Restricted Intake Research Articles

Ketone bodies supplementation restores the barrier function, induces a metabolic switch, and elicits beta-hydroxybutyrate diffusion across a monolayer of iPSC-derived brain microvascular endothelial cells

Glucose constitutes the main source of energy for the central nervous system (CNS), its entry occurring at the blood-brain barrier (BBB) via the presence of glucose transporter 1 (GLUT1). However, under food intake restrictions, the CNS can utilize ketone bodies (KB) as an alternative source of energy. Notably, the relationship between the BBB and KBs and its effect on their glucose metabolism remains poorly understood. In this study, we investigated the effect of glucose deprivation on the brain endothelium in vitro, and supplementation with KBs using induced pluripotent stem cell (iPSC)-derived brain microvascular endothelial cell-like cells (iBMECs).Glucose-free environment significantly decreased cell metabolic activity and negatively impacted the barrier function. In addition, glucose deprivation did not increase GLUT1 expression but also resulted in a decrease in glucose uptake and glycolysis. Supplementation of glucose-deprived iBMECs monolayers with KB showed no improvement and even worsened upon treatment with acetoacetate. However, under a hypoglycemic condition in the presence of KBs, we noted a slight improvement of the barrier function, with no changes in glucose uptake. Notably, hypoglycemia and/or KB pre-treatment elicited a saturable beta-hydroxybutyrate diffusion across iBMECs monolayers, such diffusion occurred partially via an MCT1-dependent mechanism. Taken together, our study highlights the importance of glucose metabolism and the reliance of the brain endothelium on glucose and glycolysis for its function, such dependence is unlikely to be covered by KBs supplementation. In addition, KB diffusion at the BBB appeared induced by KB pre-treatment and appears to involve an MCT1-dependent mechanism.

Zinc Enhancement through Supplementation and Dietary Implementation – Does It Affect Oxidative Stress and Antioxidant Status in Chronic Kidney Disease Patients?

Background: Chronic kidney disease (CKD) patients might be zinc deficient due to compromised nutritional intake and dietary protein restrictions; protein foods being rich in zinc. Zinc deficiency might cause increased oxidative stress and consequently reduced antioxidant parameters. Tailored dietary counseling along with zinc supplementation may play a major role in affecting the zinc and antioxidant status of patients. Aim: The aim of this study was to investigate the effect of zinc supplementation and dietary counseling on oxidative stress and antioxidant parameters in CKD patients. Materials and Methods: 185 subjects were enrolled for the study (145 were predialysis patients [Group-1 (Stage-3 CKD) and Group-2 [Stage-4 CKD]) on the basis of Kidney Disease Outcomes Quality Initiative CKD stages from 1 to 5; and 40 apparently healthy controls. Zinc supplementation alone (Intervention 1) was given to 50 CKD patients (30 Group-1 and 20 Group-2). Diet counseling (Intervention 2) consisted of 45 patients (25 Group-1; 20 Group-2). 50 patients (30 Group-1 and 20 Group-2) received both zinc supplementations along with diet counseling (Intervention 3). Dietary zinc status, oxidative stress and antioxidants were accessed for all subjects. Results: Intervention-1 and 3 groups exhibited highly significant improvement in antioxidant status and lowering of oxidative stress. Conclusion: Improving zinc status through dietary counseling and supplementation may help in combating enhanced oxidative stress by improving antioxidant parameters in renal failure patients.

Treatment of maple syrup urine disease: Benefits, risks, and challenges of liver transplantation.

Maple syrup urine disease (MSUD) is caused by a deficiency in the activity of the branched-chain α-ketoacid dehydrogenase (BCKD) complex, promoting the accumulation of the branched-chain amino acids (BCAA) leucine, isoleucine, and valine, as well as their respective α-keto acids. MSUD is an autosomal recessive hereditary metabolic disorder characterized by ketoacidosis, ataxia, coma, and mental and psychomotor retardation. The mechanisms involved in the brain damage caused by MSUD are not fully understood. Early diagnosis and treatment, as well as proper control of metabolic decompensation crises, are crucial for patients' survival and for a better prognosis. The recommended treatment consists of a high-calorie diet with restricted protein intake and specific formulas containing essential amino acids, except those accumulated in MSUD. This treatment will be maintained throughout life, being adjusted according to the patients' nutritional needs and BCAA concentration. Because dietary treatment may not be sufficient to prevent neurological damage in MSUD patients, other therapeutic strategies have been studied, including liver transplantation. With transplantation, it is possible to obtain an increase of about 10% of the normal BCKD in the body, an amount sufficient to maintain amino acid homeostasis and reduce metabolic decompensation crises. However, the experience related to this practice is very limited when considering the shortage of liver for transplantation and the risks related to the surgical procedure and immunosuppression. Thus, the purpose of this review is to survey the benefits, risks, and challenges of liver transplantation in the treatment of MSUD.

#6606 MEDICATION VOLUME COMPARISON TO BIND PHOSPHATE

Abstract Background and Aims Elevated phosphate concentrations are associated with a significantly increased risk of cardiovascular disease and overall mortality in patients with chronic kidney disease. Current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend lowering elevated serum phosphorus concentrations toward the normal range in patients with end-stage kidney disease on dialysis through restriction of dietary phosphorus intake, increase in clearance by dialysis, and the use of phosphate binders. However, ∼75% of dialysis patients are not achieving normal phosphate concentrations, potentially due to low adherence and/or binders’ insufficient phosphate binding capacity to match dietary intake. A phosphate binder with a higher phosphate binding capacity could improve phosphate control and potentially clinical outcomes. This study evaluated the medication volume of various phosphate binders to bind 1 gram of phosphorus. Methods Five phosphate binders were assessed: ferric citrate (210 mg ferric iron), calcium acetate (667 mg calcium acetate), lanthanum carbonate (500 and 1,000 mg lanthanum), sevelamer carbonate (800 mg sevelamer carbonate), and lanthanum dioxycarbonate (500 and 1,000 mg lanthanum). The mean daily dose volume to bind 1 g of phosphate was calculated as volume per tablet multiplied by the mean number of tablets taken per day. The volume to bind 1 g of phosphate was calculated by dividing the volume per tablet by its in vivo binding capacity, based on NIH DailyMed website. Results Binding to 1 g of phosphate required 5.6 cm3 of lanthanum dioxycarbonate compared with lanthanum carbonate (19.8 cm3), calcium acetate binders (25.0 cm3), ferric citrate (46.5 cm3), and sevelamer carbonate (73.4 cm3) (Figure 1). Conclusion The study found that lanthanum dioxycarbonate had the lowest volume to bind the same amount of phosphate compared to other binders. With a low medication volume and high phosphate binding capacity, lanthanum dioxycarbonate, a novel investigational nanotechnology product, can be a welcoming choice for patients to manage their hyperphosphatemia. The drug's decreased pill size (making it easy to swallow) and its tolerability have the potential to increase medication adherence and improve phosphate control.

#5367 CLINICAL SIGNIFICANCE OF NORMO-HYDRATION STATE IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The assessment of fluid status in dialysis patients is of paramount importance. Managing persistent volume overload and instability during dialysis is a significant challenge, with concomitant symptomatic and asymptomatic intradialytic hypotension (IDH) that results in dialysis-induced myocardial ischemia (cardiac stunning) and long patient recovery times.Our aim was to estimate the status of hydration in our peritoneal dialysis population by body composition monitoring (BCM) device to modify our pharmacological and dialysis policy and to evaluate echocardiographic parameters of the RV functions in patients with end-stage renal disease (ESRD) undergoing PD. Method We used a Fresenius Body Composition Monitor (BCM), a whole-body bioimpedance spectroscopy (50 frequencies, 5–1,000 kHz), to assess the body composition of 35 patients on peritoneal dialysis in our centre..We measured body weight, 24 h diuresis and performed a BCM session. Analysed results of echocardiography focused on RV (tricuspid annular plane systolic excursion (TAPSE). As per statistics, comparisons between 2 groups done by students t test, Mann Whitney U test or Wilcoxon test. Correlation between data was done by Pearson or spearman correlation. And lastly categorical variables were assessed by fisher's exact, and Chi squared test. Results Average age was 47 years old (SD 9,45 t-test p = 0,1154:). Gender distribution was 54,3% of our patients were female. 8,6% of our patients were anuric, 91,4% had residual urine (more than 1 litre). TAPSE value were average 23,17 mm (±4,5).We measured over-hydration in 8 cases by BCM that followed dialysis policy modification. In 8 PD patients we measured more than 2 L volume overload (VO) with BCM followed by dialysis policy modification (fluid intake restriction, diuretic dose increasing, frequent solution exchange). Conclusion Our data raised the importance of regular echocardiography to identify it. More attention should be focused on improving BP and volume control and identifying treatment strategies that effectively lower further deterioration in PD patients. One way of doing this is monitoring with BCM. With this clinician can manage persistent overload in CAPD patients, to better modify the dialysis regime, restrict fluid intake and use diuretics, to all in all preserve LV and RV function, and to prevent deterioration of the peritoneal membrane, and most importantly improve their survival.

Results of Salt Intake Restriction Monitored with the New Sodium Control Biosensor

Introduction: Adherence to a low-sodium (Na) diet is crucial in patients under hemodialysis, as it improves cardiovascular outcomes and reduces thirst and interdialytic weight gain. Recommended salt intake is lower than 5 g/day. The new 6008 CAREsystem monitors incorporate a Na module that offers the advantage of estimating patients’ salt intake. The objective of this study was to evaluate the effect of dietary Na restriction for 1 week, monitored with the Na biosensor. Methods: A prospective study was conducted in 48 patients who maintained their usual dialysis parameters and were dialyzed with a 6008 CAREsystem monitor with activation of the Na module. Total Na balance, pre-/post-dialysis weight, serum Na (sNa), changes in pre- to post-dialysis sNa (ΔsNa), diffusive balance, and systolic and diastolic blood pressure were compared twice, once after 1 week of patients’ usual Na diet and again after another week with more restricted Na intake. Results: Restricted Na intake increased the percentage of patients on a low-Na diet (<85 Na mmol/day) from 8% to 44%. Average daily Na intake decreased from 149 ± 54 to 95 ± 49 mmol, and interdialytic weight gain was reduced by 460 ± 484 g per session. More restricted Na intake also decreased pre-dialysis sNa and increased both intradialytic diffusive balance and ΔsNa. In hypertensive patients, reducing daily Na by more than 3 g Na/day lowered their systolic blood pressure. Conclusions: The new Na module allowed objective monitoring of Na intake, which in turn could permit more precise personalized dietary recommendations in patients under hemodialysis.

Intermittent fasting – a novel approach to treating overweight and obesity? – meta-analysis and literature review

Introduction Intermittent fasting (IF) is a form of dietary intervention that includes periods of regular calorie intake alternated with periods of fasting. IF has gained a lot of attention as a potential approach to treating metabolic syndrome-related diseases. Therefore, health care professionals need to be able to provide their patients with evidence-based information on IF. The aim of this article is to review data on effectiveness of IF in weight loss, especially in comparison with calorie restriction.&#x0D; MethodsPubMed and Google Scholar databases were searched for studies published from 1.01.2017 to 31.12.2022 that included phrases “intermittent fasting” or “alternate day fasting”, “intermittent fasting obesity”, “alternate day fasting obesity”. Intervention studies on obese or overweight patients were included. We excluded studies of short duration and studies that focused on intercurrent medical conditions. In total, 14 articles that suited those criteria were identified.&#x0D; ResultsIntermittent fasting induces pronounced metabolic changes in the body due to strict and time-limited restriction of calorie intake and in animal models was proved to prolong lifespan and modulate tumorigenesis and aging. It is a proposed new approach to treating obesity, which is a a major risk factor for cardiovascular diseases and diabetes.&#x0D; ConclusionsIn our study, IF was found as effective, but not superior to calorie restriction in reducing body mass, improving body composition and reducing other cardiometabolic risk factors. Our findings are consistent with other recent systematic reviews. Further research is needed to directly compare various IF regimens and determine patients’ characteristics that may be associated with more successful implementation of intermittent fasting regimens.

Can you learn to starve yourself? Inducing food avoidance in the laboratory

The restriction of energy intake is a central and persistent symptom of anorexia nervosa. Recent models of the disorder suggest that food restrictions are learned avoidance behaviours, which are acquired and maintained by classical and operant conditioning. The present study aims to test this learning model of food restriction. It investigates whether introducing negative consequences for the intake of tasty high-calorie food and introducing positive consequences for its avoidance can create food avoidance, increase fear of food, and decrease eating desires in healthy individuals. 104 women were randomly assigned to an experimental or control condition and completed an appetitive conditioning and avoidance learning task. While the experimental condition received money after avoiding the tasty high-calorie food item and heard an aversive sound after not avoiding food intake, the control condition never received these consequences. In the extinction phase, reward and punishment discontinued for both conditions. We measured avoidance frequency, mouse movements, fear, eating desires and stimulus liking. Participants in the experimental condition avoided the food more often than controls and showed increased fear, reduced eating desires and less liking for cues associated with food intake. These results support the notion that food avoidance behaviours, reduced eating desires and fear of food can be learned via classical and operant conditioning. Conditioning paradigms might be a useful tool to study the development and maintenance of food restriction in anorexia nervosa.

Pneumorrhachis with spontaneous pneumomediastinum in pediatric patients: An 11-year retrospective study in Southern Taiwan

Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM. Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed. In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n=24) and SPM plus PR (n=6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p=0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5mg/L), identified predisposing factors, and those with more severe grade of SPM (p=0.005, 0.001 and<0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p<0.001). All patients were successfully treated without morbidity and mortality. Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.

Association of NAFLD with FGF21 Polygenic Hazard Score, and Its Interaction with Protein Intake Level in Korean Adults.

Fibroblast growth factor 21 (FGF21) is a hormone that participates in the regulation of energy homeostasis and is induced by dietary protein restriction. Preclinical studies have suggested that FGF21 induction exerts a protective effect against non-alcoholic fatty liver disease (NAFLD), while human studies have revealed elevated levels of and potential resistance to FGF21 in patients with NAFLD. However, whether the FGF21 pathway also contributes to NAFLD risk at the genetic level remains uncertain. A few attempts to investigate the impact of individual genetic variants at the loci encoding FGF21 and its receptors on NAFLD risk have failed to establish a clear association due to a limited effect size. Therefore, this study aimed to (1) develop a polygenic hazard score (PHS) for FGF21-related loci that are associated with NAFLD risk and (2) investigate the effect of its interaction with protein intake level on NAFLD risk. Data on 3501 participants of the Korean Genome Epidemiology Study (Ansan-Ansung) were analyzed. Eight single-nucleotide polymorphisms of fibroblast growth factor receptors and beta-klotho were selected for PHS determination using forward stepwise analysis. The association between the PHS and NAFLD was validated (p-trend: 0.0171 for men and <0.0001 for women). Moreover, the association was significantly modulated by the protein intake level in all participants as well as women (p-interaction = 0.0189 and 0.0131, respectively) but not in men. In particular, the women with the lowest PHS values and a protein intake lower than the recommended nutrient intake (RNI) exhibited a greater NAFLD risk (HR = 2.021, p-trend = 0.0016) than those with an intake equal to or greater than the RNI; however, those with higher PHS values had a high risk, regardless of protein intake level. These findings demonstrate the contribution of FGF21-related genetic variants and restricted protein intake to NAFLD incidence.

The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study.

The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the study. The population under study (n = 24) had a median age of 47.5 (41.5-52.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33-89) vs. 85 (54-95), p < 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02-0.09) vs. 0.05 (0.02-0.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6-37.3) vs. 35.3 (31.2-39.0), p < 0.0001), WC (106.5 (95.0-112.5) vs. 110.0 (103.0-124.0), p < 0.0001), neck circumference (38.0 (35.0-41.5) vs. 39.5 (38.0-42.5), p < 0.0001), fat mass (32.3 (23.4-40.7) vs. 37.9 (27.7-43.5), p < 0.0001), and extracellular water (17.3 (15.2-20.8) vs. 18.3 (15.9-22.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5-39.0) vs. 38.0 (34.0-40.5), p = 0.01), triglycerides (72 (62-90) vs. 90 (64-132), p = 0.03), and the liver markers AST (17 (14-19) vs. 18 (15-27), p = 0.01) and γGT (16 (13-20) vs. 16 (14-27), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.

Increased cytokine levels induced by high phenylalanine concentrations in late diagnosis PKU patients compared to early diagnosis: Anti-inflammatory effect of L-carnitine.

Phenylketonuria (PKU) was the first genetic disease to have an effective therapy, which consists of phenylalanine intake restriction. However, there are patients who do not adhere to treatment and/or are not submitted to neonatal screening. PKU patients present L-carnitine (L-car) deficiency, compound that has demonstrated an antioxidant and anti-inflammatory role in metabolic diseases. This study evaluated the effect caused by exposure time to high Phe levels in PKU patients at early and late diagnosis, through pro- and anti-inflammatory cytokines, as well as the L-car effect in patients under treatment. It was observed that there was a decrease in phenylalanine levels in treated patients compared to patients at diagnosis, and an increase in L-car levels in the patients under treatment. Inverse correlation between Phe versus L-car and nitrate plus nitrite versus L-car in PKU patients was also showed. We found increased proinflammatory cytokines levels: interleukin (IL)-1β, interferons (IFN)-gamma, IL-2, tumor necrosis factor (TNF)-alpha, IL-8 and IL-6 in the patients at late diagnosis compared to controls, and IL-8 in the patients at early diagnosis and treatment compared to controls. Increased IL-2, TNF-alpha, IL-6 levels in the patients at late diagnosis compared to early diagnosis were shown, and reduced IL-6 levels in the treated patients compared to patients at late diagnosis. Moreover, it verified a negative correlation between IFN-gamma and L-car in treated patients. Otherwise, it was observed that there were increased IL-4 levels in the patients at late diagnosis compared to early diagnosis, and reduction in treated patients compared to late diagnosed patients. In urine, there was an increase in 8-isoprostane levels in the patients at diagnosis compared to controls and a decrease in oxidized guanine species in the treated patients compared to the diagnosed patients. Our results demonstrate for the first time in literature that time exposure to high Phe concentrations generates a proinflammatory status, especially in PKU patients with late diagnosis. A pro-oxidant status was verified in not treated PKU patients. Our results demonstrate the importance of early diagnosis and prompt start of treatment, in addition to the importance of L-car supplementation, which can improve cellular defense against inflammation and oxidative damage in PKU patients.

Role of flavonoids in controlling obesity: molecular targets and mechanisms.

Obesity presents a major health challenge that increases the risk of several non-communicable illnesses, such as but not limited to diabetes, hypertension, cardiovascular diseases, musculoskeletal and neurological disorders, sleep disorders, and cancers. Accounting for nearly 8% of global deaths (4.7 million) in 2017, obesity leads to diminishing quality of life and a higher premature mortality rate among affected individuals. Although essentially dubbed as a modifiable and preventable health concern, prevention, and treatment strategies against obesity, such as calorie intake restriction and increasing calorie burning, have gained little long-term success. In this manuscript, we detail the pathophysiology of obesity as a multifactorial, oxidative stress-dependent inflammatory disease. Current anti-obesity treatment strategies, and the effect of flavonoid-based therapeutic interventions on digestion and absorption, macronutrient metabolism, inflammation and oxidative stress and gut microbiota has been evaluated. The use of several naturally occurring flavonoids to prevent and treat obesity with a long-term efficacy, is also described.

An iterative approach to the development of a sole ulcer induction model in Holstein cows

Our objective was to develop a sole ulcer (SU) induction model that can be used to investigate new and more efficacious methods for the treatment and prevention of SU. Three iterations [phase (P)1, P2, and P3] of an SU induction model designed to mimic mechanical and presumed metabolic pathways for SU development were conducted. The results from P1 and P2 identified alterations for the subsequent phase. Each phase used cows with similar calving dates that were randomly assigned (n = 4) to treatments. Control cows (P1CON, P3CON) did not undergo any challenges to induce SU development. Treatment cows were challenged with a hoof block (B) applied to the right hind lateral hoof. Other treatments included restricted lying time (L), restricted feed intake (F), or systemic lipopolysaccharide (LPS) administration. Treatment comparisons were P1CON versus P1BL, P2B versus P2BL, and P3CON versus P3BLF and P3BLF+LPS for P1, P2, and P3, respectively. Pregnant nulliparous Holstein cows were used in P1 and P3, and the P1 cohort was used in P2 during mid-lactation [125.9 ± 7.20 d in milk (DIM)]. Challenges were applied during a set challenge period (P1: -14 to 14 DIM, P2: 126-168 DIM, P3: -14 to 28 DIM). The P1BL cows had a hoof block applied and lying time restricted for 5 h/d. The P2B and P2BL cows had a hoof block and P2BL cows also had their lying time restricted for 18 h/d for 2 d/wk. The P3BLF and P3BLF+LPS cows had a hoof block, 6 h/d of lying time restricted 2 d/wk, and had their DMI restricted by 30% for 2 d/wk. At weekly intervals during wk 1 to 3 postpartum, P3BLF+LPS cows received jugular administration of 0.031, 0.062, and 0.125 µg of LPS per kg of body weight, respectively. Primary response measurements included hoof lesion and locomotion scoring, lying time, hoof thermography, and weight distribution per hoof. No SU induction occurred but sole hemorrhages, a precursor to SU, occurred during the postchallenge period of all phases. Temperature of the blocked hoof at the end of the challenge period did not change for P3CON cows but increased by 5.5°C and 6.2°C for P3BLF and P3BLF+LPS, respectively. Notable increases in lameness and lack of weight-bearing on the blocked hind hoof occurred for challenge treatment cows during the challenge period of P2 and P3. These changes did not persist after the hoof blocks were removed, indicating that hoof blocks succeeded in altering cow gait mechanics, but not enough to induce long-term lameness or SU. Lying restriction challenged cows in P2 and P3, indicated by a compensatory increase in lying time on the day following lying restriction compared with that on the day before restriction. In P3, lying time had the greatest depression during restriction and compensation following restriction in P3BLF+LPS cows, with LPS challenges potentially increasing the other challenge's effects. Future iterations of the SU induction model should include hoof block use, evaluate longer and more frequent standing and inclusion of forced walking bouts, and include DMI and LPS metabolic challenges.

Portal Systemic Encephalopathy without Significant Changes of Chronic Liver Disease: A Case Report

Introduction: Determining the etiology of an encephalopathy can be challenging for the neurologists, especially when the preliminary investigations do not indicate any significant biochemical or other systemic abnormality. Portosystemic shunts maybe easily missed and may present as recurrent encephalopathy with elevated serum ammonia or cerebrospinal glutamate levels. These shunts maybe easily identified in the presence of overt chronic liver disease, but maybe easily missed in patients with cryptogenic liver disease or in congenital abnormalities of the intrahepatic vascular system without an associated chronic liver disease. Materials and Methods: The triple-phase computed tomography (CT) or contrast magnetic resonance imaging can demonstrate the extent of portal vein thrombosis, map the extent of the portosystemic collateral, and aid in planning the treatment in patients with difficult anatomy of the portosystemic collaterals. Treatment regimens for patients with portosystemic shunts manifesting as hyperammonemic encephalopathy include restriction of oral protein intake, lactulose administration, oral nonabsorbable antibiotics, closure of the endovascular shunt, or finally, liver transplant. We present a case of a 55-year-old female with seizure disorder presenting with recurrent episodes of encephalopathy with elevated serum ammonia without the overt signs of chronic liver disease with identification of portosystemic shunting on a triple-phase CT of the abdomen. Conclusion: Specialized investigations to identify the presence of portosystemic collaterals should be conducted in patients with cryptogenic encephalopathy with elevated serum ammonia.

Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.

Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews.

Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews.

Oral Sodium to Preserve Renal Efficiency in Acute Heart Failure: A Randomized, Placebo-Controlled, Double-Blind Study

Evidence for modulating the sodium chloride (NaCl) intake of patients hospitalized with acute heart failure (AHF) is inconclusive. Salt restriction may not benefit; hypertonic saline may aid diuresis. To compare the safety and efficacy of oral NaCl during intravenous (IV) diuretic therapy in renal function and weight. Seventy hospitalized patients with AHF who were being treated with IV furosemide infusion consented to receive, randomly, 2 grams of oral NaCl or placebo 3 times a day in a double-blind manner during diuresis. Treatment efficacy (bivariate primary endpoints of change in serum creatinine levels and change in weight) was measured at 96 hours, and adverse safety events were tracked for 90 days. Sixty-five patients (34 NaCl, 31 placebo) were included for analysis after 5 withdrew. A median of 13 grams of NaCl was given compared to placebo. At 96 hours, there was no significant difference between treatment groups with respect to the primary endpoint (P = 0.33); however, the trial was underpowered, and there was greater than expected standard deviation in weight change. The mean change in creatinine levels and weight was 0.15 ± 0.44 mg/dL and 4.6 ± 4.2 kg in the placebo group compared with 0.04 ± 0.40 mg/dL and 4.0 ± 4.3 kg in the NaCl group (P = 0.30 and 0.57, respectively). Across efficacy and safety endpoints, we observed no significant difference between the 2 groups other than changes in serum sodium levels (-2.6 ± 2.7 in the placebo group and -0.3 ± 3.3 mEq/L in the NaCl group; P < 0.001) and in serum blood urea nitrogen levels (11 ± 15 in the placebo group; 3.1 ± 13 mEq/L in the NaCl group; P = 0.025). In this single-center study, liberal vs restrictive oral sodium chloride intake strategies did not impact the safety and efficacy of intravenous diuretic therapy in patients with AHF. (ClinicalTrials.gov registration NCT04334668.).

Is “stay-at-home” synonymous of inactivity? Factors related to sedentary lifestyle in a Brazilian sample during COVID-19 initial quarantine

PurposeThe purpose of this study is to describe the prevalence of a sedentary lifestyle (<150 min of physical exercise/week) and associated factors of this behavior in Brazil.Design/methodology/approachAn observational study was conducted through an online questionnaire in August–September 2020 (5.5 months after the beginning of the pandemic in the country). Socioeconomic, lifestyle, anthropometric, dietary and perceived stress data were evaluated as possible related factors to a sedentary lifestyle through multiple logistic regression analysis.FindingsA total of 1,347 individuals were evaluated (median of 31 years old, 80.1% women), of whom 76.7% were considered sedentary. Associated factors to a sedentary lifestyle were being overweight; a greater difference between current weight and prepandemic weight; female sex; lower percentage of home-cooked meals; greater increase in the frequency of consumption of alcoholic beverages; higher frequency of consumption of cereals, sausages and sweets during the pandemic; and higher score of perceived stress.Originality/valueTo the best of the authors’ knowledge, no studies have aimed to reveal the associated factors to a sedentary lifestyle during the COVID-19 pandemic in Brazil. Protective factors against a sedentary lifestyle were eating breakfast, being a student, living with parents, a higher frequency of fruit consumption, a higher rate of alcohol consumption and a higher cognitive restriction of food intake during the pandemic. Most of the study participants were sedentary, especially women. A sedentary lifestyle was associated with worse lifestyle/eating habits and stress. Such findings encourage an interdisciplinary approach because habits and lifestyle have numerous interferences.

Intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella: A case report

Hyponatremia is a common electrolyte disorder in elderly critically ill patients, and it may be associated with poor outcomes, higher morbidity, and mortality. Syndrome of inappropriate antidiuresis (SIAD) is one of the main causes of hyponatremia, with an insidious onset that is highly misdiagnosed. Primary empty sella lesions are specific, mostly asymptomatic, and easily overlooked. SIAD combined with empty sella is much rarer in clinic, this article focuses on the diagnosis and management of an elderly patient with intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella. An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia. The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function. Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance. His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500-2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy. Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.