Strict Diet Research Articles

Glucose breath test for the detection of small intestine bacterial overgrowth: Impact of diet prior to the test.

Glucose breath test (GBT) is used for the diagnosis of small intestine bacterial overgrowth. A restrictive diet without fibers and/or fermentable food is recommended on the day before the test. The aim of our retrospective study was to evaluate the impact of two different restrictive diets on the results of GBT. A change of the pretest restrictive diet was applied in our lab on September 1, 2020. The recommended diet was a fiber-free diet before this date, and a fiber-free diet plus restriction of all fermentable food afterward. We thus compared the results of GBT performed before (group A) and after (group B) this pretest diet modification. Demographics, reasons to perform GBT, digestive symptoms, and hydrogen and methane baseline values and variations after glucose ingestion were compared between the two groups. 269 patients underwent GBT in group A, and 316 patients in group B. The two groups were comparable in terms of demographics. Methane and hydrogen baseline values were significantly higher in group A (respectively 14 [18] vs. 8 [14] ppm, p < 0.01 and 11 [14] vs. 6 [8] ppm, p < 0.01). The percentage of positive tests was higher in group A for methane (43% vs. 28%, p < 0.05), and for hydrogen (18% vs. 12%, p = 0.03). This retrospective study suggests the importance of the restrictive diet prior to GBT. A strict limitation of fibers and fermentable food decreased hydrogen and methane baseline values, and the prevalence of positive GBT. Thus a strict restrictive diet should be recommended on the day before the test, in order to limit the impact of food on hydrogen and methane breath levels, and possibly improve the diagnosis quality of GBT.

Fecal calprotectin levels in patients with non-celiac wheat sensitivity: a proof of concept

Some data suggest the existence of intestinal inflammation in patients with non-celiac wheat sensitivity (NCWS). We aimed to verify whether fecal calprotectin (FCP), a marker of intestinal inflammation, could be used to confirm this inflammatory status and to test its diagnostic performance in differentiating NCWS from irritable bowel syndrome/functional dyspepsia (IBS/FD). We conducted a multicenter study, comparing NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge, with IBS/FD subjects. In the retrospective phase, FCP values were analyzed to define the prevalence of its positivity and its role as a NCWS diagnostic biomarker. In the prospective phase we tested the effects of a strict 6-month wheat-free diet (WFD) on FCP values. 31.3% (n = 63/201) of NCWS patients had above normal FCP values (NCWS FCP +), whereas all IBS/FD patients proved negative (P = 0.0001). FCP using a cut-off value > 41 µg/g showed a 58.6% sensitivity and a 98.0% specificity (AUC 0.755, 95% C.I. 0.702–0.837) in distinguishing NCWS from IBS/FD patients. Of the 63 NCWS FCP+, 65.1% had negative FCP values after ≥ 6 months of WFD, with a significant reduction in FCP values (P < 0.0001). All NCWS FCP- subjects still preserved negative FCP values after ≥ 6 months of WFD. Our study showed that FCP can be a useful but supplementary diagnostic marker for differentiating between NCWS and IBS/FD. Strict WFD adherence reduced FCP values, normalizing them in 65.1% of NCWS FCP + subjects. These data suggest the existence of two NCWS subgroups: NCWS FCP + characterized by a probable predominantly inflammatory/immunologic pattern and NCWS FCP− featuring non-immuno-mediated etiopathogenetic mechanisms. (Registration number NCT01762579).

Vegetarian Diet in Children: Benefits, Drawbacks and Risks

Introduction&#x0D; Vegetarianism is an eating pattern centred on plant-based food. It encompasses many diets that differ in terms of whether they contain goods originating from animals, like milk and eggs. Nowadays, vegetarianism is increasing in popularity in developed nations, particularly in Europe. Individuals choose vegetarian diets for reasons related to health, ethics, or ecology. The rising popularity of vegetarian diets is not limited to adults but is also increasing among children.&#x0D; Aim of the study&#x0D; Vegetarian diets are generally considered to be beneficial for health. However, there are concerns over the ability to meet the dietary requirements necessary during infancy, youth, and adolescence on a vegetarian diet. Therefore, the primary aim of this systematic review is to answer questions about the efficacy of a plant-based diet in meeting the nutritional requirements of children and how to avoid the risk of nutritional deficiencies among vegetarian children.&#x0D; Material and methods&#x0D; Article provides an overview of the current literature about the vegetarian diet in children. The information has been collected from a comprehensive search of electronic databases, scientific journals, and statement papers published by nutrition and paediatric organisations.&#x0D; Results&#x0D; Following a vegetarian diet can be a beneficial decision for all children, assuming that it is properly organised and well balanced. The majority of paediatric and nutrition organisations do not recommend more strict diets for children, such as a vegan diet, which fully excludes not only meat but all animal products.

Determinants of commercialization of African Indigenous Vegetables among smallholder farmers in Bungoma County, Kenya

Rising awareness of various lifestyle diseases and illnesses has led to an increased understanding of healthy eating habits, the increased demand for African Indigenous Vegetables (AIVs), and a strict healthier diet in Kenya. Apart from the awareness about the benefits of consuming the AIVs, their commercialization is still low due to how producers are less informed and not connected to market actors beyond their community. On the other hand, the literature on factors that influence commercialization is still limited. The purpose of this study is to sought to reduce that gap by determining the factors that influenced the commercialization of African Indigenous Vegetables (AIVs) among smallholder farmers in Bungoma County. In order to identify 384 respondents from whom data was collected, multistage sampling was used through personally administered questionnaires. The fractional regression model (FRM) was used to determine factors influencing the commercialization of AIVs in Bungoma County. The FRM results indicate that the eight explanatory variables included in the model significantly influenced the commercialization of AIVs among smallholder farmers. These variables are the gender of the farmer, land size, mode of payment, distance to the markets, AIV yields, AIV cost of production, duration to reach the market, and value addition. The researcher recommended that all gender should be engaged in the commercialization of AIVs and that the government to put in place policies and regulations that support the commercialization of AIVs, as they support other cash crops, which would equally enhance the quality and quantity improvement of AIVs that are distributed to various markets.

Processed vegan food packaging: influencing vegan diet and lifestyle consumption choices

As the demand for plant-based meat analogues (PBMAs) continues to surge globally, understanding the marketing strategies that drive consumer choice becomes imperative(1). This research project, part of a larger study at Massey University, explores the design and packaging of vegan food products, specifically focusing on processed PBMAs and how this influences vegan diet consumption choices in New Zealand vegans. We examined the packaging of vegan processed food available in New Zealand supermarkets and those promoted online, with a focus on processed PBMAs. This informed the development of an online survey including: demographics, motivations for following a vegan diet, and questions related to perceptions and preferences about vegan diets and processed PBMA packaging. The survey was offered to individuals who had previously participated in vegan research at Massey University and followed a strict vegan diet. There were 235 participants of whom 198 completed the survey. This consisted of primarily females (n = 156, 74%) and individuals of New Zealand European descent (n = 159, 71%), aged 18 to 76 years (37.8 ± 12.3). The participants had varying durations of following a vegan diet, with the largest group (n = 87, 42%) adopting it for 5 to 10 years. The primary motivation for following a vegan diet was animal welfare (n = 205), followed by environmental concerns (n = 189) and health (n = 175). Participants were able to select more than one option, suggesting there are often multiple reasons for choosing to follow a vegan diet. Factors influencing purchase decisions for PBMAs included nutrient claims on packaging, with protein having the highest positive influence. Environmental concerns also played a significant role, with eco-friendly packaging and positive environmental claims being important. Packaging images, particularly of the final prepared product, had a significantly positive impact on purchasing decisions (4.12 ± 0.78) where 1 represented a negative influence and 5 represented a positive influence on a Likert Scale. The majority sometimes, or always checked the nutrition information panel (n = 167, 85%) and examined the ingredients (n = 191, 98%). Participants reported concern about the nutritional value of processed PBMAs (n = 94), and reported that they are aware that these foods are classified as ‘ultra-processed (n = 91). This research provides valuable insights into the reasons people choose vegan diets and what influences their choices when it comes to purchasing PBMAs. It highlights the significance of marketing strategies in the plant-based meat alternatives industry. However, to gain a more comprehensive understanding of this evolving market, further research is necessary. Future research should consider a wider range of demographics and regional distinctions to better understand how consumer preferences in plant-based diets are changing. This should also include looking at how the market is maturing, with buyers becoming more aware of things like nutrients and the processing of food, which can impact the sustainable food choices individuals make.

Genetic and functional correction of argininosuccinate lyase deficiency using CRISPR adenine base editors

Argininosuccinate lyase deficiency (ASLD) is a recessive metabolic disorder caused by variants in ASL. In an essential step in urea synthesis, ASL breaks down argininosuccinate (ASA), a pathognomonic ASLD biomarker. The severe disease forms lead to hyperammonemia, neurological injury, and even early death. The current treatments are unsatisfactory, involving a strict low-protein diet, arginine supplementation, nitrogen scavenging, and in some cases, liver transplantation. An unmet need exists for improved, efficient therapies. Here, we show the potential of a lipid nanoparticle-mediated CRISPR approach using adenine base editors (ABEs) for ASLD treatment. To model ASLD, we first generated human-induced pluripotent stem cells (hiPSCs) from biopsies of individuals homozygous for the Finnish founder variant (c.1153C>T [p.Arg385Cys]) and edited this variant using the ABE. We then differentiated the hiPSCs into hepatocyte-like cells that showed a 1,000-fold decrease in ASA levels compared to those of isogenic non-edited cells. Lastly, we tested three different FDA-approved lipid nanoparticle formulations to deliver the ABE-encoding RNA and the sgRNA targeting the ASL variant. This approach efficiently edited the ASL variant in fibroblasts with no apparent cell toxicity and minimal off-target effects. Further, the treatment resulted in a significant decrease in ASA, to levels of healthy donors, indicating restoration of the urea cycle. Our work describes a highly efficient approach to editing the disease-causing ASL variant and restoring the function of the urea cycle. This method relies on RNA delivered by lipid nanoparticles, which is compatible with clinical applications, improves its safety profile, and allows for scalable production.

Biochemical Markers of Iron Status Among Iraqi Patients at Different Severity Levels of Celiac Disease

In people with a hereditary predisposition, gluten consumption causes celiac disease, a multifactorial autoimmune condition. The ensuing small intestine inflammatory process develops specific antibodies and causes various gastrointestinal and extra-intestinal symptoms with varying degrees of severity. Evaluation of the blood iron profile at various histological celiac disease severity in Iraqi patients was the goal of the current study. Seventy-five Iraqi patients with celiac disease, with a mean age of 18.68± 11.13 years, were the study's participants. These people tested positive for celiac antibodies and experienced gastrointestinal symptoms. Based on the disease histological severity, they were divided into two groups: marsh (III a, b, c) group and marsh (0, I) group. For comparison purposes, 46 people who appeared to be in good health and matched in age and gender to the patients utilized in the study were also included. The levels of iron, transferrin, hemoglobin, ferritin, total iron binding capacity, unsaturated iron binding capacity, and the percentage of transferrin that is saturated with iron were all measured. In comparison to the other patient groups under study, celiac patients (marsh III) group, and particularly those of group (marsh III c), showed a substantial drop (p&lt;0.05) in iron, the percentage of transferrin saturating with iron, the levels of each ferritin and of hemoglobin. The total iron binding capacity and the unsaturated iron binding capacity showed a significant elevation (p&lt;0.05) in (marsh III c) patients’ group, meanwhile non-significant differences (p&gt; 0.05) were found in transferrin concentration. Moreover, significant differences (p&lt; 0.05) were obtained in the iron profile between celiac patients who followed strict gluten free diet and those patients with gluten contained diet.

Targeting phenylalanine assemblies as a prospective disease-modifying therapy for phenylketonuria

Phenylketonuria is characterized by the accumulation of phenylalanine, resulting in severe cognitive and neurological disorders if not treated by a remarkably strict diet. There are two approved drugs today, yet both provide only a partial solution. We have previously demonstrated the formation of amyloid-like toxic assemblies by aggregation of phenylalanine, suggesting a new therapeutic target to be further pursued. Moreover, we showed that compounds that halt the formation of these assemblies also prevent their resulting toxicity. Here, we performed high-throughput screening, searching for compounds with inhibitory effects on phenylalanine aggregation. Morin hydrate, one of the most promising hits revealed during the screen, was chosen to be tested in vivo using a phenylketonuria mouse model. Morin hydrate significantly improved cognitive and motor function with a reduction in the number of phenylalanine brain deposits. Moreover, while phenylalanine levels remained high, we observed a recovery in dopaminergic, adrenergic, and neuronal markers. To conclude, the ability of Morin hydrate to halt phenylalanine aggregation without reducing phenylalanine levels implies the toxic role of the phenylalanine assemblies in phenylketonuria and opens new avenues for disease-modifying treatment.

Argininemia: Pathophysiology and Novel Methods for Evaluation of the Disease

Argininemia or arginase-1 deficiency constitutes a rare, genetic, metabolic disorder caused by mutations in arginase 1—the last enzyme of the urea cycle—that hydrolyses L-arginine to ornithine and urea. The disease is associated with progressive development of spasticity and other symptoms, including seizures, developmental delay, cognitive impairment, and hepatic pathology. The present review attempts to summarize the current knowledge on the pathophysiology of the disease and highlight novel methods for its evaluation. Different factors, such as the accumulation of arginine, ammonia, and guanidino compounds, act as neurotoxins and may account for the neurological sequelae observed in the disease. New markers, such as arginine/ornithine ratio along with metabolomics, machine learning algorithms, and genetic methods, can be useful in the early diagnosis of argininemia, while mobile phone apps can assist argininemic patients in adhering to the strict diet required. Neurophysiology, multi-modal imaging, and new modelling methods, such as induced pluripotent stem cells, hold promise for providing new insights into the pathophysiology of the disease. There are still many uncertainties regarding the underlying mechanisms of argininemia, but the use of novel modelling methods and new technology can lead to the decipherment of its pathophysiology, improvement of diagnostic accuracy, and better disease management.

Factors predicting remission in hyperthyroid patients after low-dose I-131 therapy: 20years retrospective study from a tertiary care hospital.

To assess the therapeutic outcome and factors predicting remission in hyperthyroid patients treated with low-dose I-131 (radioactive iodine) from a tertiary care hospital in South India. This 20-year single-institutional retrospective study was carried out on 3891 hyperthyroid adult patients. Only those patients with complete clinical records were audited. Selection criteria were based on patients with scintigraphic diagnosis of either Graves' disease (GD), toxic multinodular goitre (TMNG) or autonomous toxic nodule (ATN) and the records of those who received low-dose I-131 therapy (LDT) between March 2000 and 2020 at Amrita Institute, Cochin were analysed. SPSS 10 software was used for statistical analysis. The records of 3891 hyperthyroid predominantly female patients were analysed. 65% patients had GD, 33% had TMNG and 3% were ATN. High rates of remission as early as 12 weeks (in 61% patients) was observed with a single dose of LDT while on strict iodine-free diet for 3-4weeks prior to LDT. Study reveals that those with lower free T4 (fT4), small goitre (thyroid volume < 25cm3), < 15% thyroid trapping function, shorter time duration from onset of hyperthyroidism to LDT, and treatment-naïve patients were factors determining high remission rates. Mann Whitney U test and Chi-square test was used to correlate variables in the remission and relapse groups. We found a positive correlation between fT4, thyroid volume (r = 0.35, p < 0.01) and trapping function (r = 0.34, p < 0.01), which were independent of age, sex, body mass index and TSH levels in our study. High therapeutic outcome was observed with a single dose of LDT while on iodine-free diet. Remission with single dose of LDT occurred in 90% patients by 5th month. Of them 56% patients were treatment naive prior to LDT. LDT is thus a safe and effective therapy in hyperthyroid patients and can be recommended as a primary modality of management.

Allergic reaction following reintroduction of cow’s milk in a 2-month-old infant on an elimination diet for atopic dermatitis

Atopic dermatitis, a multifactorial, relapsing, and inflammatory condition, can affect the patient’s quality of life to a great extent. Simultaneous food allergy has also been noted in many patients with atopic dermatitis. Cow milk protein allergy is a commonly reported issue in children. Here, we presented a case of allergic reaction in a 2-month-old boy diagnosed with cow’s milk allergy based on mild atopic dermatitis despite the absence of immediate symptoms after milk ingestion. Dietary modifications (feeding of the exclusive hydrolyzed formula; elimination diet) were suggested; however, as there was no apparent improvement in the child’s symptoms, the parents reintroduced regular formula to his diet. The first re-exposure led to immediate reactions in the form of hives and irritability. The condition was diagnosed with an allergic reaction on presentation to the emergency room and was managed successfully. The follow-up visit confirmed the diagnosis of IgE-mediated cow’s milk allergy based on the history and the positive allergy testing to cow’s milk. Putting the child suffering from atopic dermatitis on a strict elimination diet might not be prudent as it increases the financial burden and the risk of developing severe life-threatening allergic reactions following accidental exposure to the allergen, as repeated oral exposure to allergens is very important for the development of tolerance.

Effects of Iodinated Contrast-enhanced CT on Urinary Iodine Levels in Postoperative Patients with Differentiated Thyroid Cancer.

This study aims to observe the fluctuating urine iodine levels in patients with differentiated thyroid cancer (DTC) following iodinated contrastenhanced computed tomography (eCT) scans. The presence of iodine in iodinated contrast agents (ICAs) can impede the effectiveness of radioactive iodine treatment (RAIT) and diagnostic scans in individuals diagnosed with DTC, as it can engage in competitive interactions with 131I. According to established guidelines, it is recommended to postpone RAIT for a period of three to four months in individuals who have had prior exposure to ICAS. The measurement of spot urine iodine concentration is a valuable indicator for assessing the overall iodine content throughout the body. The objective is to identify the optimal timing for administering postoperative RAIT in DTC patients. At various time points after surgery, a cohort of 467 random urine samples (126 male samples, 341 female samples, age (45±12 years)) was obtained from 269 DTC patients. The samples were analyzed for urinary iodine and urinary creatinine levels, and the urinary iodine/urine creatinine ratio (I/Cr) was computed. All samples were divided into two groups according to whether eCT before operation: the non-enhanced CT (eCT-) group and the enhanced CT (eCT+) group. The urine samples in the eCT- group were categorized into four subgroups according to the duration of strict low iodine diet (LID): (eCT-I+) no LID; (eCT-I-2W) 2 weeks of LID; (eCT-I-4W) 4 weeks of LID; and (eCT-I-6W) 6 weeks of LID. The last three groups were merged into the eCT- and effective LID group (eCT- I-). The urine samples from the eCT+ group were categorized into five subgroups: (0.5M eCT+)0.5 month after eCT+; (1M eCT+)1 month after eCT+; (2M eCT+) 2 months after eCT+; (3M eCT+) 3 months after eCT+; (≥4M eCT+) ≥4 months after eCT+. In addition, the patients within 2 months after eCT+ were divided into 2 groups according to their LID: no effective LID group (eCT+ I+) and effective LID group (eCT+ I-). Utilizing the Kruskal-Wallis and Mann-Whitney U rank sum tests, the differences in I/Cr between groups were compared. In the eCT-group, the I/Cr ratios of eCT-I-2W, eCT-I-4W, and eCT-I-6W were significantly lower than those of eCT-I+ (χ2 values: 4.607.99, all P 0.05). However, there was no significant difference in I/Cr between eCT-I-2W, eCT- I-4W, and eCT-I-6W (2 values: 0.591.31, all P > 0.05). Significantly higher I/Cr values were observed in 0.5M eCT+ and 1M eCT+ than in eCT-I+ (χ2 values: 3.22 and 2.18, respectively, all P<0.05). There was no significant difference in I/Cr between 2M eCT+ and eCT-I+ (χ2 = 0.76, P = 0.447). The I/Cr rations of 3M eCT+, ≥4M eCT+ were not significantly different with eCT-I- (χ2 values: 1.76; 0.58; all P > 0.05). However, they were considerably lower than eCT-I+ (χ2 values: 7.03; 5.22; all P<0.05). The I/Cr for patients who underwent eCT within two months (eCT+ I-, eCT+ I+) did not differ significantly (χ2 = 1.79, P = 0.073). For patients who are considering receiving radioactive iodine therapy (RAIT) following a diagnosis of differentiated thyroid cancer (DTC), it is recommended that the interval between RAIT treatment and enhanced computed tomography [eCT] scans be conducted at least three months.

The Benefit of Healthy Lifestyle in the Era of New Medications to Treat Obesity.

Incretin-based medications for treating obesity produce substantial short- and long-term weight loss and improve obesity-related comorbidities. However, associating lifestyle modification with new medications to treat obesity is generally advisable for several reasons. Firstly, healthy eating patterns and physical activity may offer important additional benefits, enhancing the patient's health and well-being. In addition, regular specialist counselling in lifestyle modification can help patients maintain their motivation levels and develop specific skills for addressing obstacles during the lengthy process of weight loss and maintenance, potentially improving outcomes in the long term. Given the high efficacy of the new weight-loss drugs, it would be timely to streamline and simplify the current gold standard of obesity management based on lifestyle modification. For example, it now seems redundant to prescribe strict diets or meal replacements to reduce calorie intake, or to recommend patients practice 200 to 300 minutes of moderate-to-vigorous-intensity exercise for enhanced weight loss. Moderate calorie restriction and, at least 150 minutes of moderate-intensity aerobic exercise and two sessions of muscle-strengthening activities per week may be more achievable and appropriate goals for sustainable weight loss in most patients on pharmaceutical obesity treatment. As regards lifestyle modification counselling, future studies should assess its optimal intensity and duration in the "new medications for obesity era".

Weight loss: when the body image does not keep up

The body image, defined as an individual's 'inner vision' of himself, stems from the combination of multiple factors. The body dissatisfaction, which represents its negative version, is associated with eating disorders, a sedentary lifestyle and weight gain. Several patients suffering from obesity consider weight loss as a strategy to work on their body image. Multiples studies confirm a positive association between weight loss and improved body images. Nevertheless, few elements seem to predispose to body dissatisfaction persistence, such as a history of strict diets, eating disorders or other psychopathologies. To treat body dissatisfaction, we need to focus our attention on self-esteem, a balanced lifestyle, and media education.

Ayurvedic Management of Ghrahani [Crohn’s Disease]-A Single Case Study

Crohn’s disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It causes a wide variety of symptoms like abdominal pain, diarrhoea (even bloody if inflammation is severe), vomiting, weight loss. It may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye, tiredness, and lack of concentration. Crohn’s disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn’s disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Crohn’s disease is caused by interactions between environmental, immunological and bacterial factors in genetically susceptible individuals. This result in a chronic inflammatory disorder, in which the body’s immune system attacks the gastrointestinal tract possibly directed at microbial antigens. Crohn’s disease has traditionally been described as an autoimmune disease, but recent investigators have described it as an immune deficiency state. According to Ayurveda, Crohn’s can be compared to ‘Grahani’ disease. Grahani in Ayurveda, is actually an anatomical term to describe small intestines (specifically Ileum and jejunam). Any vitiation or inflammation to this particular part by imbalanced Doshas (Vata, Pitta, Kapha) can cause a wide variety of symptom similar to that of Crohn’s disease, anywhere across the digestive system. Degree and nature of symptoms may vary as per the doshic predominance &amp; involvement. At CHARAKA, we are providing very effective treatment for Crohn’s disease based on the classical principle of Ayurveda and our research. Treatment involves internal research medicines, strict diet regime and life style modifications. In more severe and chronic cases, Panchakarma therapy is selectively done along with these. Pichha Basti indicated in Parvahika, Grahani and Atisara by Acharya Charaka and Vagbatta. This Basti reduce inflammation due to its Grahi, Deepandravya and Picchila Guna

Extension experience report: health, education and environment

The plant-based diet has nutritional properties capable of providing health benefits. Vegetarianism consists of maintaining a diet that excludes all types of meat and its derivatives from the diet. Veganism has a strict vegetarian diet, as it does not use any food or products of animal origin. Considering the relevance of encouraging sustainable production and consumption, this study aimed to report the activities on the Instagram® platform of a university extension group called VEG.A.N. UNIRIO. It consists of a descriptive study, of the experience report type. There is a need to disseminate information about vegetarianism and discuss issues that form part of the triad: vegetarianism, health and the environment. The information presented on social media ranges from research carried out by the group and pertinent topics such as food insecurity. It is a result of a process carried out and divided into stages and built by the entire group, to reach more people about the discussions highlighted by the entire group.

Is Wheat Glutenin Extract Intrinsically Allergenic? Evaluation Using a Novel Adjuvant-Free Mouse Model of Systemic Anaphylaxis.

Wheat is a prominent allergenic food that can trigger life-threatening anaphylaxis. Presently, it remains unclear whether wheat glutenin (WG) extract possesses inherent sensitization potential independently, without the use of adjuvants, and whether it can sensitize mice to the extent of inducing life-threatening systemic anaphylaxis. In this study, we tested the hypothesis that repeated skin exposures to WG extract without adjuvant will sensitize mice with the resultant anaphylactic reaction upon systemic WG challenge. Balb/c mice were bred and maintained on a strict plant protein-free diet and were repeatedly exposed to a WG extract or vehicle once a week for 9 weeks. WG-specific (s)IgE and total (t)IgE levels were quantified. Mice were challenged with WG extract to induce anaphylactic reactions as measured by hypothermic shock response (HSR) and mucosal mast cell degranulation response (MMCR). We also conducted proteomic analysis of 120 spleen immune markers. These skin-sensitized mice exhibited exposure-dependent IgE responses and near-fatal anaphylaxis upon challenge. Proteomic analysis identified seven dramatically elevated immune biomarkers in anaphylactic mice. These data reveal that WG is intrinsically allergenic, and that chronic skin exposure to WG extract can prime the mice for potentially fatal anaphylaxis.

Piloting a Mediterranean Ketogenic Nutrition Program to Address Pain in Older Adults with Mild Cognitive Impairment

AbstractBackgroundPain is a persistent problem in older adults associated with poorer quality of life, greater risk of falls, functional impairment, and risk for cognitive impairment. Psychosocial and lifestyle interventions may be especially important to consider in older populations who may be more susceptible to negative side effects of pain medications. Ketogenic nutrition (KN) is one promising option that may offer a nonpharmacologic pathway for treating pain; however, KN is also a relatively strict and complex diet associated with challenges in dissemination and long‐term adherence, especially in older adults with memory impairments.MethodThis pilot clinical trial (N = 58) evaluated a 6‐week Mediterranean KN program designed to evaluate adherence and preliminary effects of the program on pain in individuals with possible mild cognitive impairment (aged 60‐85). Participants completed daily at‐home urine ketone testing during the program, weekly evaluations of psychosocial and health characteristics, and three in‐person assessments of health, ketones, pain, and other relevant measures.ResultsAnalyses demonstrated significant improvement in pain intensity across the assessment period. Average daily urine ketone level and average self‐reported adherence across the 6‐week program were both positively correlated with improvements in pain‐related quality of life (ps&lt;.05).ConclusionFindings offer preliminary evidence that a group, Mediterranean KN program and adherence to this type of nutrition may reduce the experience of pain and pain‐related outcomes for older adults.

Premature coronary artery disease and severe hypertriglyceridemia in a patient with monogenic diabetes: a case report

Aim. Maturity- onset diabetes of the young (MODY) is a group of monogenic diseases with an autosomal dominant inheritance. This is a rarely diagnosed disease, occurring in 1 of 10 thousand adults and in 1 of 23 thousand children. Brief description. We present a case report of a patient with a monogenic diabetes HNF4A-MODY, severe hypertriglyceridemia, progressive premature coronary artery disease and a HNF4A gene pathogenic variant (ENST00000316099.8:c.1145dup).Discussion. This case demonstrates the effectiveness of triple hypoglycemic therapy, including empagliflozin for the treatment of monogenic diabetes. Despite the fact that the patient with diabetes reached the target glycated hemoglobin level, the combination of the disease with other cardiovascular risk factors (hypertension, hypertriglyceridemia, obesity, smoking, male sex) led to the progression of coronary and peripheral atherosclerosis. Considering the data of genetic testing, returning to sulfonylurea therapy should be considered. It is important for patient to follow a strict lipid-lowering diet and taking combination lipid-lowering therapy (rosuvastatin, fenofibrate and omega-3 polyunsaturated fatty acids) in order to achieve the target level of low-density lipoprotein cholesterol &lt;1,4 mmol/l and triglycerides &lt;1,7 mmol/l.

Digoxin Pharmacokinetics in Patients with Obesity Before and After a Gastric Bypass or a Strict Diet Compared with Normal Weight Individuals.

Several drugs on the market are substrates for P-glycoprotein (P-gp), an efflux transporter highly expressed in barrier tissues such as the intestine. Body weight, weight loss, and a Roux-en-Y gastric bypass (RYGB) may influence P-gp expression and activity, leading to variability in the drug response. The objective of this study was therefore to investigate digoxin pharmacokinetics as a measure of the P-gp phenotype in patients with obesity before and after weight loss induced by an RYGB or a strict diet and in normal weight individuals. This study included patients with severe obesity preparing for an RYGB (n = 40) or diet-induced weight loss (n = 40) and mainly normal weight individuals scheduled for a cholecystectomy (n = 18). Both weight loss groups underwent a 3-week low-energy diet (<1200 kcal/day) followed by an additional 6 weeks of <800 kcal/day induced by an RYGB (performed at week 3) or a very-low-energy diet. Follow-up time was 2 years, with four digoxin pharmacokinetic investigations at weeks 0, 3, and 9, and year 2. Hepatic and jejunal P-gp levels were determined in biopsies obtained from the patients undergoing surgery. The RYGB group and the diet group had a comparable weight loss in the first 9 weeks (13 ± 2.3% and 11 ± 3.6%, respectively). During this period, we observed a minor increase (16%) in the digoxin area under the concentration-time curve from zero to infinity in both groups: RYGB: 2.7 µg h/L [95% confidence interval (CI) 0.67, 4.7], diet: 2.5 µg h/L [95% CI 0.49, 4.4]. In the RYGB group, we also observed that the time to reach maximum concentration decreased after surgery: from 1.0 ± 0.33 hours at week 3 to 0.77 ± 0.08 hours at week 9 (-0.26 hours [95% CI -0.47, -0.05]), corresponding to a 25% reduction. Area under the concentration-time curve from zero to infinity did not change long term (week 0 to year 2) in either the RYGB (1.1 µg h/L [-0.94, 3.2]) or the diet group (0.94 µg h/L [-1.2, 3.0]), despite a considerable difference in weight loss from baseline (RYGB: 30 ± 7%, diet: 3 ± 6%). At baseline, the area under the concentration-time curve from zero to infinity was -5.5 µg h/L [95% CI -8.5, -2.5] (-26%) lower in patients with obesity (RYGB plus diet) than in normal weight individuals scheduled for a cholecystectomy. Further, patients undergoing an RYGB had a 0.05 fmol/µg [95% CI 0.00, 0.10] (29%) higher hepatic P-gp level than the normal weight individuals. Changes in digoxin pharmacokinetics following weight loss induced by a pre-operative low-energy diet and an RYGB or a strict diet (a low-energy diet plus a very-low-energy diet) were minor and unlikely to be clinically relevant. The lower systemic exposure of digoxin in patients with obesity suggests that these patients may have increased biliary excretion of digoxin possibly owing to a higher expression of P-gp in the liver.