Specific Nutritional Recommendations Research Articles

Sleep and quality of life of patients with glycogen storage disease on standard and modified uncooked cornstarch

BackgroundGlycemic control in hepatic glycogen storage diseases (GSDs) relies on specific nutritional recommendations, including strict avoidance of a fasting period. Uncooked cornstarch (UCCS) is an important therapeutic component. A new modified UCCS, Glycosade™, was created with the objective of prolonging euglycemia. We aimed to determine the length of euglycemia on Glycosade™ using a continuous glucose monitor (CGM) and to evaluate whether longer euglycemia and thus less nighttime interruptions would improve sleep and quality of life (QoL) after the introduction of the modified cornstarch. MethodsWe conducted a prospective cohort study to assess quality and quantity of sleep and quality of life (QoL) in patients with GSDs on standard UCCS and after the introduction of Glycosade™. Sleep and QoL evaluation was done for patients using validated questionnaires, a standardized sleep diary and actigraphy. Length of fast and glucose variability were determined with CGM. ResultsNine adults with GSD Ia took part in the study. Glycosade™ introduction was done under close supervision during a hospital admission. Comparison of sleep in 9 patients showed sleep disturbances on standard UCCS that were improved with Glycosade™. QoL was normal both pre and post Glycosade™. The CGM confirmed maintenance of a longer fasting period with Glycosade™ at home. ConclusionGlycosade™ represents an alternative option for GSD patients. We showed possible benefits in terms of sleep quality. We also confirmed the longer length of fast on Glycosade™. SynopsisA new modified form of uncooked starch for patients with glycogen storage disease represents an alternative option as it showed a longer length of fast and improvements in sleep quality.

RECOMENDAÇÕES NUTRICIONAIS PARA O TRATAMENTO DA FIBROMIALGIA

Fibromyalgia is a clinical syndrome characterized by chronic pain, fatigue, sleep disturbances, anxiety, depression, among other symptoms. The objective of this review was to update dietetic knowledge about fibromyalgia. An integrative review was carried out, in which the databases Science Direct, Medline Pubmed and Scientific Electronic Library Online (Scielo) were consulted from July to September 2016, with fibromyalgia and nutrition descriptors, searching originaland reviewed articles, guidelines and consensus of national and international recommendations published from 2003 to 2016. Fibromyalgia occurs most often in women aged 35 to 60 years, commonly overweight or obese. There are few original studies on nutrients or nutritional therapy for fibromyalgia, and there are no specific dietary recommendations. There is an important relationship with oxidative stress, wherein there are may be mitochondrial dysfunction, which would make beneficial therapy with antioxidant nutrients, such as vitamins C, E and β-carotene. There are reports of vitamin E reduction in individuals with fatigue and depression. Some topics addressed in studies were oxidative stress and supplementation with coenzyme Q10 (coQ10), the relationship between body composition and symptoms of fibromyalgia and vitamin D deficiency. Fatigue can be aggravated in individuals with non-celiac gluten sensitivity, however, studies that further investigate this relationship are still needed. Although there are no specific nutritional recommendations, these individuals can benefit from diet based on the principles of healthy nutrition, rich in antioxidants and weight reduction, when indicated. DOI: 10.12957/demetra.2017.27833

Dietary intakes and diet quality according to levels of organic food consumption by French adults: cross-sectional findings from the NutriNet-Santé Cohort Study.

We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes. Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models. The NutriNet-Santé Study. French adults from the NutriNet-Santé Study (n 28 245). Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products. The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.

Environmental Risk Factors in Psoriasis: The Point of View of the Nutritionist.

Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activation, where both environmental and genetic factors contribute to its pathogenesis. Among the risk factors for psoriasis, evidence is accumulating that nutrition plays a major role, per se, in psoriasis pathogenesis. In particular, body weight, nutrition, and diet may exacerbate the clinical manifestations, or even trigger the disease. Understanding the epidemiological relationship between obesity and psoriasis is also important for delineating the risk profile for the obesity-related comorbidities commonly found among psoriatic patients. Moreover, obesity can affect both drug’s pharmacokinetics and pharmacodynamics. Additionally, the overall beneficial effects on the obesity-associated comorbidities, clinical recommendations to reduce weight and to adopt a healthy lifestyle could improve the psoriasis severity, particularly in those patients with moderate to severe disease, thus exerting additional therapeutic effects in the conventional treatment in obese patients with psoriasis. Education regarding modifiable environmental factors is essential in the treatment of this disease and represents one of the primary interventions that can affect the prognosis of patients with psoriasis. The goal is to make psoriatic patients and health care providers aware of beneficial dietary interventions. The aim of this review is to assess the relevance of the environmental factors as modifiable risk factors in psoriasis pathogenesis, with particular regard to the involvement of obesity and nutrition in the management of psoriasis, providing also specific nutrition recommendations.

Dietary Recommendations for Cyclists during Altitude Training.

The concept of altitude or hypoxic training is a common practice in cycling. However, several strategies for training regimens have been proposed, like “live high, train high” (LH-TH), “live high, train low” (LH-TL) or “intermittent hypoxic training” (IHT). Each of them combines the effect of acclimatization and different training protocols that require specific nutrition. An appropriate nutrition strategy and adequate hydration can help athletes achieve their fitness and performance goals in this unfriendly environment. In this review, the physiological stress of altitude exposure and training will be discussed, with specific nutrition recommendations for athletes training under such conditions. However, there is little research about the nutrition demands of athletes who train at moderate altitude. Our review considers energetic demands and body mass or body composition changes due to altitude training, including respiratory and urinary water loss under these conditions. Carbohydrate intake recommendations and hydration status are discussed in detail, while iron storage and metabolism is also considered. Last, but not least the risk of increased oxidative stress under hypoxic conditions and antioxidant supplementation suggestions are presented.

The relationship between folic acid, vitamin B12, and vitamin B6 intakes and depression in women who use hormonal oral contraceptives: 2003–2008 National Health and Nutrition Examination Survey

BackgroundDepression is one of the leading causes of disability and mortality worldwide. Women are at increased risk for depressive disorders. Diet has been shown to have a significant impact on mental health and outcomes. Many studies have associated oral contraceptive (OC) use with impaired status of key nutrients identified to affect normal brain function and neurotransmitter activity, including folate, vitamins B6 and B12. This study aimed to investigate the relationship between nutrient intake and depression in OC users.MethodsSelf‐reported dietary folate, vitamin B12, and vitamin B6 intakes were used to determine the relationship between nutrient intakes and depression in women who used OCs (n = 34) in a selected cohort of women aged 18 to 49 years of age (n = 409) from the 2003–2008 National Health and Nutrition Examination Survey. The relationships between OC use, vitamins, and depression were tested using χ2 and independent samples t‐tests.ResultsWomen who used OCs were 10.2% more likely to be depressed than women who did not use OCs (45.7% vs. 35.5%, p &lt; .001). Women who used OCs consumed less folate (558.31 ± 256.65 μg vs 592.81 ± 418.72 μg) and vitamin B12 (6.74 ± 5.75 μg vs 12.32 ± 48.85 μg) than women who did not use OCs (p &lt; .001). Conversely, women who used OCs consumed more vitamin B6 (5.53 ± 14.78 mg vs 3.73 ± 11.24 mg) than consumed by women who did not use OCs (p &lt; .001). In addition, both groups of women achieved average intakes that were higher than the RDA for all three vitamins. Depression was correlated to quartile levels of vitamin intake for all women (p &lt;.001). No benefit against depression was observed with inadequate intakes or intakes that exceeded the RDAs for women who did not use OCs. In fact, women in this group whose folate and vitamin B6 intakes exceeded the RDA ( the fourth quartile intake levels) were 2% and 3.9%, respectively, more depressed than those who consumed less than the RDA (the first quartile, p &lt; .001). For women who did not use OCs, vitamin B12 intakes exceeding the RDA were associated with 1.3% less depression than intakes below the RDA (p &lt; .001). Women who used OCs were 10.2%, 9.7%, and 11.1% more likely to be depressed than women who did not use OCs when they consumed less than the RDA for folate, vitamin B12, and vitamin B6, respectively, as seen in the first quartile (p &lt; .001). Compared to the first three intake quartiles for all three vitamins, women who used OCs and who consumed within the fourth quartile (which exceeded the RDAs for folate, vitamin B12, and vitamin B6) appeared to be less depressed (13%, 75%, and 7%, respectively) than those women who consumed below the RDA (p &lt; .001). Interestingly, the least amount of depression in women who used OCs was found when vitamin B6 intake levels were at or somewhat above the RDA, as seen with the second and third quartile groups.ConclusionCurrently, there are no specific nutrition recommendations to prevent or treat depression or mood disorders. The results suggest that dietary intake of folate, vitamins B6 and B12 has an impact on mental health and mood, and that significant differences in average vitamin intake exist between women who use OCs and women who do not use OCs. Future studies are needed to determine if depression results from or could be reduced with a woman's dietary intake. Further research would strengthen the understanding of these relationships by including laboratory values to assess vitamin status and overall bioavailability of these nutrients among OC users.

Nutritional Practices, Interventions and Recommendations for Junior Rugby League Players

Rugby league is an intermittent, collision team sport played at amateur and professional levels across junior and senior age categories worldwide. A paucity of literature exists with regard to research on nutrition for junior rugby league players. This lack of research makes the development of specific nutritional recommendations for players problematic. There is a concern that players may adopt the latest fad diet or supplement to augment their performance at a risk to their performance, training adaptation, recovery, injury susceptibility and health. Youth culture, social media, socio-economic status, behavioural and educational issues may contribute to the poor dietary practices of players. To maintain health, optimise growth and enhance athletic performance and recovery, junior rugby league players need to consume an appropriate diet. Junior rugby league players should periodise their nutritional intake according to the training and competition phase. 1.5-1.7 g.kg-1 day-1 of protein is recommended with equally spaced meals throughout the day to maximise protein synthesis. During phases where skeletal muscle tissue is prioritised this recommendation should be towards the higher end, 1.7 g.kg-1 day-1. Carbohydrate ingestion between 4-8 g.kg-1 day-1 should be adjusted daily according to the daily exercise needs of the player. A food first policy should be adopted basing food intake on primarily whole and minimally processed sources from a variety of foods will help players meet their micronutrient intake. Implementation of a nutrition education programme should be undertaken with players improve the nutritional knowledge and dietary practice. This paper reviews the current scientific data related to the energy needs of junior rugby league players, special nutrient needs during training and competition and the use of supplements.

Development of a Healthy Eating Index for patients with type 2 diabetes

Objective:This study sought to develop a dietary index for assessment of diet quality aiming for compliance with dietary recommendations for diabetes: The Diabetes Healthy Eating Index.Methods:Cross-sectional study with 201 outpatients with type 2 diabetes (61.4±9.7 years of age; 72.1% were overweight; 12.1±7.7 years of diagnosis; 7.3±1.3% mean HbA1c). Clinical and laboratory evaluations were performed together with 3-day weight diet records. The dietary index developed included 10 components: "diet variety", "fresh fruits", "vegetables", "carbohydrates and fiber sources", "meats and eggs", "dairy products and saturated fatty acids", "oils and fats", "total lipids", "cholesterol", and "transunsaturated fatty acids". The performance of each component was evaluated using the Item Response Theory, and diet quality was scored from 0-100%.Results:Overall, diet quality in this sample was 39.8±14.3% (95%CI=37.8-41.8%), and only 55 patients had a total diet quality score &gt;50%. Good compliance was observed in only four index components: "total lipids", "variety", "fiber sources", and "dairy and saturated fatty acids". The components that differentiated patients with poor dietary quality from those with good dietary quality were "vegetables", "diet variety", "dairy and saturated fatty acids" and "total lipids". The greatest determinants of dietary quality were the components "diet variety", "vegetables", and "total lipids".Conclusion:This dietary index proposed assesses diet quality in compliance with the specific nutritional recommendations for diabetes. In clinical practice, this novel index may be a useful tool for the assessment and management of diet of patients with type 2 diabetes.

Flavonoid Intakes are Predictive of Dietary Quality and Most Components of the Healthy Eating Index 2010

Although one might assume that a diet containing an abundance of bioactive compounds like flavonoids would be more compliant with established national nutrition guidance than a diet low in these compounds, no research has examined this premise. This study's objective was to examine associations between flavonoid intake and total and individual component scores of the Healthy Eating Index (HEI) 2010. One day of 24-hour dietary recall data from adults 蠅20 years (n = 5,420) who participated in What We Eat in America, NHANES 2007-2008 was analyzed. Flavonoid intakes were calculated using USDA's “Flavonoid Values for USDA Survey Foods 2007-2008.” The sample was divided into quartiles based on flavonoid intake. Trends in adjusted mean total and component HEI scores by flavonoid intake were assessed via orthogonal polynomial contrasts. Positive linear trends in total HEI score and nearly all HEI components were observed with increasing quartile of flavonoid intake (<0.001). As expected, component scores concerning fruits and vegetables improved significantly with increasing flavonoid intake, but so did component scores not necessarily related to flavonoid-containing foods, including refined grains and empty calories. A diet high in flavonoids is a proxy for higher overall diet quality and greater compliance to multiple, specific national nutrition recommendations. Funding by ARS, USDA and ODS, NIH.

Dietary Patterns and Metabolic Syndrome in Adults

Aims: Considering that diet is a potential factor contributing to the development of Metabolic Syndrome (MetS) and it is increasingly prevalent among population worldwide, the aim of the present study was to correlate dietary patterns with MetS and its main risk factors in adults. Study Design: Cross-sectional. Place and Duration of Study: School of Public Health, University of Sao Paulo, between August 2007 and January 2010. Methodology: This study was conducted with 267 adults (189 women and 78 men) submitted to evaluation procedures which included body composition (waist circumference (WC), height and weight) and blood pressure measurements, biochemical analysis from a single blood sample after a 12-h fasting (serum triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and fasting glucose) and assessment of dietary intake using a 24-hour recall. Dietary patterns (DPs) were identified using principal components factor analysis with varimax orthogonal rotation. Results: Three distinct DPs were identified from the principal component factor analysis: “Traditional”, “Healthy” and “Western”. Among individuals with MetS, there was a positive correlation between Healthy pattern and HDL-c (P = .03), as well as between Western pattern and WC, TG and LDL-c (P = .001, P = .04 and P = .047). In people without MetS, the negative correlation was observed between Traditional pattern and LDL-c (P = .049), and positive correlation between Healthy pattern and age, TC and, LDL-c (P = .01, P = .03 and P = .03). Conclusion: Our assessment offers information concerning food combinations that may increase the risk and prevalence of MetS. However, more studies are required to confirm these findings and Short Research Article Oliveira et al.; EJNFS, 5(4): 297-304, 2015; Article no.EJNFS.2015.027 298 to assist in the prevention and development of specific nutritional recommendations for this syndrome.

Mineral content and adequacy of oral hospital diets offered to chronic kidney disease pre-dialysis patients

Summary Background & aims The diet for patients with Chronic Kidney Disease (CKD) has important clinical impact on the disease progression. This study determined the contents of Ca, P, K, Na, Mg, Fe, Mn, Cu, Zn and Se in an oral hospital diet and a Oral Food Complement (OFC), prepared for CKD patients, with the adequacy quantified with respect to nutritional recommendations. Methods Samples of the diet were collected in a Brazilian public hospital, with mineral determination by ICP-OES. The Dietary Reference Intake and specific nutritional recommendations for CKD patients were used to assess the nutritional adequacy. Results About 14.3% of the diets produced for CKD patients were analyzed. The levels of P, K, Mn and Na were over the recommendation, with Na exceeding the Upper Level. Inadequacy of Ca and Se were observed for all groups and ages. Inadequate values of iron were found for adult women. The combination of OFC with the diet was sufficient to provide adequate values of Fe, however, did not increase Ca and Se contents to adequate levels, and added unnecessary quantities of P, K and Na. Conclusion With the exception of K and P the diets exhibited insufficient mineral contents and toxic levels of Na. Diet menus and OFC compositions need to be changed to meet the nutritional recommendations and support the clinical assistance of CKD patients and also contribute to the nutritional education of this group.

208 Nutritional intervention among children with CF

Objectives: To assess the effect of a six months’ implementation of a nutritional intervention protocol on nutritional status in patients with cystic fibrosis. Methods: Nutritional status of 77 patients with CF (53.2% males, mean age 10.73±6.67 years, was evaluated. Anthropometry was expressed as z-scores for age and sex using WHO Anthro software and classified following the WHO criteria and Frisancho references for MUACp, TSTp and MAMCp. Phase angle (PhA) and body cell mass (BCM) were assessed by BIA. Three-day food intake and 24 h recall (five-pass) were recorded and analyzed using the “Food Processor” software. The intervention protocol was based on specific nutrition recommendations. Fifty-two children were re-evaluated 3 and 6 months later. Results: The mean value for Weight–Height z score was −0.04 (±1.65), Height– age z was −0.37 (±1.19), Weight–age z was −0.22 (±1.39), BMI–age z was 0.07 (±1.32), MUACz was −0.12 (±1.29), TSFz was 0.06 (±1.03). The mean value of the BMIp was 50.16. The mean PhA values were 4.94 (±0.91). Six months after the initiation of nutritional intervention, energy intake/total energy expenditure ratio (median) was significantly increased (p = 0.001). Mean values of Waz, Haz and MUACz were significantly improved (p = 0.039, p = 0.020 and p = 0.004, respectively). Conclusions: The implementation of a nutritional intervention protocol can improve further nutrition intake, as well as the overall nutritional status, in a short term study. Longer implementation and regular follow-up are expected to further improve outcome.

Sexual Ethics in Iranian Medicine

Context: Effect of sexual relations on mental and physical health has been the concern of the Iranian physicians, over a thousand years ago. Sexual ethics is one of the specific health topics of Iranian medicine archives. From the Iranian medicine point of view, because of different mental and physical differences in human, their sexual power and need for sex is different. It is necessary to observe the normal range, since the sexual indulgence causes different illnesses. Evidence Acquisitions: In Iranian medicine, different variables such as time, location, mental and physical situation, and also various forms of sex are discussed in sexual health. Safe sex not just reduces many mental disorders, but also prevents many neurological, digestive, urinary and genital disorders. Also, sexual indulgence is most harmful for health and causes stiffness, weakness and different diseases; therefore observing moderation in sex, according to the therapeutic characteristics and power, has been emphasized. Results: To have safe sex, it is necessary to consider time, mental, and physical status. Having sex when the stomach is full impairs digestion. Sexual relationship after heavy sports and severe emotional reactions such as anger or sadness, and after diarrhea or blood sampling is harmful. It has been recommended that having sex in temperate weather, and after evacuation of urine and feces, considering necessary arrangements, make the couple reach orgasm. Also, in the Iranian traditional medicine references, specific nutritional and health recommendations have been proposed for the sexually active people. Conclusions: Health care recommendations of Iranian physicians involve precious and new points for the updated scientific communities. Scientific revision of these recommendations can be promising for public health improvement.

P185 Outcomes of patients with ulcerative colitis: azathioprine tolerant and azathioprine intolerant

The second discrepancy concerns the nutritional aspects of IBD care. Patients did not receive the information they expect on the impact nutrition could have on their disease (61%), nor the specific nutritional recommendations they believed they need (66%). In addition, 79% of Gastroenterologists and Nurses reported lacking skills to provide nutritional information and its rationale, and only 51% of Nurses/34% of Gastroenterologists reported they often or consistently explain to their patients the role of nutrition in UC/CD. Conclusions: The results from this study question whether patients’ expectations and needs are known and understood. While the gap in emotional support may reflect gaps in HCP skill sets, the gap in nutritional information is at least partly explained by a lack of clear evidence and guidance on the role of nutrition in UC/CD. Regardless, patient-centric practice requires that HCP understand and address the expectations of IBD patients to improve communication, enhance compliance and optimize health outcomes.

Malnutrition and Nutrition-Therapy: Our Neglected Responsibility

Around 30% of hospitalized patients in Europe are malnourished, and the figures for the community are also alarming. In certain diseases the proportion of malnourished patients can go up to 60%. The consequences of malnutrition are still neglected. The levels of knowledge and awareness of nutritional problems are low among all caregivers. Malnutrition is a heavy burden for the society, leading to increased morbidity, longer hospital stays, increased complications, decreased quality of life for the patients, and higher costs. Interventions to ensure appropriate nutritional care would be cost-effective. The impact of nutritional support is well known from many clinical trials. For each patient group specific nutritional recommendations are published in several reviews and guidelines. Although it is known how to do better, the nutritional support is often not regarded as an important therapeutic tool of the patients. In this issue several interesting papers summarize different important aspects related to malnutrition and nutritional support. The first paper describes the mechanism of cancer cachexia and the clinical implication and helps to understand why nutrition should be a central part in the management of cancer patients. It is well known that with an adequate nutritional support an increase of the quality of life can be achieved. Two further papers are dealing with nutritional aspects in the elderly. A large survey in Germany confirms the high prevalence of malnutrition in nursing homes. A significant number of orally and tube-fed patients were malnourished. The most important factors leading to malnutrition were analysed. Oropharyngeal dysphagia is a high prevalent problem in the elderly and is a leading factor for malnutrition and aspiration. The paper in this issue gives important information for diagnosing and the treatment for this clinically relevant problem. Three papers are related to surgical and ICU patients. Too often malnutrition is neglected in surgical patients. The clinical outcome is significantly different in malnourished patients compared to well-nourished controls. The paper on malnutrition in surgery wards confirms the importance of screening all surgical patients. 1/3 of the reported patients were malnourished, and the outcome was not as good compared to the patients not at nutritional risks. Elective surgery should be avoided until the nutritional deficits are corrected. In a further paper the perioperative nutritional support is described. Enteral nutrition was not given for long time to patients with acute pancreatitis because of the fear of worsening the outcome. This opinion has changed in the last decade. The importance and limits of enteral nutrition are well explained in this issue. In other three papers more general nutritional items are addressed. In the ICU hyperglycaemia is associated with poor outcome. Several interesting trials were published in the past on this specific problem. Until now the best blood sugar control is still debated. The review in this issue helps the reader to understand this controversial problem in more detail. In patients with severe malnutrition it is important to know that nutrition support can also be harmful if the refeeding syndrome is not considered. The paper on the refeeding syndrome is therefore very helpful for understanding and avoiding the refeeding problems. In nutritional practice the placing of a percutaneous endoscopy gastrostomy is very common. This procedure is done more and more on a propofol-based sedation. There are only few data on the safety of propofol-based sedation in the PEG procedure. The paper in this issue shows that propofol is a safe procedure if it is done according to the common guidelines. There is no significant difference in overall complication rates, sedation, and procedure-related complication. Obesity is also regarded as a form of malnutrition. Controlled weight loss is well recognized as to be beneficial to reduce complications in these patients. One paper in this issue reports data on a specific supplement on the effect on weight loss. The use of green coffee extract shows some promising effects but the available trials are of poor methodological quality. A general recommendation cannot be given now. The last paper is dealing with the important unhealthy Western diet. This diet is too high in n-6 polyunsaturated fatty acids (PUFA) and too low in n-3 PUFAs. We know that these diets can have negative effects on health. It is extremely important that all efforts should be undertaken to decrease this unhealthy diet in the future. Until now these important recommendations are not sufficiently implemented in the daily practice. This paper is therefore very important for promoting general health. We hope that the selected manuscripts help the readers to understand more the importance of recognizing the burden of malnutrition and to raise the awareness of the impact of nutritional support for the patients. Irit Chermesh Lubos Sobotka Corina Hartman Remy Meier

Referring veterinarians' opinions and veterinary teaching hospital veterinarians' perceptions of those opinions regarding communication and nutritional product recommendations

To compare opinions of referring veterinarians and perceptions of veterinary teaching hospital (VTH) veterinarians of those opinions regarding nutritional product recommendations made by VTH veterinarians. Survey. VTH veterinarians from 10 US colleges of veterinary medicine and referring veterinarians within a 160-km (100-mile) radius of each of those colleges. Questions intended to assess the attitudes of VTH clinicians and referring veterinarians toward recommendations on nutritional products were designed by use of item statements with a 7-point Likert scale. Data were evaluated by use of crosstab analysis and Likert bipolar scaling to measure overall positive or negative responses to statements and to determine significant differences in responses to demographic and communication questions. Referring veterinarians returned 1,430 of 12,720 surveys, and VTH veterinarians returned 98 of 690 surveys (response rate, 11.2% and 14.2%, respectively). Significant communication gaps between general practitioners and board-certified veterinarians existed. The VTH veterinarians consistently reported providing written case summaries sooner than referring veterinarians reported receiving them. Referring veterinarians indicated that they expected and welcomed specific nutritional recommendations more than was perceived by VTH veterinarians. VTH veterinarians should not assume the attitudes of referring veterinarians, particularly with regard to specific nutritional recommendations. Failure to discuss specific nutritional recommendations may prevent effective consultation between veterinarians and also may directly affect clients who may experience delays in treatment for their pets. Procedural issues related to delivery and receipt of written case summaries should be investigated by VTH veterinarians and general practitioners.

Gender affects liver desaturase expression in a rat model of n−3 fatty acid repletion

Dietary n−3 polyunsaturated fatty acids (PUFA) are major components of cell membranes and have beneficial effects on human health. Docosahexaenoic acid (DHA; 22:6 n−3) is the most biologically important n−3 PUFA and can be synthesized from its dietary essential precursor, α-linolenic acid (ALA; 18:3 n−3). Gender differences in the efficiency of DHA bioconversion have been reported, but underlying molecular mechanisms are unknown. We compared the capacity for DHA synthesis from ALA and the expression of related enzymes in the liver and cerebral cortex between male and female rats. Wistar rats, born with a low-DHA status, were supplied with a suboptimal amount of ALA from weaning to 8 weeks of age. Fatty acid composition was determined by gas chromatography, the mRNA expression of different genes involved in PUFA metabolism was determined by RT-PCR (low-density array) and the expression of proteins was determined by Western blot analysis. At 8 weeks, DHA content was higher (+20 to +40%) in each phospholipid class of female livers compared to male livers. The “Δ4,” Δ5 and Δ6 desaturation indexes were 1.2–3 times higher in females than in males. The mRNA expression of Δ5- and Δ6-desaturase genes was 3.8 and 2.5 times greater, respectively, and the Δ5-desaturase protein was higher in female livers (+50%). No gender difference was observed in the cerebral cortex. We conclude that female rats replete their DHA status more readily than males, probably due to a higher expression of liver desaturases. Our results support the hypothesis on hormonal regulation of PUFA metabolism, which should be taken into account for specific nutritional recommendations.

Diet-gene interactions between dietary fat intake and common polymorphisms in determining lipid metabolism

Current dietary guidelines for fat intake have not taken into consideration the possible genetic differences underlying the individual variability in responsiveness to dietary components. Genetic variability has been identified in humans for all the known lipid metabolim-related genes resulting in a plethora of candidate genes and genetic variants to examine in diet-gene interaction studies focused on fat consumption. Some examples of fat-gene interaction are reviewed. These include: the interaction between total intake and the 514C/T in the hepatic lipase gene promoter in determining high-density lipoprotein cholesterol (HDL-C) metabolism; the interaction between polyunsaturated fatty acids (PUFA) and the 75G/A polymorphism in the APOA1 gene plasma HDL-C concentrations; the interaction between PUFA and the L162V polymorphism in the PPARA gene in determining triglycerides and APOC3 concentrations; and the interaction between PUFA intake and the 1131TC in the APOA5 gene in determining triglyceride metabolism. Although hundreds of diet-gene interaction studies in lipid metabolism have been published, the level of evidence to make specific nutritional recommendations to the population is still low and more research in nutrigenetics has to be undertaken.

Bevor die Knochen brüchig werden

Osteoporosis is a systemic skeletal disease with an increased fragility of the bones. Diet plays an important role in the formation and treatment of this widespread disease. The risk factors are an undersupply of calcium and vitamin D, underweight, as well as alcohol and nicotine abuse. Chinese Medicine regards osteoporosis primarily as a disorder in the change phase water and the organ kidney. Pathogenic factors like humidity and coldness, unhealthy lifestyle, wrong diet, and the emotional aspect fear are regarded as risk factors. By an integrated dietotherapy based on Traditional Chinese Medicine, very individual and specific nutritional and diet recommendations for prophylaxis and therapy of osteoporosis are possible.

CrossRef Listing of Deleted DOIs

A paucity of literature exists with regard to research on nutrition for the pediatric athlete. This lack of research makes the development of specific nutritional recommendations for young athletes problematic. This issue is made difficult by the macro- and micronutrient intake required for growth and development in conjunction with that required for sports. Exogenous carbohydrate drinks could be considered for the young athlete engaged in both endurance exercise and high-intensity exercise. Monitoring of the energy intake during resistance training in the pediatric athlete needs to be considered, as there is evidence to suggest that energy deficits may occur. If decrements in exercise performance are noted, then serum ferritin and hemoglobin concentrations should be monitored, as nonanemic iron deficiency is prevalent in the pediatric athlete. The pediatric athlete exercising in the heat is susceptible to voluntary dehydration and evidence exists to suggest that a carbohydrate-electrolyte drink will abolish this phenomenon.