Restricted Intake Research Articles

A CASE STUDY OF A 54-YEAR-OLD MAN WITH NYHA CLASS III, STAGE 2 HYPERTENSION, AND TYPE II DIABETES MELLITUS

Background: Heart failure is when the heart cannot pump enough blood to fulfill the body's needs. This disease is dangerous and can lead to death. The most common risk factors are hypertension, diabetes mellitus, and metabolic syndrome.Case Presentation: A 54-year-old man complained of shortness of breath for the last one month, which worsened during light activities and decreased when he was in a semi-sitting position. The patient had a history of hypertension and type-II diabetes mellitus for the last five years. On physical examination, the patient's blood pressure was 140/100 mmHg, respiratory rate was 25 bpm. There were paroxysmal nocturnal dyspnea, orthopnea, rales on both basal lung fields, dyspnea on exertion, ankle edema, a pansystolic murmur heard in the apex, ascites and ankle edema. Blood laboratory examination showed HbA1c 6%, chest X-ray and ECG showed cardiomegaly.Conclusion: The patient was diagnosed with NYHA Class III Heart Failure with stage 2 hypertension and type-2 diabetes mellitus and was treated with fluids, diuretics, ACE inhibitors, beta-blockers, low salt diet, restriction of fluid intake, and oral antidiabetics.

Isonitrogenous low-carbohydrate diet elicits specific changes in metabolic gene expression in the skeletal muscle of exercise-trained mice.

With the renewed interest in low-carbohydrate diets (LCDs) in the sports field, a few animal studies have investigated their potential. However, most rodent studies have used an LCD containing low protein, which does not recapitulate a human LCD, and the muscle-specific adaptation in response to an LCD remains unclear. Therefore, we investigated the effects of two types of LCDs, both containing the same proportion of protein as a regular diet (isonitrogenous LCD; INLCD), on body composition, exercise performance, and metabolic fuel selection at the genetic level in the skeletal muscles of exercise-trained mice. Three groups of mice (n = 8 in each group), one fed a regular AIN-93G diet served as the control, and the others fed either of the two INLCDs containing 20% protein and 10% carbohydrate (INLCD-10%) or 20% protein and 1% carbohydrate (INLCD-1%) had a regular exercise load (5 times/week) for 12 weeks. Body weight and muscle mass did not decrease in either of the INLCD-fed groups, and the muscle glycogen levels and endurance capacity did not differ among the three groups. Only in the mice fed INLCD-1% did the plasma ketone concentration significantly increase, and gene expression related to glucose utilization significantly declined in the muscles. Both INLCD-1% and INLCD-10% consumption increased gene expression related to lipid utilization. These results suggest that, although INLCD treatment did not affect endurance capacity, it helped maintain muscle mass and glycogen content regardless of the glucose intake restrictions in trained mice. Moreover, an INLCD containing a low carbohydrate content might present an advantage by increasing lipid oxidation without ketosis and suppressing muscle glucose utilization.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

An Exploratory Study of the Purchase and Consumption of Beef: Geographical and Cultural Differences between Spain and Brazil.

Beef consumption and production in Spain and Brazil are different with the consumption of beef in Brazil being three times higher than in Spain. In addition, there are variations in the economic value of production and in the traceability system. Therefore, the aim of this research was to understand the purchasing and consumption patterns using the customer behavior analysis technique of focus groups, which analyzed motivations for the consumption of beef, classifying their preferences by the intrinsic and extrinsic attributes at the time of purchase. The key aspect of the consumption of beef, both for Spanish and Brazilian consumers, was personal satisfaction/flavor. Spanish consumers were more conscious than Brazilians of the beneficial and harmful qualities that meat provides. The presence of fat was the factor that most restricted intake in both countries. The most important intrinsic attributes for Spanish and Brazilian consumers were the visual aspects of the meat: color, freshness, and the quantity and disposition of fat. The most important extrinsic characteristics were the price and expiration date. Spanish consumers see packaged meat as convenient and safe, although it is considered by Brazilians to be over-manipulated. The traceability certification on the label provides credibility to the product for the Spanish but only partially for Brazilians.

Pancytopenia due to Restrictive Food Intake in an Autistic Adult.

Autism spectrum disorder (ASD) is a neuro-behavioral syndrome that develops in childhood and can be comorbid with restrictive and avoidant food intake disorder. This case details a young man who was hospitalized with pancytopenia due to restrictive nutritional intake related to his severe ASD. He was found to have undetectable vitamin B12 levels. His blood counts improved with transfusion, nutritional supplementation, and dental care. This report illustrates the importance of understanding ASD and potential medical complications of related behaviors.

Phosphate and Cellular Senescence.

Cellular senescence is one type of permeant arrest of cell growth and one of increasingly recognized contributor to aging and age-associated disease. High phosphate and low Klotho individually and synergistically lead to age-related degeneration in multiple organs. Substantial evidence supports the causality of high phosphate in cellular senescence, and potential contribution to human aging, cancer, cardiovascular, kidney, neurodegenerative, and musculoskeletal diseases. Phosphate can induce cellular senescence both by direct phosphotoxicity, and indirectly through downregulation of Klotho and upregulation of plasminogen activator inhibitor-1. Restriction of dietary phosphate intake and blockage of intestinal absorption of phosphate help suppress cellular senescence. Supplementation of Klotho protein, cellular senescence inhibitor, and removal of senescent cells with senolytic agents are potential novel strategies to attenuate phosphate-induced cellular senescence, retard aging, and ameliorate age-associated, and phosphate-induced disorders.

Evaluation of urinary na levels as a risk factor in patients with coronary artery disease.

Restriction of salt intake is advised in the general population to reduce cardiovascular risk. Daily higher salt intake may contribute to high coronary artery disease (CAD) prevalence in the Turkish population, although there is limited data regarding salt intake and urinary sodium (Na) extraction in patients with CAD. In this study, we aimed to assess the relationship between urine Na, potassium (K), protein and creatine levels in patients with CAD. One hundred participants, aged 30-65, who underwent coronary angiography under elective conditions were enrolled in this study between May 2019 and August 2019. Patients who had known CAD before, acute coronary syndrome, hypertension, congestive heart failure, diabetes mellitus (DM), structural heart disease, malignancy, renal failure, and severe comorbid states were excluded from the study. Coronary angiograpy revealed CAD in 61 patients and normal coronary arteries in 39 patients who were classified as the control group. Morning urine samples were collected for analysis.The 24-hour urine sodium was calculated using the KAWASAKI method. Spot urinary protein extraction and spot urinary micro-protein/creatinine ratio were significantly higher in the CAD group than in the control group (p=0.035, p=0.031, respectively). Also, serum creatinine (Cr) was found to be higher while glomerular filtration rate (GFR) and Na levels were found to be lower in the CAD group than in the control group (p=0.014, p=0.012, p=0.016 respectively). The logistic regression model was statistically significant, χ2(25)=41.45, p=0.021 and GFR, Na levels, spot urinary micro-protein/creatinine, and HDL levels were assessed as predictive factors for CAD.CONCLUSİON: Urinary Na and K extraction is not affected by the presence of CAD. Also, spot urinary Na/ K ratio and 24-hour sodium extraction were similar between patients with and without CAD. However, decreased GFR and increased urinary micro-protein/creatinine ratio could be risk factors for CAD. Furter studies with large samples are needed to assess this relationship (Tab. 6, Ref. 16).

Abstract- Poster

IntroductionWater intoxication is a rare condition characterized by over consumption of water. In the case outlined below, it emerged as a result of psychogenic polydipsia.Case report informationHere we report an elderly male who presented with polydipsia while being on prolonged lithium therapy for more than 10 years for bipolar affective disorder. Further evaluation showed hyponatremia as a result of water intoxication due to the polydipsia and it confirmed the diagnosis of lithium induced polydipsia which responded to change in the drug and behavioral therapy.Intervention/treatmentProper evaluation of such a patient was done by comparison of serum and urine osmolality before confirming the diagnosis. The hyponatremia was resolved with water intake restriction. Discontinuation of lithium and start of valproate in such a patient was done. And as the manic phase of the patient subsided the symptoms of polydipsia also decreased.ResultHis manic symptoms and, as his symptoms improved, the water restriction was more manageable, and the serum sodium levels also increased, after ensuring water intake less than 1.5L per day, following which his serum osmolality and urine osmolality now were in the normal range.DiscussionPolyuria may occur more frequently with twice daily dosing. Lithium can cause a reduction in urinary concentrating capacity: Nephrogenic diabetes insipidus. Hence the occurrence of thirst and polyuria. This effect is usually reversible in the short to medium term but renal effects may be irreversible after long term treatment: >1.5 years.Psychogenic polydipsia is a disorder that can lead to significant morbidity and mortality and occurs in 6% to 20% of psychiatric patientsConclusionGiven how common psychogenic polydipsia is, we suggest that routine enquiry should be made into excessive water intake, in both inpatient and outpatient settings.

The Fluid Management Experience in Patients with Chronic Kidney Disease Undergoing Hemodialysis in Indonesia: A Qualitative Study

Background: Fluid management can reduce mortality, severe comorbidities, and debilitating symptoms in patients on hemodialysis. Therefore, a restricted fluid intake plan is crucial for patients with chronic kidney disease (CKD). Little evidence has been found to date on exploring the experience in fluid management of CKD patients in Indonesia.Purpose: This study aimed to explore the fluid management experience of adults with chronic kidney disease participating in hemodialysis treatment in Indonesia.Methods: A qualitative study with a phenomenological approach was conducted. Purposive sampling was used to recruit 14 adults patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital in Padang between July and September 2020. Manual content analysis using the Colaizzi approach was used to identify themes.Results: Data analysis revealed four themes with 12 sub-themes. The four major themes include the challenge of thirst control, fluid/diet restriction management, inadequate information, and the support system.Conclusions: The result showed the severe suffering and sadness experienced by CKD patients who conform to fluid restrictions. It is important to provide clear information on the fluid prescription or the exact consumable amount per day. Structured education with a personal approach is recommended to ensure detailed information regarding "fluid prescribing". The support obtained from family, friends, and dialysis staff is a significant factor in promoting acceptance and adherence.

Valine tRNA levels and availability regulate complex I assembly in leukaemia.

Although deregulation of transfer RNA (tRNA) biogenesis promotes thetranslation of pro-tumorigenic mRNAs in cancers1,2, the mechanisms and consequences of tRNA deregulation in tumorigenesis are poorly understood. Herewe use a CRISPR-Cas9 screento focus on genes that have beenimplicated in tRNA biogenesis, and identify a mechanism by which altered valine tRNA biogenesis enhances mitochondrial bioenergetics in T cell acute lymphoblastic leukaemia (T-ALL). Expression of valine aminoacyl tRNA synthetase is transcriptionally upregulated by NOTCH1, a key oncogene in T-ALL, underlining a role for oncogenic transcriptional programs in coordinating tRNA supply and demand. Limiting valine bioavailability through restriction of dietary valine intake disrupted this balancein mice, resulting in decreased leukaemic burden and increased survival in vivo. Mechanistically, valine restriction reduced translation rates of mRNAs that encode subunits of mitochondrial complex I, leading to defective assembly of complex I and impaired oxidative phosphorylation. Finally, a genome-wide CRISPR-Cas9 loss-of-function screen in differential valine conditions identified several genes, including SLC7A5 and BCL2, whose genetic ablation or pharmacological inhibition synergized with valine restriction to reduce T-ALL growth. Our findings identify tRNA deregulation as a critical adaptation inthe pathogenesis of T-ALL and provide a molecular basis for the use of dietary approaches to target tRNA biogenesis in blood malignancies.

Periodised Carbohydrate Intake Does Not Affect Substrate Oxidation but May Contribute to Endurance Capacity

ABSTRACT The aim of this study was to investigate whether periodising carbohydrate intake around specific training sessions will enhance endurance training adaptations. Seventeen healthy recreationally endurance-trained males (n = 5) and females (n = 12) (27.5 ± 5.4 years) participated in a four-week training intervention. Participants were divided into two groups: FASTED (stayed fasted between evening high-intensity interval training session and low-intensity training session in the following morning) and FED (no restriction in food intake). Pre- and post-testing included peak oxygen uptake (VO2peak), anaerobic capacity, and 60 min submaximal running tests. Fasted venous blood samples were drawn for the determination of triglyceride and glucose concentrations. VO2peak increased in both FASTED (4.4 ± 3.0%, p = 0.001) and FED (4.6 ± 4.2%, p = 0.017), whereas maximal running velocity increased only in the FASTED (3.5 ± 2.7%, p = 0.002). Lactate concentrations in the anaerobic test after intervention were greater in FASTED than FED (p = 0.025-0.041). Running time in the anaerobic test was improved in FASTED (from 64.1 ± 15.6–86.3 ± 23.2 s, p < 0.001) but not in FED (from 56.4 ± 15.2–66.9 ± 21.3 s, p = 0.099). Substrate oxidation did not change after intervention in either of the groups (p = 0.052–0.597). Heart rate was lower in the submaximal running test in FASTED (p < 0.001) but not in FED (p = 0.097). Training with periodised carbohydrate availability does not have any effect on substrate oxidation. However, it seems to enhance the capacity to perform high-intensity exercise.

Management of Chemotherapy Induced Mucositis

Oral mucositis is a severe ailment that causes erythema, edema, and ulceration of the oral mucosa, as well as pain and oral intake restrictions. Chemotherapy and radiation therapy are the most often utilized cancer treatment options. Despite the fact that these treatments are used to improve a patient's quality of life, they are linked to a number of negative side effects. Oral mucositis is a common side effect in patients undergoing head and neck radiation therapy. While some chemotherapy-related side effects are being better managed, mucositis is becoming more common. Reducing patient risk factors, adopt proven preventative measures, and optimize supportive care practices targeted to the patients' needs and symptoms are all recommendations that can be made. In clinical practice and research, a variety of measures have been used to record the amount and severity of oral mucositis. The World Health Organization (WHO) scale is a simple, easy-to-use scale that can be used in clinical practice on a regular basis. There are multiple approaches for management of Mucositis. Cryotherapy, palifermin, and sucralfate are among the three therapies that showed statistically significant effect in avoiding or lowering the severity of mucositis according to reports. In this article we’ll be looking at Chemotherapy induced mucositis, its etiology, epidemiology, evaluation. And most importantly management.

Association of Urinary Potassium Excretion with Blood Pressure Variability and Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease.

Dietary potassium intake is a dilemma in patients with chronic kidney disease (CKD). We investigated the association of urine potassium excretion, a surrogate for dietary potassium intake, with blood pressure variability (BPV) and cardiovascular (CV) outcomes in patients with pre-dialysis CKD. A total of 1860 participants from a cohort of pre-dialysis CKD (KNOW-CKD) patients were divided into the quartiles by spot urine potassium-to-creatinine ratio. The first quartile (26.423 ± 5.731 mmol/gCr) was defined as low urine potassium excretion. Multivariate linear regression analyses revealed an independent association of low urine potassium excretion with high BPV (adjusted β coefficient 1.163, 95% confidence interval 0.424 to 1.901). Cox regression analyses demonstrated that, compared to high urine potassium excretion, low urine potassium excretion is associated with increased risk of CV events (adjusted hazard ratio 2.502, 95% confidence interval 1.162 to 5.387) but not with all-cause mortality. In conclusion, low urine potassium excretion is associated with high BPV and increased risk of CV events in patients with pre-dialysis CKD. The restriction of dietary potassium intake should be individualized in patients with pre-dialysis CKD.

Body composition and bone mineral strength in female adolescent patients with anorexia nervosa

Rationale: Anorexia nervosa (AN) is characterized by a severe restriction of energy intake with low body weight reflecting depletion in body compartments.1 As a consequence some associated complications arise, particularly at the bone - low bone mineral strenght.

The materno-placental microbiome of gravid beef cows under moderate feed intake restriction

The materno-placental microbiome of gravid beef cows under moderate feed intake restriction

Impact of the nutritional status of children with congenital heart diseases on the early post-operative outcome

BackgroundChildren with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery.ResultsWe conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03).ConclusionsChildren with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

Effects of enteral nutrition on heart function, inflammatory markers and immune function in elderly patients with chronic heart failure.

ABSTRACTObjectives:To evaluate the effect of enteral nutrition on heart function, inflammatory markers and immune function in elderly patients with chronic heart failure and its clinical significance.Methods:Eighty patients with moderate and severe heart failure admitted to the Cardiology Intensive Care Unit (CCU) of Baoding First Central Hospital from May 2019 to May 2020 were included in this study and randomly divided into two groups: the experimental group and the control group, with 40 patients in each group. The experimental group was given enteral nutrition support therapy on the basis of conventional therapy for one month, while the control group was given restricted salt and water intake on the basis of conventional therapy, and patients were given free diet according to their wishes. The changes in heart function before and after treatment, changes in inflammatory factors such as TNF-a, CRP, IL-6, changes in levels of immunoglobulins such as IgA, IgM, and IgG, and the improvement of the performance status of the two groups were compared and analyzed.Results:After treatment, indicators such as BNP, LVEDD, LVEF and 6min walking distance in the experimental group were significantly improved compared with the control group, with statistically significant differences (p<0.05), and the levels of inflammatory factors such as TNF-a, CRP and IL-6 in the experimental group were significantly reduced compared with those in the control group (p=0.00). The levels of IgG, IgA, IgM and other immunoglobulins in the experimental group improved more significantly after treatment than those in the control group, with statistically significant differences (IgG, IgA, p=0.00; IgM, p=0.01). Moreover, the experimental group was significantly superior to the control group in the improvement rate of performance status score (ECOG) after treatment (p=0.04); The incidence of gastrointestinal adverse reactions in the experimental group was 20%, and that in the control group was 15%. No statistically significant difference can be observed in the gastrointestinal tolerance of both groups (p=0.56).Conclusions:Reasonable enteral nutrition boasts a variety of benefits for the recovery of elderly patients with chronic heart failure. With reasonable enteral nutrition, the heart function of elderly patients with chronic heart failure can be significantly improved, inflammatory factors can be reduced, immunity and performance status can be enhanced, and gastrointestinal tolerance can be ameliorated without obvious gastrointestinal reactions.

The Role of Dopamine in Contributing to Vulnerable and Resilient Phenotypes in a Mouse Model of Anorexia Nervosa

In the current issue of Biological Psychiatry, Beeler et al. (1) provide a compelling study of potential risk and resilience to activity-based anorexia (ABA), a rodent model of anorexia nervosa (AN). Traditionally, ABA combines restricted intake with unlimited running wheel access, which ultimately leads rodents to increase their activity, self-starve, and expire unless removed from the test paradigm. Working to extend the applicability of this model to risk for AN, Beeler et al. (1) aimed to determine whether genetically modifying dopamine would have an impact on resilience to the expected course of ABA.

Implicit approach‐avoidance tendencies toward food and body stimuli absent in individuals with anorexia nervosa, bulimia nervosa, and healthy controls

Body and food-related information are thought to activate cognitive biases and contribute to the maintenance of eating disorders (ED). Approach-avoidance biases may play an important role in the maintenance of dietary restriction and excessive food intake. Therefore, the present study aimed to examine approach-avoidance biases toward food and body stimuli in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). The study included 42 individuals with AN, 24 individuals with BN, and 38 HCs. We used two implicit Approach-Avoidance Tasks (AAT) to assess approach-avoidance biases: participants completed a Food-AAT (high-calorie vs. low-calorie food) and a Body-AAT (thin vs. normal weight bodies). Additionally, explicit ratings of food and body stimuli were assessed. There were no significant Group×Stimulus×Direction interactions in the implicit Food-AAT or implicit Body-AAT. In explicit ratings, individuals with AN and BN reported less urge to eat and more regret if they ate high-calorie and low-calorie food; individuals with AN and BN rated normal weight bodies as less normal weight, less attractive and less desirable than HCs. There were no group differences in explicit ratings of the thin body. We did not find evidence for biased approach-avoidance tendencies toward food or body stimuli in individuals with AN or BN. Future studies are necessary to understand conflicting findings regarding approach-avoidance biases toward food and body stimuli in individuals with ED.

Hematological Adaptations to Post-Exercise Sauna Bathing with No Fluid Intake: A Randomized Cross-Over Study

ABSTRACT Purpose: Sauna bathing is recommended to improve the sports training process, yet empirical evidence confirming its effectiveness is still inconclusive. We examined the effects of post-exercise sauna bathing on hematological adaptations and exercise capacity in healthy men. Methods: Thirteen physical education students participated in randomized cross-over study: two, 4-week interventions, with 10-week washout. The interventions involved 3 times per week 60-min stationary cycling either with 30-min of post-exercise sauna bathing (89 ± 3°C, 10 ± 2% RH) or without; no fluid was ingested during both exercise and sauna sessions. Before and after both interventions, participants were tested for total hemoglobin mass (tHb-mass), intravascular volumes, erythropoietin, ferritin, red blood cell parameters with reticulocyte fractions, along with maximal/peak and submaximal variables in a graded exercise test (GXT). Results: Regardless of intervention type, tHb-mass increased (p = .014) whereas ferritin concentration decreased (p = .027); however, changes in tHb-mass were within the range of typical error (<1.8%). Absolute and relative values of maximal power and power at gas exchange threshold, as well as peak oxygen uptake (all p < .010), also increased irrespective of intervention type. Conclusions: The use of post-exercise sauna bathing with fluid intake restrictions does not provide any additional benefits in tested variables over endurance training alone. Thus, further evidence is required before recommendations to utilize this post-exercise conditioning strategy are deemed valid.