Reduction In C-reactive Protein Levels Research Articles

Topical emollient therapy in the management of severe acute malnutrition in children under two: A randomized controlled clinical trial in Bangladesh.

BackgroundTopical emollient therapy can improve neonatal health and growth and potentially provides an additional avenue for augmenting the provision of nutrition to children with severe acute malnutrition (SAM). We hypothesised that topical treatment of hospitalised children with SAM using sunflower seed oil (SSO), in addition to standard-of-care for SAM, would improve skin barrier function and weight gain, reduce risk of infection, and accelerate clinical recovery.MethodsWe conducted a randomised, two-arm, controlled, unblinded clinical trial in 212 subjects aged 2 to 24 months who were admitted for care of SAM at the ‘Dhaka Hospital’ of icddr,b during January 2016 to November 2017. Enrollment was age-stratified into 2 to <6 months and 6 to 24 months age groups in a 1:2 ratio. All children received SAM standard-of-care, and the SSO group was also treated with 3 g of SSO per kg body weight three times daily for 10 days. Primary outcome was rate of weight gain over the 10-day study period. Secondary endpoints included rate of nosocomial infection, time to recovery from acute illness, skin condition score, rate of transepidermal water loss (TEWL) and C-reactive protein (CRP) level.ResultsRate of weight gain was higher in the SSO than the control group (adjusted mean difference, AMD = 0.90 g/kg/d, 95% confidence interval (CI) = -1.22 to 3.03 in the younger age stratum), but did not reach statistical significance. Nosocomial infection rate was significantly lower in the SSO group in the older age stratum (adjusted odds ratio (OR) = 0.41, 95% CI = 0.19 to 0.85; P = 0.017), but was comparable in the younger age stratum and overall. Skin condition score improved (AMD = -14.88, 95% CI = -24.12 to -5.65, P = 0.002) and TEWL was reduced overall (AMD = -2.59, 95% CI = -3.86 to -1.31, P < 0.001) in the SSO group. Reduction in CRP level was significantly greater in the SSO group (median: -0.28) than the control group (median 0.00) (P = 0.019) in the younger age stratum.ConclusionsTopical therapy with SSO was beneficial for children with SAM when applied as adjunctive therapy. A community-based trial with a longer intervention period is recommended to validate these results.Trial registrationClinicalTrials.gov: NCT02616289

Clinical effect of electroacupuncture at Baihui and Shuigou points in treatment of brain injury in patients with sepsis-associated encephalopathy

To investigate the clinical effect of electroacupuncture at Baihui (GV20) and Shuigou (GV26) points in the treatment of brain injury in patients with sepsis-associated encephalopathy(SAE). A total of 70 patients with SAE were randomly divided into control group and treatment group, with 35 patients in each group. The patients in the control group were given routine western medicine treatment, including anti-infective therapy, nerve nutrition, and mechanical ventilation, and those in the treatment group were given electroacupuncture at GV20 and GV26 in addition to the treatment in the control group. The course of treatment was 1 week for both groups. Serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and neuron-specific enolase (NSE) were measured for both groups, the Montreal Cognitive Assessment (MoCA) scale was used to assess the change in cognitive function, and Glasgow Coma Scale (GCS) score was determined before and after treatment and was used to evaluate treatment outcome after treatment. Both groups had significant reductions in the serum levels of CRP, IL-6, and NSE after 24 h and one week of treatment (P<0.05), and compared with the control group, the treatment group had significant reductions in the levels of CRP, IL-6 and NSE after treatment (P<0.05). The treatment group had significant increases in the total score of MoCA and the scores of all dimensions except attention after one week of treatment (P<0.05), and the treatment group had significantly higher scores than the control group after treatment (P<0.05). Both groups had a significant increase in GCS score after one week of treatment (P<0.05), and the treatment group had a significantly higher GCS score than the control group after treatment (P<0.05). The treatment group had a significantly higher total effective rate than the control group ［88.6% (31/35) vs 57.1% (20/35), P<0.05］. Electroacupuncture at GV20 and GV26 can effectively improve brain injury and effective rate in SAE patients.

Inflammation, pressure ulcers and poor functional status predict negative rehabilitation outcomes in postacute geriatric patients.

The purposes of this retrospective study were to document the prevalence of serum C-reactive protein (CRP), a biomarker of inflammation, and its potential predictive value for Rehabilitation outcomes in post-acute elderly inpatients. The medical records of 304 elderly subjects admitted to our Rehabilitation Institute for any disease following an acute event were examined. High levels of CRP (> 0.5mg/dl) were present in 100% of the subjects, and the value > 1.5mg/dl (n = 86) predicted unfavourable outcomes (n = 28; 32.5% of the patients: death or transfer to other institutions). Among the patients with favourable outcomes (discharge home n = 255), 62.7% still exhibited severe disabilities. Pressure ulcers and low functional status also predicted unfavourable outcomes. The study highlights the need for future investigations into the possible reduction of CRP levels, after an intensive nutritional approach and combined physical interventions.

Effects of strawberry intervention on cardiovascular risk factors: a meta-analysis of randomised controlled trials.

We conducted a meta-analysis of randomised controlled trials (RCT) to examine the effects of strawberry interventions on cardiovascular risk factors. We searched multiple databases including PubMed, Web of Science and Scopus to identify eligible studies published before 19 May 2019. The endpoints were blood pressure, total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, TAG, fasting blood glucose, endothelial function and inflammatory factors. Pooled analyses were performed using random- or fixed-effects models according to a heterogeneity test. We also conducted sub-group analyses by baseline endpoint levels. We included eleven RCT in this meta-analysis (six for blood pressure, seven for lipid profile, seven for fasting blood glucose and six for C-reactive protein (CRP)). Overall, the strawberry interventions significantly reduced CRP levels by 0·63 (95 % CI -1·04, -0·22) mg/l but did not affect blood pressure, lipid profile or fasting blood glucose in the main analyses. Our analysis stratified by baseline endpoint levels showed the strawberry interventions significantly reduced TC among people with baseline levels >5 mmol/l (-0·52 (95 % CI -0·88, -0·15) mmol/l) and reduced LDL-cholesterol among people with baseline levels >3 mmol/l (-0·31 (95 % CI -0·60, -0·02) mmol/l). There was little evidence of heterogeneity in the analysis and no evidence of publication bias. In summary, strawberry interventions significantly reduced CRP levels and may improve TC and LDL-cholesterol in individuals with high baseline levels.

The effect of resveratrol supplementation on C-reactive protein (CRP) in type 2 diabetic patients: Results from a systematic review and meta-analysis of randomized controlled trials

ObjectiveC-reactive protein (CRP) is considered to be an inflammatory marker in type 2 diabetes (T2D) and it is produced by liver cells. The evidence has suggested that resveratrol has anti-inflammatory effect. This study aimed to evaluate the effect of resveratrol supplementation on CRP level in patients with T2D using a systematic review and meta-analysis of randomized controlled trials. MethodsElectronic databases were completely searched using Medline, ISI Web of Science, EMBASE and Cochrane Library and Scopus until October 2019. Meta-analysis was performed using random-effects model and inverse variance method. Heterogeneity and publication bias were evaluated in selected studies. Sensitivity analyses and prespecified subgroup were conducted to evaluate potential heterogeneity. Meta-regression was performed to assess the effect of potential confounders on the estimated effect sizes. ResultsSix trials comprising a total of 491 subjects were included in this meta-analysis. The results showed significant reduction in the level of CRP [SMD (-0.34 mg/l) (95 % CI, -0.52, to -0.16) p < 0.05] in participants with T2D following supplementation with resveratrol. No significant publication bias was observed in the meta-analysis. Subgroup and sensitivity analyses indicated that the pooled effects of resveratrol supplementation on CRP level in T2D patients were affected by resveratrol dose and duration of resveratrol. Random-effects meta-regression did not indicate any significant association of CRP level with potential confounders including resveratrol dose, duration of treatment, age and gender of type 2 diabetic patients. ConclusionWe found a significant reduction in CRP level in patients with type 2 diabetes, who received resveratrol supplementation.

An Open-label Clinical Study to Determine the Effect of Enhanced Absorption Formula (MB EnzymeProandreg;) on the Bioavailability of Whey Protein in Healthy Male Subjects

Background: Several reports recommend that the dietary supplementation with Whey Protein (WP) in liquid form has been a popular choice for most of the individuals, especially athletes. Some product labels suggest a high serving size of 50 g for WP. Nevertheless, due to the limited endogenous digestive enzymes output and fast transit time, the average amount digested and absorbed may be approximately 15 g, thereby restricting protein bioavailability. The objective of this study was to find out whether MB EnzymePro®, a unique patent-pending Enhanced Absorption FormulaTM (EAF) of digestive proteases, significantly increases the digestion and absorption of WP, ultimately increasing bioavailability. The study also investigated its usefulness in significantly altering nitrogen (N2) balance and C-Reactive Protein (CRP) levels. Methods: An open-label, three-period, crossover, an oral bioavailability study was performed in healthy male subjects under fasting conditions. The study was carried out as per the Institutional Ethics Committee (IEC) approved study protocol and was registered with Clinical Trials Registry-India (CTRI). The study involved twenty-four subjects (age 20-36 years, BMI 20.0-24.0 kg/m2). A single dose of 50 g of WP alone (control), with one capsule (treatment A) and two capsules (treatment B) of MB EnzymePro® was administered to each group comprising 8 subjects. Blood samples were collected at specific time points up to 4 h for amino acid profile and CRP analysis. A total of 17 amino acids were quantified. Urine was collected after up to 24 h for total N2 analysis. Pharmacokinetic parameters were calculated using Phoenix® WinNonlin®. Results: The overall protein bioavailability enhancement was more than 50% for WP with MB EnzymePro®. A significant increase of more than 60% in BCAAs was noticed in the MB EnzymePro® treatment. The N2 balance and CRP levels were significantly better in the treated groups than the control group. Conclusion: Compared with the control condition, a patent-pending blend of digestive proteases (MB EnzymePro®) increased the digestion and absorption (bioavailability) of WP with improved N2 balance and reduced CRP levels.

Effect of Oral Nutrition Supplements and TGF-β2 on Nutrition and Inflammatory Patterns in Patients With Active Crohn's Disease.

Crohn's disease (CD) is often associated with nutrition disorders. Many nutrition therapeutic alternatives have been studied. Nevertheless, the actual role of nutrition therapy is still controversial. The objective of this study was to assess the effects of nutrition supplementation with and without transforming growth factor-beta 2 (TGF-β2) on inflammatory, endoscopic, histopathologic, and nutrition parameters in active CD. Thirty-eight patients were allocated into 3 groups: group 1 (patients who received only nutrition orientation), group 2 (nutrition orientation and a normoproteic, normocaloric nutrition supplement), and group 3 (nutrition orientation and the nutritional supplement with TGF-β2). Clinical and nutrition evaluation, C-reactive protein (CRP) levels, and assessment of endoscopic and histologic parameters in the intestinal mucosa were performed before and after nutrition intervention. The mean follow-up period was 3 months. In the beginning of the study, groups were homogeneous regarding age, gender, CD behavior and localization, and medication in use. In the end of the study, the Clinical Disease Activity Index score was reduced in groups 2 and 3; in group 3, a reduction in CRP levels and an improvement in histologic findings were observed. Among patients who received nutritional supplement, some anthropometric patterns were improved. The results of the study indicate that nutritional supplementation improved nutrition and inflammatory patterns in patients with active CD. However, only patients receiving TGF-β2-enriched formula showed improvement in histologic parameters and significant reduction in CRP levels.

Effects of Jump Rope Exercise on Adiposity &amp; Vascular Function in Prehypertensive Adolescent Girls

Childhood obesity is strongly associated with cardiovascular disease (CVD) development. It is necessary to combat unfavorable outcomes of obesity at a young age by utilizing effective interventions, such as exercise. PURPOSE: To examine the effects of a jump rope exercise program on CVD risk factors, including body composition, vasoactive substances, inflammation, and vascular function in prehypertensive adolescent girls. METHODS: Forty girls (age 14-16) were recruited and randomly assigned to a jump rope exercise group (EX, n=20) or control group (CON, n=20). Body composition, nitrate and nitrite levels, endothelin-1 (ET-1), c-reactive protein (CRP), systolic blood pressure and diastolic blood pressure (SBP, DBP), and arterial stiffness were measured before and after 12 weeks. RESULTS: There were significant group by time interactions following the 12-week program for body composition (from 33.8±3.6 to 30.2±3.1%), central adiposity (from 86.4±4 to 83.3±5 cm), SBP (from 126±3.3 to 120±2.1 mmHg), and brachial-to-ankle pulse wave velocity (from 8.2±1.0 to 7.4±0.2 m/s). Nitrate/nitrite levels increased (from 54.5±5.1 to 57.2±5.2 μmol) along a reduction in CRP levels (from 0.5±0.4 to 0.2±0.1 mg/L). There were no significant changes in ET-1 (P=0.22). CONCLUSIONS: These findings indicate that jump rope exercise may be an effective intervention to improve these CVD risk factors in prehypertensive adolescent girls. Jumping rope is an easily accessible exercise modality that may have important health implications for CVD prevention in younger populations.

Rosa canina – Rose hip pharmacological ingredients and molecular mechanics counteracting osteoarthritis – A systematic review

BackgroundThe successful use of rose hip for the treatment of osteoarthritis is well documented. Several randomized placebo controlled double-blind studies, as mono or combination therapy, have demonstrated treatment efficacy as well as excellent tolerability. PurposeThis review focuses on the molecular mechanism underlying the clinical effects of rose hip in osteoarthritis (OA). MethodsThe database Medline was screened – using the search term “Rosa canina” or “rose hip” – for publications on pharmacological or mechanistic studies with relevance to OA; in addition for findings on pharmacologically active constituents as well as clinical studies. The screening results were complemented by following-up on cited literature. ResultsIn particular, 24 pharmacological studies on Rosa canina or preparations thereof were considered relevant. Potent antioxidant radical scavenging effects are well documented for numerous rose hip constituents besides Vitamin C. Furthermore, anti-inflammatory activities include the reduction of pro-inflammatory cytokines and chemokines, reduction of NF-kB signaling, inhibition of pro-inflammatory enzymes, including COX1/2, 5-LOX and iNOS, reduction of C-reactive protein levels, reduction of chemotaxis and chemoluminescence of PMNs, and an inhibition of pro-inflammatory metalloproteases. ConclusionThe antioxidant and anti-inflammatory effects of Rosa canina match its clinical action – especially considering new findings on the pharmacological disease pattern of OA. The entirety of several compounds including phenolics, terpenoids, galactolipids, carotenoids, fruit acids and fatty oils can be considered responsible for the observed pharmacological and clinical effects. Further research is needed to eludicate how and in which manner single rose hip compounds interact with their molecular pharmacological targets.

High convective volumes are associated with improvement in metabolic profile in diabetic patients on online haemodiafiltration

Background and objectiveOnline haemodiafiltration (OL-HDF) with high convective transport volumes improves patient survival in haemodialysis. Limiting the amount of convective volume has been proposed in patients with diabetes mellitus due to glucose load that is administered with replacement fluid. The objective of the study was to analyze the influence of substitution volume on the evolution of the metabolic profile and body composition of incident diabetic patients on OL-HDF. Material and methodsProspective observational study in 29 incident diabetic patients on postdilution OL-HDF. Baseline data included clinical and demographic data, laboratory parameters (metabolic, nutritional and inflammatory profile) and body composition with bioimpedance spectroscopy (BIS). Laboratory parameters and mean substitution volume per session were collected every 4 months, and in 23 patients a further BIS was performed after a minimum of one year. Variations in glycosylated hemoglobin (HbA1c), triglycerides, total cholesterol, LDL-c, HDL-c, albumin, prealbumin and C reactive protein (CRP) were calculated at one year, 2 years, 3 years, and at the end of follow-up. Quarterly and annual variations were calculated as independent periods, and changes in body composition were analyzed. ResultsAge at baseline was 69.7±13.6 years, 62.1% were male, 72.3±13.9kg, 1.78±0.16m2, with 48 (35.5–76) months on dialysis. Approximately 81.5% received insulin, 7.4% antidiabetic drugs and 51.9% statins. Mean substitution volume was 26.9±2.9L/session and follow-up period (time on OL-HDF) was 40.4±26 months.A significant correlation was observed between mean substitution volume and the increase in HDL-c (r=0.385, p=0.039) and prealbumin levels (r=0.404, p=0.003) throughout follow-up. Moreover, substitution volume was correlated with a reduction in CRP levels at one year (r=−0.531, p=0.005), 2 years (r=−0.463, p=0.046), and at the end of follow-up (r=−0.498, p=0.007). Patients with mean substitution volume >26.9L/session had a higher reduction in triglycerides and CRP, and an increase in HDL-c levels. These patients with >26.9L/session finished the study with higher HDL-c (48.1±9.4mg/dL vs. 41.2±11.6mg/dL, p=0.025) and lower CRP levels (0.21 [0.1–2.22]mg/dL vs. 1.01 [0.15–6.96]mg/dL, p=0.001), with no differences at baseline.Quarterly comparisons between substitution volume and laboratory changes [n=271] showed a significant correlation with a reduction in HbA1c (r=−0.146, p=0.021). Similar findings were obtained with annual comparisons [n=72] (r=−0.237, p=0.045). An annual mean substitution volume over 26.6L/session (29.3±1.7L/session vs. 23.9±1.9L/session) was associated with a reduction in HbA1c (−0.51±1.24% vs. 0.01±0.88%, p=0.043). No correlation was observed between substitution volume and changes in weight, body mass index or BIS parameters. ConclusionThere is not enough evidence to restrict convective transport in diabetic patients on OL-HDF due to the glucose content of the replacement fluid.

Effect of sitagliptin and glimepiride on C-reactive protein (CRP) in overweight Type-2 diabetic patients.

Objectives:To compare the anti-inflammatory effect of sitagliptin and glimepiride by measuring CRP in overweight Type-2 diabetic patients.Methods:This clinical trial was conducted at diabetic clinic of Islam Central Hospital, Sialkot over a period of six months from June to November 2017. A total of 110 overweight Type-2 diabetic patients were divided in to two groups. Group-A was given tablet sitagliptin 50mg while Group-B was given tablet glimepiride 2mg for a period of 12 weeks. The dose was titrated according to blood sugar level. The primary outcome was measuring changes in CRP while secondary outcomes was changes in BMI, blood sugar, HbA1C, lipid profile and CRP from baseline in both study group using SPSS 16.Results:After 12 weeks treatment, body weight increased in glimepiride but slightly reduced in sitagliptin, however comparison between them was non significant (p=0.07). Although both groups reduced blood sugar and HbA1c but comparison between them was non significant (p=0.59 and p=0.17 respectively) value. However lipid profile improved significantly in sitagliptin vs. glimepiride group i.e total cholesterol (-25±32.5 vs +1.5±45.4 P=0.02) triglycerides (-19±44.6 vs-1.8±48.7 P=0.001) LDL- cholesterol (-10±22.4 vs-0.8±18.7 P=0.001) HDL-cholesterol (-2.6±6.2 vs 1.2±5.2 P=0.03).Sitagliptin significantly reduced CRP in comparison to glimepiride (-2.3±1.8 vs0.8±1.5 P=0.001).Conclusion:Sitagliptin has strong anti inflammatory effect marked by reduction in CRP level in comparison to glimepiride in overweight type-2 diabetic patients. It also exerted beneficial effect on glycemic and lipid profiles.

Metabolic syndrome and periodontal disease: An overview for physicians.

The metabolic syndrome (MetS) (also known as insulin resistance syndrome, syndrome X) is a cluster of factors associated with increased risk of developing coronary heart disease or type 2 diabetes mellitus. Several studies in the past have reviewed an association between MetS and periodontitis. Periodontal disease is considered an infectious and chronic inflammatory disease, and it has been considered to be a potential risk in cardiovascular and respiratory diseases and diabetes, and has implications in adverse pregnancy outcomes, osteoporosis, and so on. These systemic disorders have been documented as capable of affecting the periodontium or treatment of periodontal disease. Oral inflammatory lesions have different basic mechanisms concerning the possible association with systemic diseases. They concern local spread, metastatic spread, or immunologic cross-reactivity. In many studies, sometimes contrasting, periodontal pathogens have been evaluated in atheromatous plaques isolated from patients with chronic periodontitis. Oral inflammatory lesions have been shown unequivocally to contribute to elevated systemic inflammatory responses. In some studies, intensive periodontal therapy showed a significant reduction in c-reactive protein levels, interleukin-6, and low-density lipoprotein cholesterol after 2 months. The aim of this article is to reflect the association between MetS and periodontitis and to suggest an understanding to promote interprofessional practice; with proper oral care and plaque control, we can reduce the severity of MetS.

Probiotic supplementation and reducing infiammation in hemodialysis patients: A systematic review

Background: Chronic kidney disease (CKD) is a growing health problem worldwide. Uremic toxin buildup caused by protein bacterial metabolites such as indoleamines, urea, and indoxyl sulfate contribute to dysbiosis in the gut microbiome in hemodialysis patients, which contributes to a pro-infiammatory environment. Aims: This systematic review of the literature considers the confiicting evidence on probiotic supplementation and infiammatory status in CKD patients receiving hemodialysis. Methods: PubMed, EBSCO, and Google Scholar were all used to search for control/clinical trials demonstrating the effects of probiotic supplementation on these protein bacterial metabolites and C-reactive protein (CRP) levels. Results: Four of the five studies observed no significant findings in the reduction of infiammatory status in this population. One study demonstrated a significant reduction in CRP levels after 3 months of probiotic supplementation. Many articles varied between using single and multiple strains of bacteria which contributed to limitations to the studies. There was limited supporting evidence to suggest that probiotic supplementation could reduce infiammatory status in hemodialysis patients. Conclusions: Based on the findings, more research is needed before any conclusive recommendations can be made on whether probiotic supplementation would be beneficial for patients receiving hemodialysis treatments.

The effects of a 12-week jump rope exercise program on abdominal adiposity, vasoactive substances, inflammation, and vascular function in adolescent girls with prehypertension.

Childhood obesity is strongly associated with cardiovascular disease (CVD) development. It is necessary to combat unfavorable outcomes of obesity at a young age by utilizing effective interventions, such as exercise. We sought to examine the effects of a jump rope exercise program on CVD risk factors, including body composition, vasoactive substances, inflammation, and vascular function in prehypertensive adolescent girls. Forty girls (age 14-16) were recruited and randomly assigned to a jump rope exercise group (EX, n = 20) or control group (CON, n = 20). Body composition, nitrate and nitrite levels, endothelin-1 (ET-1), C-reactive protein (CRP), systolic blood pressure and diastolic blood pressure (SBP, DBP), and arterial stiffness were measured before and after 12 weeks. There were significant group by time interactions following the 12-week program for body composition (from 33.8 ± 3.6 to 30.2 ± 3.1%), central adiposity (from 86.4 ± 4 to 83.3 ± 5cm), SBP (from 126 ± 3.3 to 120 ± 2.1mmHg), and brachial-to-ankle pulse wave velocity (from 8.2 ± 1.0 to 7.4 ± 0.2m/s). Nitrate/nitrite levels increased (from 54.5 ± 5.1 to 57.2 ± 5.2µmol) along a reduction in CRP levels (from 0.5 ± 0.4 to 0.2 ± 0.1mg/L). There were no significant changes in ET-1 (P = 0.22). These findings indicate that jump rope exercise may be an effective intervention to improve these CVD risk factors in prehypertensive adolescent girls. Jumping rope is an easily accessible exercise modality that may have important health implications for CVD prevention in younger populations.

Los altos volúmenes convectivos se asocian a la mejoría del perfil metabólico en los pacientes diabéticos en hemodiafiltración online

Background and objectiveOnline haemodiafiltration (OL-HDF) with high convective transport volumes improves patient survival in haemodialysis. Limiting the amount of convective volume has been proposed in patients with diabetes mellitus due to glucose load that is administered with replacement fluid. The objective of the study was to analyse the influence of substitution volume on the evolution of the metabolic profile and body composition of incident diabetic patients on OL-HDF. Material and methodsProspective observational study in 29 incident diabetic patients on postdilution OL-HDF. Baseline data included clinical and demographic data, laboratory parameters (metabolic, nutritional and inflammatory profile) and body composition with bioimpedance spectroscopy (BIS). Laboratory parameters and mean substitution volume per session were collected every 4 months, and in 23 patients a further BIS was performed after a minimum of one year. Variations in glycosylated haemoglobin (HbA1c), triglycerides, total cholesterol, LDL-c, HDL-c, albumin, prealbumin and C reactive protein (CRP) were calculated at one year, 2 years, 3 years, and at the end of follow-up. Quarterly and annual variations were calculated as independent periods, and changes in body composition were analysed. ResultsAge at baseline was 69.7±13.6 years, 62.1% were male, 72.3±13.9kg, 1.78±0.16m2, with 48 (35.5-76) months on dialysis. Approximately 81.5% received insulin, 7.4% antidiabetic drugs and 51.9% statins. Mean substitution volume was 26.9±2.9L/session and follow-up period (time on OL-HDF) was 40.4±26 months.A significant correlation was observed between mean substitution volume and the increase in HDL-c (r=0.385, p=0.039) and prealbumin levels (r=0.404, p=0.003) throughout follow-up. Moreover, substitution volume was correlated with a reduction in CRP levels at one year (r=–0.531, p=0.005), 2 years (r=–0.463, p=0.046), and at the end of follow-up (r=–0.498, p=0.007). Patients with mean substitution volume >26.9L/session had a higher reduction in triglycerides and CRP, and an increase in HDL-c levels. These patients with >26.9L/session finished the study with higher HDL-c (48.1±9.4mg/dL vs. 41.2±11.6mg/dL, p=0.025) and lower CRP levels (0.21 [0.1-2.22] mg/dL vs. 1.01 [0.15-6.96] mg/dL, p=0.001), with no differences at baseline.Quarterly comparisons between substitution volume and laboratory changes [n=271] showed a significant correlation with a reduction in HbA1c (r=–0.146, p=0.021). Similar findings were obtained with annual comparisons [n=72] (r=–0.237, p=0.045). An annual mean substitution volume over 26.6L/session (29.3±1.7L/session vs. 23.9±1.9L/session) was associated with a reduction in HbA1c (–0.51±1.24% vs. 0.01±0.88%, p=0.043). No correlation was observed between substitution volume and changes in weight, body mass index or BIS parameters. ConclusionThere is not enough evidence to restrict convective transport in diabetic patients on OL-HDF due to the glucose content of the replacement fluid.

Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis.

We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients. A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137. Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2months after treatment) with standardized mean difference (SMD) of - 0.42 (95% CI - 0.68 to - 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of - 0.37 (95% CI - 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of - 0.32 (95% CI - 0.92 to 0.28, p = 0.29) and 0.16 (95% CI - 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of - 0.61 (95% CI - 1.16 to - 0.07, p = 0.03) and - 1.04 (95% CI - 1.70 to - 0.38, p = 0.002), respectively. Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.

Efficacy of Nutritional Interventions on Inflammatory Markers in Haemodialysis Patients: A Systematic Review and Limited Meta-Analysis.

Low-grade chronic inflammation is prevalent in patients undergoing haemodialysis (HD) treatment and is linked to the development of premature atherosclerosis and mortality. The non-pharmacological approach to treat inflammation in HD patients through nutritional intervention is well cited. We aimed to assess the efficacy of different nutritional interventions at improving inflammatory outcomes in HD patients, based on markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumour necrosis factor-α (TNF-α). We searched PubMed, Cochrane Library, and Embase for randomized controlled trials (RCT) published before June 2017. Inclusion criteria included RCTs on adult patients on maintenance HD treatment with duration of nutritional interventions for a minimum 4 weeks. Risk of bias was assessed using the Jadad score. In total, 46 RCTs experimenting different nutritional interventions were included in the review and categorized into polyphenols rich foods, omega-3 fatty acids, antioxidants, vitamin D, fibres, and probiotics. Meta-analyses indicated significant reduction in CRP levels by omega-3 fatty acids (Random model effect: −0.667 mg/L, p < 0.001) and vitamin E (fixed model effect: −0.257 mg/L, p = 0.005). Evidence for other groups of nutritional interventions was inconclusive. In conclusion, our meta-analysis provided evidence that omega-3 fatty acids and vitamin E could improve inflammatory outcomes in HD patients.

Physical Activity Alters Inflammation in Older Adults by Different Intensity Levels.

To examine the influence of reallocating time spent at different objectively measured physical activity (PA) behaviors on markers of systemic inflammation in older women with different levels of metabolic risk. Accelerometer-based monitoring of PA was conducted in a population of community-dwelling older women (n = 111; age, 65-70 yr) for determination of daily sedentary time, time in light PA (LPA) and moderate-to-vigorous PA (MVPA). Blood samples were collected for the assessment of the systemic inflammatory markers C-reactive protein (CRP), fibrinogen, and adiponectin. Metabolic risk was assessed by standardized procedures based on definitions for the metabolic syndrome. Data were analyzed by linear regression models based on isotemporal substitution analysis. Reallocating 30 min of sedentary time with either time in LPA (β = -0.47; P < 0.05) or MVPA (β = -0.42; P < 0.05) was related to reduced fibrinogen level, whereas no corresponding effect was evident when shifting time in LPA with time in MVPA, while holding sedentary time constant. In contrast, reallocating a 30-min period in sedentary (β = -0.70; P < 0.01) or LPA (β = -0.71; P < 0.01) with MVPA was associated with a significant reduction in CRP level, whereas no impact on CRP was observed when a period of sedentary behavior was replaced with LPA. Importantly, all significant influences on fibrinogen and CRP by displacement of different PA behaviors remained after adjustment for metabolic risk status among participants. No significant associations with adiponectin were observed. Altogether, this work supports the existence of different intensity thresholds mediating beneficial effects of PA on important clinical markers of systemic inflammation in older women across different stages of disease prevention.

Effect of Magnesium Supplementation on Plasma C-reactive Protein Concentrations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Results of previous clinical trials evaluating the effect of magnesium supplementation on inflammatory markers are controversial. A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to evaluating the effect of oral magnesium supplementation on plasma C-reactive protein (CRP) concentrations. PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (from inception to August 09, 2016) to identify RCTs, evaluating the effect of magnesium on CRP levels. A random-effects model and a generic inverse variance method were used to compensate for the heterogeneity of studies. Publication bias, sensitivity analysis, and meta-regression assessments were conducted using standard methods. Overall, the impact of magnesium supplementation on plasma concentrations of CRP was assessed in 11 studies. Magnesium treatment was not found to significantly affect plasma concentrations of CRP (WMD: -0.11 mg/L, 95% CI: -0.75, 0.52, p=0.727). When the analysis was stratified to compare subgroups of studies in populations with baseline plasma CRP values of ≤ 3 and > 3 mg/L, a significant reduction of CRP values was observed in the latter subgroup (WMD: -1.12 mg/L, 95% CI: -2.05, -0.18, p=0.019) but not in the former group (WMD: 0.61 mg/L, 95% CI: -0.10, 1.32, p=0.090). The difference between subgroups was statistically significant (p=0.004). Results of the present meta-analysis indicated that magnesium supplementation reduces CRP levels among individuals with inflammation (CRP levels > 3 mg/dL). This finding suggests that magnesium supplements may have a beneficial role as an adjuvant for the management of low-grade chronic systemic inflammation.

Does Improved Periodontal Health affect Metabolic and Inflammatory Markers in Patients with Diabetes Mellitus? A Comparative Study

Background: Periodontal disease is considered as the “sixth complication of diabetes mellitus”. Patients suffering from diabetes mellitus (DM) are known to have increased susceptibility to infections which lead to poor metabolic control. Although it has been reported that improved metabolic control may lead to improved periodontal health it is still unclear whether the control of periodontal infections may improve the metabolic control of diabetes.&#x0D; Aim: To compare the effect of periodontal therapy on metabolic and inflammatory markers in diabetic patients.&#x0D; Materials and Methods: The study type was in vivo comparative study. 60 patients were selected for the study using simple random sampling method. The patients were grouped into control and case with 30 in each group. In all patients, plaque index, gingival index, probing pocket depth and clinical attachment level were assessed with the help of with The University of North Carolina probe (UNC-15) probe at baseline, 1 month and 3 month. Similarly, venous blood samples were taken for evaluating fasting glucose level, post prandial glucose level, glycated haemoglobin and C-reactive protein (CRP) at baseline, 1 month and 3 month. In treatment group, full mouth scaling and root planing was done and oral hygiene instructions was provided.&#x0D; Results: The result of the study suggested that non surgical periodontal therapy helps in controlling glycemic level and CRP values in patients with diabetes mellitus.&#x0D; Conclusion: Non-surgical periodontal treatment is associated with improved glycaemic control and reduction in CRP level in patients with DM.