Strict Diet Research Articles

Female athlete triad affects rat intestinal morphology and sucrase-isomaltase expression.

Female athletes follow a strict diet and perform rigorous exercise to boost their performance, which induces health issues called the female athlete triad (FAT), defined as the combination of disordered eating, amenorrhoea and low bone mineral density. It is known to have a significant effect on bones. However, its effects on the small intestine, which is responsible for nutrient uptake into the body, remain unclear. In this study, we created an animal model of FAT to examine its effects on digestive and absorptive molecules in the small intestine. Thirty 5-week-old female Sprague-Dawley (sd) rats with an initial body weight of about 147 g were divided into control (Con, n = 7), exercise (Ex, n = 7), food restriction (FR, n = 8) and exercise plus food restriction (FAT, n = 8) groups. The rats were subjected to 4 weeks of wheel running (Ex, FAT) and 50-40 % food restriction (FR, FAT) to examine the effects on bone and typical digestive enzymes and transporters in the jejunum. Two-way ANOVA and the Kruskal-Wallis test were used for statistical analysis of normal and non-normal data, respectively. Four weeks of exercise and food restriction decreased bone weight (vs. other group P < 0·01) and bone breaking power (vs. other group P < 0·01). Villus height decreased in the jejunum (vs. other group P < 0·01), but the expression of typical macronutrients digestive enzyme and absorptive molecules remained unchanged. In contrast, sucrase-isomaltase gene (v. Ex P = 0·02) and protein expression were increased (vs. other group P < 0·05). The study findings show that FAT affects sucrase-isomaltase without histone methylation changes.

Efficacy of topical application of insulin versus platelet rich plasma versus normal saline dressings in the healing of diabetic foot ulcers: A study from a tertiary care center in India

Background: Diabetic foot ulcers (DFU) are one of the major complications of diabetes. Despite proper insulin treatment and a strict diabetic diet, 15% of diabetic population develop non-healing ulcers which leads to amputation of the lower limb. Wound dressings represent a part of the management of diabetic foot ulceration. Normal saline (0.9%) wound dressings have been a useful adjunct in the treatment of open wounds. Topical insulin dressing improves wound healing by regulating oxidative and inflammatory responses. PRP dressing has emerged as an adjunctive and newer method for treating DFUs. Hence, the present study was undertaken to compare the effect of topical insulin, platelet-rich plasma (PRP), and normal saline dressing in healing of DFU. Aims and Objectives: The aim of the study was to study the comparison between topical application of insulin versus PRP versus regular normal saline dressing in healing of DFU. Materials and Methods: It is a duration based prospective comparative study including 60 patients divided equally into normal saline dressing group, topical insulin dressing group and PRP dressing group after they fulfilled all the inclusion and exclusion criteria and after obtaining the proper informed and written consent from relatives/patients. Ulcers at days 0, 7 and 14 in terms of size, depth and percentage reduction in area of wound were analyzed. Results: The mean ulcer size at day 14 in normal saline was 4.19±0.95, in Insulin 2.64±0.83 while 2.08±0.47 in PRP group. The mean ulcer depth at day 14 in normal saline was 5.35±1.18, in insulin 4.30±1.38 while 2.35±1.42 (mm) in PRP group, percentage reduction of mean ulcer size in normal saline was 27.02±4.46, in insulin 50.31±7.53 and 63.80±5.75% in PRP group. Conclusion: PRP appears to be a promising agent in terms of faster wound healing, more significant reduction in the size of DFU as compared to topical insulin and other conventional dressings.

Meal Patterns for Vegetarians

Presented in the paper are three eating patterns for various types of vegetarians. Meal pattern no. 1 stresses the vitality of the replacement of the lack of vitamins and minerals associated with the strict vegan diet. Meal pattern no. 2 emphasizes the inclusion of foods to reduce the level of low-density lipoprotein (LDL) in the daily lacto-vegetarian diet. As well as that meal pattern no. 2 increases methionine and tryptophane in human blood. Meal pattern no. 3 intended for lacto-ovo-vegetarians is a balanced diet dominated by complex carbohydrates and an increased level of antioxidants in the diet.

Phenylalanine hydroxylase mRNA rescues the phenylketonuria phenotype in mice.

Phenylketonuria (PKU) is an inborn error of metabolism caused by a deficiency in functional phenylalanine hydroxylase (PAH), resulting in accumulation of phenylalanine (Phe) in patients’ blood and organs. Affected patients encounter severe developmental delay, neurological deficits, and behavioral abnormalities when not treated. Early diagnosis and treatment are extremely important; newborn screening programs have been implemented in most countries to ensure early identification of patients with PKU. Despite available treatment options, several challenges remain: life-long adherence to a strict diet, approval of some medications for adults only, and lack of response to these therapies in a subpopulation of patients. Therefore, there is an urgent need for treatment alternatives. An mRNA-based approach tested in PKU mice showed a fast reduction in the accumulation of Phe in serum, liver and brain, the most significant organ affected. Repeated injections of LNP-formulated mouse PAH mRNA rescued PKU mice from the disease phenotype for a prolonged period of time. An mRNA-based approach could improve the quality of life tremendously in PKU patients of all ages by replacing standard-of-care treatments.

Food security of people with celiac disease in the Republic of Moldova through prism of public policies.

Food security is an important lever for the implementation of rights-based legislation, policies, and programs, while being a public health and socio-economic priority. Foodborne illnesses have a major impact on public health, and nutritional interventions are essential therapeutic strategies to combat them. Gluten ingestion has been linked to several clinical disorders, collectively called gluten-related disorders. The most serious of these is celiac disease. The only way to treat celiac disease is to stick to a gluten-free diet for life. Following a strict diet is also the only way to prevent the long-term consequences of the disease. Public policies are essential to ensure the food security of people with gluten-related disorders. The aim of the research is to assess the level of care for people with celiac disease in the Republic of Moldova, in terms of public policies, to ensure a sustainable sector that effectively satisfies the food security of people with disorders associated with gluten consumption. To assess the level of care for people with gluten-related disorders, the working algorithm was taken, with reference to global public policies in support of people with celiac disease, developed and validated by Falcomer et al., Focused on 6 items. The results of the study showed that the Republic of Moldova does not have adequate policy support to ensure food security for people with gluten-related disorders, which poses major challenges and, as a result, may increase the complications of these problems.

CELAAN FISIK PADA FILM IMPERFECT KARYA ERNEST PRAKASA (KAJIAN MITOS KECANTIKAN NAOMI WOLF)

The purpose of this research is to describe the forms of verbal body shaming found in the film "Imperfect" by Ernest Prakasa. The method used is qualitative. Data were collected through the method of listening, recording, and documentation by using a data card instrument, and tested for validity through triangulation of sources. This research shows that; 1) body shaming in the work environment requires women to look beautiful and attractive as a condition for obtaining a position as manager, 2) body shaming has eroded women's confidence because in culture, women will be considered to exist if they are beautiful, 3) body shaming in religion requires women to look beautiful based on the demands of society and the media, 4) body shaming weakens women's sexuality in making love, 5) body shaming of fat forces women to go on strict diets that are harmful to health, and 6) body shaming has made women make changes to their bodies by that hurts.

S3412 Functional Medicine Approach to Care Improves Quality of Life and Blood Alcohol Levels in a Patient With Autobrewery Syndrome

Introduction: Autobrewery syndrome, or gut fermentation syndrome (GFS), is a rare condition characterized by elevated blood alcohol concentration (BAC) in the absence of alcohol consumption. Treatment involves antifungals and a low carb diet, which are often ineffective. In this case, we describe a patient with GFS who failed traditional therapy, was unable to complete activities of daily living due to high BAC, and responded well to a functional medicine approach to care with sustained improvement in BAC. Case Description/Methods: In 7/2020, a 58-year-old man with T2D, obesity, HTN and gout developed recurrent episodes of dysarthria, behavioral changes, and somnolence. On multiple occasions in the ER, his BAC level was found to be elevated. The patient and family denied alcohol use. He was ultimately diagnosed with GFS. He self-initiated a strict low-carb diet with initial success in controlling his BAC from 11/2020 to 12/2020. From 10/2020 to 10/2021, he underwent multiple courses of antifungal medications (nystatin, fluconazole, micafungin, and oral amphotericin). The longest period of remission (BAC 0) was 41 days while on micafungin. After 41 days on micafungin and a restricted diet, his BAC increased. Over this time, he lost 80 lbs. In 11/2021, he established with a functional medicine GI and dietitian. Stool metabolomics showed no obvious abnormalities. The 5 R protocol (remove, replace, repair, reinoculate, rebalance) was introduced. He started with an aggressive bowel regimen with prucalopride and lactulose. He completed 15 days of high-potency Bacillus subtilis probiotic, followed by a transition to a more diverse probiotic. He added daily intake of a medical food to his restricted diet. New foods were then introduced, one at a time, in the evening, with subsequent monitoring of BAC. In 2/2022, he started Undecylenic acid (10-Undecenoic Acid) as fatty acid support. Lifestyle modifications were added to emphasize more exercise, daily outdoor walks, optimal sleep, and decreasing stress. He did well until BAC levels spiked in 3/2022 due to consumption of alcohol, triggered by cravings that developed when the gut production of alcohol decreased. After alcohol cessation, BAC levels have remained undetectable for 60+ days with continued diet modifications and supplements (Figure). Discussion: GFS is difficult to treat with minimal traditional treatment options. This case is a patient with GFS that failed all medical options and is now thriving after a functional medicine approach to care.Figure 1.: BAC levels continued to spike with medical therapies and have sustained improvement with functional medicine care.

Correlation and Influence of Seasonal Variation of Diet with Gut Microbiota Diversity and Metabolism Profile of Chipmunk.

Simple SummaryThe Chipmunk (Tamias Sibiricus) plays a vital role in seed dispersal, but its seasonal diet, intestinal microflora structure, and metabolism profile are not clear at present, which is the main content of this study. Understanding the above contents is helpful in understanding further the factors affecting the chipmunk’s stability and population change. Our results showed significant differences in dietary habits, intestinal microflora structure, and nutrient absorption of chipmunks in different seasons. This study demonstrated that food in different seasons had essential effects on chipmunk’s intestinal microbe structure and metabolism profile.Tamias Sibiricus is the only member of the genus Tamias, a significant and vigorous seed distributor and vital food for their predators. No information is known about the strict diet, gut microbiota structure, and metabolism profile of chipmunks and how they diversify seasonally. The above factors, as well as flexibility toward seasonal shifts, are critical in defining its growth rates, health, survivorship, and population stability. This study explored the diet, gut microbiota composition, and chipmunk metabolism. Additionally, the influence of different seasons was also investigated by using next-generation sequencing. Results revealed that seasons strongly affected a diet: streptophyte accounted for 37% in spring, which was lower than in summer (34.3%) and autumn (31.4%). Further, Ascomycota was observed at 43.8% in spring, which reduced to 36.6% in summer and the lowest (31.3%) in autumn. Whereas, nematodes showed maximum abundance from spring (15.8%) to summer (20.6%) and autumn (24.1%). These results signify the insectivorous nature of the chipmunk in summer and autumn. While herbivorous and fungivorous nature in spring. The DNA analysis revealed that chipmunk mainly feeds on fungi, including Aspergillus and Penicillium genus. Similar to diet composition, the microbiome also exhibited highly significant dissimilarity (p < 0.001, R = 0.235) between spring/autumn and spring/summer seasons. Proteobacteria (35.45%), Firmicutes (26.7%), and Bacteroidetes (23.59%) were shown to be the better discriminators as they contributed the most to causing differences between seasons. Moreover, PICRUSt showed that the assimilation of nutrients were also varied seasonally. The abundance of carbohydrates, lipids, nucleotides, xenobiotics, energy, terpenoids, and polyketides metabolism was higher in spring than in other seasons. Our study illustrates that seasonal reconstruction in the chipmunk diet has a significant role in shaping temporal variations in gut microbial community structure and metabolism profile.

Ожирение и современные методы его лечения

It is proven that obesity increases the risk of atherosclerosis and cardiovascular system diseases such as varicose disease, arterial hypertension, ischemic heart disease, stroke and myocardial infarction also diabetes mellitus, calculous cholecystitis, osteoarthrosis, sleep apnea syndrome, dyslipidemia, non-alcohol origin fatty heptoses, oncological diseases such as breast, uterus, ovarium cancer. It also decreases reproductive function. The mortality rate of people with severe obesity is 10 times higher than that of people without obesity. Patients with obesity firstly must be closely monitored by general practitioners, as well as by cardiologists, gastroenterologists, surgeons, rehabilitators, and nutritionists. There are two standard directions for treating obesity. They are: conservative, which is divided into 2 subgroups: non-pharmacological, that is, following strict diets, having physical activity, and medicinal, when certain groups of drugs are prescribed to depress the appetite center or to reduce the absorption of lipids from the intestines and affect their metabolism. The second way of treatment is surgery, which is used in extreme cases. A wide range of drugs allows us to hope that the correct and competent strategy with patients with obesity can reduce the consequences and complications caused by obesity.

Western blot analysis to confirm biscuit contamination by hidden cow’s milk protein

IgE-mediated food allergies can cause life-threatening anaphylaxis. Management of these allergies is based on a strict avoidance diet in relation to foods that may contain the allergen. The European regulations issued by the INCO (consumer information) provide a list of 14 allergens subject to mandatory declaration [1]. These allergens must be listed (in bold, underlined, large font, etc.) on food packaging in order to allow ready identification when consumers examine the labeling. The precautionary labeling, which is not regulated, includes statements at the end of the list of ingredients [2]. In France, the most frequent main allergens responsible for IgE-mediated allergies in children under 2 years of age are Cow’s Milk (CM) proteins, eggs, and peanuts [3], all of which are on the list of allergens subject to mandatory declaration. In this study, we report the case of a child who developed anaphylaxis after having consumed a biscuit labeled as having no cow’s milk proteins.

Life-threatening gastrointestinal bleeding caused by jejunal heterotopic gastric mucosa in an adult dog: a rare case report

BackgroundHeterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa.Case presentationA twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs.ConclusionsThis case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.

Comparative Transcriptomics and Methylomics Reveal Adaptive Responses of Digestive and Metabolic Genes to Dietary Shift in Giant and Red Pandas.

Both the giant panda (Ailuropoda melanoleuca) and red panda (Ailurus fulgens) belong to the order Carnivora, but have changed their dietary habits to eating bamboo exclusively. The convergent evolution characteristics of their morphology, genome and gut flora have been found in the two pandas. However, the research on the convergent adaptation of their digestion and metabolism to the bamboo diet, mediated by the dietary shift of the two pandas at the gene-expression and epigenetic regulation levels, is still lacking. We therefore used RNA sequencing among five species (two pandas and three non-herbivore mammals) and bisulfite sequencing among three species (two pandas and a carnivore ferret) to sequence key digestion and metabolism tissues (stomach and small intestine). Our results provide evidence that the convergent differentially expressed genes (related to carbohydrate utilization, bile secretion, Lys and Arg metabolism, vitamin B12 utilization and cyanide detoxification) of the two pandas are adaptive responses to the bamboo diet containing low lipids, low Lys and Arg, low vitamin B12 and high cyanide. We also profiled the genome-wide methylome maps of giant panda, red panda and ferret, and the results indicated that the promoter methylation of the two pandas may regulate digestive and metabolic genes to adapt to sudden environmental changes, and then, transmit genetic information to future generations to evolve into bamboo eaters. Taken together, our study provides new insights into the molecular mechanisms of the dietary shift and the adaptation to a strict bamboo diet in both pandas using comparative transcriptomics and methylomics.

Fecal calprotectin levels in pediatric cow's milk protein allergy.

IntroductionThe most prevalent food allergy in younger children is cow's milk protein allergy (CMPA), a hypersensitivity reaction to cow's milk protein and its most common clinical manifestation is allergic colitis. The goal of our recent study was to assess somatic symptoms of CMPA and to prospectively observe the effects of a dairy elimination diet using objective parameters and questionnaires.MethodsThe County Hospital in Szekszárd, Hungary, investigated children aged 1 to 18 who had clinical signs that might indicate CMPA. Stool samples were taken and analyzed using a fecal calprotectin (FC) rapid test (Quantum Blue fCAL, Bühlmann Laboratories, Switzerland) at the time of the diagnosis and following 3 months of an elimination diet. At the baseline visit as well as the first and second follow-up, questionnaires were filled out. Patients were divided into two subgroups according to dietary guidelines based on the results of the questionnaires.ResultsA total of 47 patients participated in the study [42.55% female, mean age: 7.36 (SD 4.22) years]. There was no significant difference in FC levels between baseline and after 3-month elimination diet [73.98 (71.12) μg/g and 68.11 (74.4) μg/g, respectively, p = 0.331]. After three months, there was a significant decrease in FC levels among patients who adhered to the strict diet [84.06 (79.48) μg/g and 41.11 (34.24) μg/g, respectively, p = 0.001].ConclusionThe findings of our study suggest that FC can be an objective marker in confirming the diagnosis of CMPA. Significant improvement in clinical symptoms and in FC levels can only be expected after a strictly followed elimination diet.

Low Copper Diet-A Therapeutic Option for Wilson Disease?

Wilson’s disease (WD) is an autosomal recessive inherited disease in which a pathological storage of copper in various organs is the mean pathophysiological mechanism. The therapy consists of drug therapy with chelating agents or zinc. For patients, nutrition is always an important issue. The aim of this review was to determine whether there are clear recommendations for a low copper diet for WD patients, or whether the essential trace element zinc plays a role? We were able to show that some of the foods with high copper content would have to be consumed in such large quantities that this is regularly not the case. Furthermore, there are also different absorption rates depending on the copper content. A lower copper intake only prevents the re-accumulation of copper. In summary, consistent adherence to drug therapy is more important than a strict diet. Only two foods should be consistently avoided: Liver and Shellfish.

Supplementation of Regular Diet With Medium-Chain Triglycerides for Procognitive Effects: A Narrative Review.

It is now widely accepted that ketosis (a physiological state characterized by elevated plasma ketone body levels) possesses a wide range of neuroprotective effects. There is a growing interest in the use of ketogenic supplements, including medium-chain triglycerides (MCT), to achieve intermittent ketosis without adhering to a strict ketogenic diet. MCT supplementation is an inexpensive and simple ketogenic intervention, proven to benefit both individuals with normal cognition and those suffering from mild cognitive impairment, Alzheimer's disease, and other cognitive disorders. The commonly accepted paradigm underlying MCT supplementation trials is that the benefits stem from ketogenesis and that MCT supplementation is safe. However, medium-chain fatty acids (MCFAs) may also exert effects in the brain directly. Moreover, MCFAs, long-chain fatty acids, and glucose participate in mutually intertwined metabolic pathways. Therefore, the metabolic effects must be considered if the desired procognitive effects require administering MCT in doses larger than 1 g/kg. This review summarizes currently available research on the procognitive effects of using MCTs as a supplement to regular feed/diet without concomitant reduction of carbohydrate intake and focuses on the revealed mechanisms linked to particular MCT metabolites (ketone bodies, MCFAs), highlighting open questions and potential considerations.

MRNA-based therapy proves superior to the standard of care for treating hereditary tyrosinemia 1 in a mouse model

Hereditary tyrosinemia type 1 is an inborn error of amino acid metabolism characterized by deficiency of fumarylacetoacetate hydrolase (FAH). Only limited treatment options (e.g., oral nitisinone) are available. Patients must adhere to a strict diet and face a life-long risk of complications, including liver cancer and progressive neurocognitive decline. There is a tremendous need for innovative therapies that standardize metabolite levels and promise normal development. Here, we describe an mRNA-based therapeutic approach that rescues Fah-deficient mice, a well-established tyrosinemia model. Repeated intravenous or intramuscular administration of lipid nanoparticle-formulated human FAH mRNA resulted in FAH protein synthesis in deficient mouse livers, stabilized body weight, normalized pathologic increases in metabolites after nitisinone withdrawal, and prevented early death. Dose reduction and extended injection intervals proved therapeutically effective. These results provide proof of concept for an mRNA-based therapeutic approach to treating hereditary tyrosinemia type 1 that is superior to the standard of care.

Dietary Patterns and Dietary Recommendations Achievement From Latin American College Students During the COVID-19 Pandemic Lockdown

This study aimed to compare the diet quality of different dietary patterns among college students from Latin American countries, including vegetarians, vegans, and omnivores during the COVID-19 pandemic. A cross-sectional, observational, multicenter study was conducted including a non- probabilistic sample of university students from 10 countries. University students were invited to participate in the study through social network platforms. Participants were self-reported to have followed a specific dietary pattern; either the Prudent diet, Western diet, Ovo-dairy-vegetarian diet, Fish-vegetarian diet, Strict vegetarian diet (vegan) or other. The last three patterns (vegetarians and vegans) were grouped as following a plant-based diet. A self-assessment survey was used to evaluate healthy eating habits using a questionnaire with values between 1 (do not consume) and 5 (consume) for a total of 9–45 points (higher values represent better eating habits). Unhealthy habits were assessed with nine questions. A total of 4,809 students filled out the questionnaire, and the majority of them were females (73.7%). A high percentage have been in lockdown for more than 5 months and were in lockdown when the survey was released. 74.3% were self-reported to follow a prudent diet, while 11.4% reported following a western dietary pattern and 8.8% a plant-based diet. When compliance with healthy and unhealthy dietary habits was analyzed, although all groups had low compliance, the plant-based diet group (56.09 ± 6.11) performed better than the Western diet group (48.03 ± 5.99). The total diet quality score was significantly higher for plant-based diet followers, who also tended to better achieve the recommendations than omnivorous students, especially the ones following a western diet. These results present evidence that young adults such as college-aged students have unhealthy dietary habits. However, the ones who follow a plant-based diet such as vegetarians and vegans exhibit better scores and healthier dietary conducts.

The emotional burden of caregiving for patients with cirrhosis.

Caregivers for patients with cirrhosis face immense physical and psychological strain that negatively impact quality of life and ability to care for oneself. The aim is to explore the caregiver experience for patients with cirrhosis, identify prominent stressors, and understand the multidimensional contributors to caregiver burden, to help tailor effective interventions. The caregivers of 25 patients with decompensated cirrhosis underwent semistructured in‐person interviews and completed written exercises targeting emotional disclosure or resilience training that were analyzed for dominant emotions and themes. Burden was quantified using the Zarit Burden Interview‐12 (ZBI, range 0–48), Distress Thermometer (0–10), and Caregiver Captivity Index (0–4). Quality of life was assessed with a visual analog scale (0–100). Median ZBI was moderate (14 [10–19]), as was distress (5 [2–7]), and captivity (2 [1–4]). Quality of life was fair (80 [70–85]). Dominant emotions included anxiety, guilt, fear, frustration, captivity, and resentment. Prominent themes included lack of time for self‐care, hierarchy of caregiver role, support from versus frustration with medical professionals, social support, spirituality and religion, and disease‐related restrictions. Hepatic encephalopathy, and need to follow strict nutrition and diet recommendations, are frequent sources of disease‐related caregiver burden. The health care system confers some degree of burden, especially when doubts arise regarding physician competence. Conclusion: Caregiver burden is significant. The impact of interventions to alleviate caregiver burden should be explored, so that their appreciated efforts do not have such detrimental effects on their quality of life.

*Ketogenic Diets Exacerbating Hypercholesterolemia in APOE Variants and APOB Mutations-Potential Role for Measuring Intestinal Absorption of Lipids

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Familial Hypercholesterolemia (FH) is caused primarily by mutations in either LDL receptor, APOB, or PCSK9 genes. There are other genetic causes of LDL elevation including APOE4 variants. Objective/Purpose We present two patients with markedly elevated LDL suspicious for FH who were subsequently diagnosed with APOE3/4 variants while on ketogenic diets. We also present a patient with a known APOB mutation who had a marked elevation of LDL on a ketogenic diet. Methods Case 1: 58-year-old male with no prior medical history was found to have elevated cholesterol of 600mg/dL and LDL>455mg/dL while on a ketogenic diet. Prior to initiating the diet, his cholesterol was 206mg/dL and LDL was 132mg/dL. Genetic testing revealed a ApoE3/4 variant. His most recent cholesterol increased to 706mg/dL and LDL to >500mg/dL. Case 2: 53-year-old male with hypertension cholesterol of 282mg/dL and LDL of 212mg/dL went on a ketogenic diet and lost 100lbs. Follow up lipid panel demonstrated a cholesterol of 400mg/dL and LDL of 317mg/dL. Genetic testing revealed a APOE3/4 variant. Case 3: 45-year-old female with FH and known APOB missense mutation went on a ketogenic diet for weight loss. Prior to initiating the diet, her total cholesterol was 311 mg/dL and LDL was 211 mg/dL. While on the ketogenic diet, her total cholesterol was 550 mg/dL and LDL was 454 mg/dL. Her LDL decreased to 276mg/dl on a less strict ketogenic diet. Results All three patients had a normal exercise stress test, normal carotid duplex ultrasound, and coronary calcium score of zero. They refused the initiation of a statin. All 3 patients had the Boston Heart Cholesterol Balance Test performed that directly measures the absorption markers (beta-sitosterol, campesterol and cholestanol) for circulating plasma cholesterol. Only the patient with the APOB mutation had increased intestinal absorption of cholesterol, suggesting a response to ezetimibe. She agreed to initiate ezetimibe, her LDL subsequently decreased by 52% to 132mg/dl. Conclusions We hypothesize patients with APOE variants and APOB mutations could have an exaggerated elevation of their LDL levels while on ketogenic diets. Although these 3 patients did not demonstrate progressive atherosclerosis, the long-term effect of this diet is unknown. We recommend that all patients on a ketogenic diet have their LDL monitored and if there is a significant increase, undergo genetic testing for FH, APOE and other genetic variants. Since this patient group is often reluctant to start statins, the Cholesterol Balance Test may be useful to identify patients who may respond well to ezetimibe. Nothing to disclose.

Acquired Chylomicronemia Due to Autoantibodies Against GPIHBP1

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis We report a case of recurrent triglyceride-induced pancreatitis that was found to be due to autoantibodies to glycosylphosphatidylinositol-anchored HDL binding protein 1 (GPIHBP1) in the setting of biopsy-proven membranous lupus nephritis. Objective/Purpose This case report highlights a very rare cause of acquired chylomicronemia and discusses the treatment of GPIHBP1 autoantibody-induced hypertriglyceridemia. Methods A 12-year-old female with no medical history was admitted to the hospital for triglyceride induced pancreatitis. Her initial lipids consisted of: triglycerides 4070, total cholesterol 290, HDLc 9, and non-HDL-c 281 mg/dL. After inpatient treatment, she was started on fenofibrate and referred to lipid clinic. Despite fenofibrate 160 mg daily, icosapent ethyl 2 g twice a day, and a strict low-fat diet, the patient continued to experience triglyceride-induced pancreatitis. Her triglycerides fluctuated between 1200 - 2300 mg/dL. Genotyping was negative for familial chylomicronemia (deficiency/mutation in LPL, APOC2, APOA5, LFM-1, and GPIHBP1). Therefore, the patient was presumed to have genotype-negative familial chylomicronemia syndrome. Over the next 2 years, the patient had 15 hospital admissions for triglyceride-induced pancreatitis. At age 14 she was started on alirocumab 75 mg injections every 14 days, which decreased, but did not eliminate, the frequency of pancreatitis episodes. Her triglyceride levels subsequently ranged 650 - 991 mg/dL. During a hospital admission at age 15, the patient was found to have nephrotic syndrome with an ANA titer >1:2560. Renal biopsy confirmed membranous lupus nephritis. She was treated with pulse-dose steroids, mycophenolate mofetil, and hydroxychloroquine. Her lupus diagnosis prompted testing for GPIHBP1 autoantibodies,which were strongly positive. Results Two months after our patient's diagnosis of GPIHBP1 autoantibody induced hypertriglyceridemia, she continues to receive treatment with prednisone 40 mg daily, mycophenolate mofetil 1000 mg twice a day, and hydroxychloroquine 200 mg daily and has received two doses of rituximab-pvvr 1000 mg. Her triglycerides remain elevated 1400 - 2200 mg/dL. Conclusions This case highlights a recently described entity in the literature, “GPIHBP1 autoantibody syndrome,” wherein patients with unexplained chylomicronemia are found to have autoantibodies to GPIHBP1, causing hypertriglyceridemia resistant to traditional medical therapy. Of the 33 known patients worldwide with GPIHBP1 autoantibody syndrome, immunosuppression with rituximab and mycophenolate are reported to be effective therapies.Our patient is currently undergoing immunosuppression, but triglyceride levels have yet to decrease. Additional time and/or rituximab doses may be needed in order to maximally suppress autoantibody production and, in turn, reduce triglyceride levels. Nothing to disclose.