults at risk of sarcopenia and receiving supportive home care. Trial registration NCT05688956; registered December 2022.

Comparative analysis of dietary iron deprivation and supplementation in a murine model of colitis

AbstractInflammatory bowel diseases are chronic inflammatory conditions with growing prevalence in western populations. Iron is an essential component of erythrocytes hemoglobin. Under the influence of elevated hepcidin production, iron is sequestered in cells during inflammation which, in turn, leads to iron restriction for red blood cell synthesis. As a consequence, iron deficiency and anemia of inflammation are the most prevalent extraintestinal complications in IBD patients. Iron deficiency is commonly treated with oral iron supplements, with limited efficacy as iron absorption is blunted during intestinal inflammation. Moreover, iron supplementation can cause intestinal complications, as previous studies have shown that it can worsen the inflammatory response. However, a comparative analysis of the effects of low, adequate, and high dietary iron content matching the iron supplementation given to patients has not been performed in mice. We therefore tested the impact of dietary iron deprivation and supplementation in a murine model of colitis induced by dextran sodium sulfate. We found that both dietary iron deprivation and supplementation were accompanied by a more severe inflammation with earlier signs of gastrointestinal bleeding compared to mice fed an iron‐adequate diet. The manipulation of dietary iron led to a profound dysbiosis in the colon of control mice that differed depending on the dietary iron content. Analysis of this dysbiosis is in line with a pronounced susceptibility to colonic inflammation, thus questioning the benefit/risk balance of oral iron supplementation for IBD patients.

Poncirus trifoliata Extract and Its Active Coumarins Alleviate Dexamethasone-Induced Skeletal Muscle Atrophy by Regulating Protein Synthesis, Mitochondrial Biogenesis, and Gut Microbiota.

Sarcopenia, an age-related decline in skeletal muscle mass and function, contributes to frailty and increased morbidity in the elderly. This necessitates the development of effective interventions to combat muscle atrophy. This study investigated the therapeutic potential of Poncirus trifoliata ethanol extract (PT) and its coumarin derivatives against dexamethasone (DEX)-induced muscle atrophy. We employed invitro and invivo models of DEX-induced muscle atrophy. C2C12 myotubes were used for mechanistic studies. C57BL/6J mice received DEX injections and oral PT supplementation (50 mg/kg/day) to evaluate effects on muscle mass, function, gene expression, and gut microbiota composition. Invitro, PT enhanced protein synthesis, mitochondrial biogenesis, and myogenic differentiation in DEX-exposed myotubes, with auraptene, ponciol, and triphasiol identified as key bioactive coumarins. Invivo, PT significantly attenuated DEX-induced muscle atrophy, increasing tibialis anterior muscle mass by 36% (p < 0.01), grip strength by 31% (p < 0.001), and maximal running speed by 18% (p < 0.05). Mechanistically, PT upregulated genes associated with muscle function and mitochondrial health. Furthermore, PT modulated gut microbiota composition, notably increasing Phocaeicola vulgatus abundance 2.2-fold, which correlated with improved muscle performance (R = 0.58, p < 0.01). These findings suggest that PT and its coumarin derivatives, particularly auraptene, ponciol, and triphasiol, hold promise as therapeutic agents for combating muscle atrophy. The observed benefits may be mediated through enhanced protein synthesis, improved mitochondrial function, and modulation of the gut-muscle axis.

European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective.

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. Patient's medical and pharmacological history are essential for identifying risk factors. Several examinations like endoscopy with small intestinal biopsies, non-invasive functional tests, and radiologic imaging are useful in diagnosing malabsorption. Due to its high prevalence, CD should always be looked for in case of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians have a central role in early detection of malabsorption and should be involved into multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving 10 scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

Oral Sodium Bicarbonate vs. Use of Higher Dialysate Bicarbonate in Hemodialysis Patients With Metabolic Acidosis: A Randomized Controlled Trial.

The optimal strategy for correcting metabolic acidosis and maintaining acid-base balance in hemodialysis patients remains unclear. This study aimed to evaluate and compare the effects of oral bicarbonate administration vs. increased dialysate bicarbonate concentration on predialysis serum bicarbonate levels in hemodialysis patients with metabolic acidosis. This was a single-center, open-label, randomized controlled trial. Adult hemodialysis patients with metabolic acidosis (serum bicarbonate < 22 mmol/L) were randomly assigned in a 1:1:1 ratio to one of three treatment groups for 16 weeks: (1) standard dialysate (32 mM bicarbonate plus 3 mM acetate), (2) increased dialysate bicarbonate (34 mM bicarbonate plus 3 mM acetate), or (3) standard dialysate with daily oral sodium bicarbonate supplementation (0.3-0.5 mmol/kg). Of the 75 eligible participants, 66 completed the study. The primary outcome was the difference in predialysis serum bicarbonate levels between the groups at 16 weeks. Baseline predialysis serum bicarbonate levels averaged approximately 19.5 mmol/L across all three groups. At 16 weeks, there was no statistically significant difference in predialysis serum bicarbonate levels among the groups (p = 0.701). The mean levels were 20.1 (SD 2.16) mmol/L in the standard dialysate group, 20.5 (SD 2.04) mmol/L in the increased dialysate bicarbonate group, and 20.8 (SD 2.61) mmol/L in the oral supplementation group. Compared to baseline, predialysis bicarbonate levels significantly increased within the increased dialysate bicarbonate group (p = 0.010) and the oral supplementation group (p = 0.021), but not in the control (standard dialysate, no oral supplementation) group. Oral or dialytic bicarbonate supplementation at the doses used in this study demonstrated equivalent effects on predialysis serum bicarbonate concentrations in acidotic hemodialysis patients. However, the amount of supplemental bicarbonate administered via either route was insufficient to achieve the target correction of acidosis (e.g., predialysis serum bicarbonate ≥ 22 mmol/L).

Short-term oral zinc supplementation enhances Natural Killer cell functionality and decreases circulating Innate Lymphoid Cell counts and frequencies in healthy young adults

BackgroundZinc is an essential trace element with high importance for immune function. Previous research has shown that vegetarians and vegans are at increased risk of zinc deficiency, due to low zinc bioavailability in plant-based food. However, its effects on immune parameters in healthy adults following these diets remain largely unexplored. Therefore, this study investigated the effects of dietary patterns, serum zinc levels, and short-term oral zinc supplementation on Natural Killer (NK) cells, circulating Innate Lymphoid Cells (cILCs), and NK cell functionality in omnivores, vegetarians, and vegans.MethodsA total of 54 study participants, including 21 omnivores, 18 vegetarians, and 15 vegans were enrolled in our study. NK cell and cILC counts and frequencies were analyzed by flow cytometry and NK cell cytotoxicity assay was performed and compared between the three dietary cohorts as well as between zinc adequate (ZA) and zinc deficient (ZD) individuals. Based on serum zinc concentrations and/or Food Frequency Questionnaire (FFQ) scores, study participants classified as ZD were supplemented with 10 mg zinc daily for 14 days. After this period, the same experiments were performed.ResultsOur results show that neither dietary patterns nor baseline zinc levels significantly affect cILC or NK cell counts, frequencies, or NK cell cytotoxicity. However, short-term oral zinc supplementation significantly reduced cILC counts and frequencies, while enhancing NK cell functionality. Here, NK cell cytotoxicity is significantly positively correlated, whereas cILC counts are negatively correlated with serum zinc concentrations. Remarkably, 72% of all study participants, including 48% of omnivores, were classified as ZD.ConclusionsSince proper NK cell functionality is required for early defense against infected or malignant cells, and cILCs act as progenitors to replenish tissue resident ILCs, which are crucial for tissue homeostasis and barrier integrity, our results suggest that routine zinc supplementation might be a simple yet effective strategy to enhance immune defense and potentially prevent diseases across different dietary groups.Trial registrationThe study was approved and registered by the Institutional Ethics Committee of the Medical Faculty of RWTH Aachen University on the 19th of July 2023 (study numbers: EK 23–148 and EK 23–234, CTC number: 23–163).

Heart ketone metabolism under acute ketone supplementation in ZDF rats, a type 2 diabetes heart failure model

BackgroundIn non-insulin-dependent, type 2, diabetes mellitus (T2D), glucose metabolism is compromised, and the heart loses its metabolic flexibility. The Zucker Diabetic Fatty rat (ZDF) model, which replicates the pathophysiology of T2D in patients, shows that as T2D progresses so does heart failure. Heart ketone metabolism seems to play a role in mitigating the heart failure process. This study assesses ketone metabolism in a ZDF heart failure model using cardiac PET imaging.MethodsSix lean ZDF rats (CTRL) and six diabetic obese ZDF rats (T2D) were evaluated for coronary flow reserve (CFR) using [13N]ammonia ([13N]NH3) cardiac PET. In addition, rats were evaluated with [11C]acetoacetate ([11C]AcAc) PET during rest and stress conditions to assess ketone metabolism, both at baseline and under an acute exogenous ketone ester oral supplementation. Blood chemistry, cardiac function and hemodynamic parameters were also evaluated under these conditions.ResultsCFR was impaired in the T2D model (CTRL: 1.8 ± 0.5; T2D: 1.4 ± 0.2, p < 0.05) suggesting the development of heart failure in the T2D model. Blood ketones increased more than 2-fold after supplementation. The [11C]AcAc heart ketone uptake values with and without ketone supplementation were similar for the CTRL group, and these values were higher than for T2D rats. For the T2D group, the uptake decreased by 20% at rest under ketone supplementation vs. no supplementation (p < 0.05) and remained unchanged under stress with and without supplementation. Because of this decrease at rest, the stress/rest ratio after supplementation increases to the level observed in CTRL. [11C]AcAc heart ketone metabolism showed a slight decrease under stress for the CTRL group, but not for the T2D. Under ketone supplementation, the metabolism stress/rest ratio increased only in T2D (1.25 ± 0.29, p = 0.03 compared to baseline).ConclusionIn a rat model of T2D and CFR impairment, we were able to measure changes in ketone metabolism using [11C]AcAc PET at rest and under stress with and without acute ketone supplementation. Our findings suggest that the heart ketone metabolism of T2D rats is impaired during the heart failure process. Ketone supplementation may have the potential to restore this cardiac reserve.

The efficacy of Sarcomeal® oral supplementation plus vitamin D3 on muscle parameters, metabolic factors, and quality of life in diabetic sarcopenia: a randomized controlled clinical trial

AimTo investigate the efficacy of Sarcomeal® sachet, as a protein supplement, plus vitamin D3 on muscle parameters, metabolic factors, and quality of life (QoL) in individuals with diabetes and sarcopenia.MethodsSixty individuals were randomized into the control or intervention group. The intervention group received a daily dose of one Sarcomeal sachet and 1000 IU of vitamin D and both groups were recommended to consume protein-rich food, be educated about the disease, and perform physical activity for 12 weeks. Various assessments including muscle parameters, blood tests, and QoL were conducted at the beginning and the end of the trial.ResultsOver 12 weeks, although the intervention group had significant improvements in mean skeletal muscle mass index (SMI) (change: 0.17[0.016, 0.329] kg/m²; p < 0.05) and handgrip strength (change: 1.33[0.256, 2.410] kg; p < 0.05), differences between groups were not statistically significant. However, significant improvements were observed in lean mass (1.70 [0.749, 2.665] kg; P < 0.01) and lean mass index (0.62[0.287, 0.954] kg/m2; P < 0.01) between groups. Weight was maintained in the intervention arm, whereas the control arm experienced significant weight loss (1.87 [0.654, 3.109] kg; P < 0.01). Participants in the intervention arm did not show significant changes in blood parameters. The most reported side effects were loss of appetite (50%) and stomach heaviness (20.8%).ConclusionThis mixture of supplements significantly improved lean muscle mass, preserved physical function, and helped maintain weight, supporting its potential as a strategy to counter muscle loss and enhance the QoL in diabetic sarcopenia patients.Clinical trial registrationThis trial is registered at the Iranian Registry of Clinical Trials (IRCT) with IRCT20230831059311N1 ID.