Mixed Lipid, Fish Oil, and Soybean Oil Parenteral Lipids Impact Cholestasis, Hepatic Phytosterol, and Lipid Composition.

OBJECTIVES: In parenteral nutrition-dependent infants and children, intestinal failure (IF)-associated liver disease (IFALD) remains an important problem. A comparative study was undertaken of parenteral mixed lipid (ML), ω-3 predominant fish oil (FO), and ω-6 predominant soybean oil (SO) emulsions in regards to hepatic phytosterol, neutral lipid, fatty acid (FA) content, and the relationship to cholestasis in piglets. METHODS: Neonatal piglets received parenteral nutrition, varying in lipid dose (5 or 10 g·â€Škg ·â€Šday) and formulation: SO5 (n = 5), SO10 (n = 5), FO5 (n = 5), and ML10 (n = 5). On day 14, liver chemistry, bile flow, histology and neutral lipid staining were assessed. Hepatic triglyceride FA content was determined using thin layer and gas chromatography, and phytosterol content was assessed using gas chromatography-mass spectrometry. RESULTS: SO groups had higher prevalence of biochemical cholestasis (P < 0.04) and lower bile flow (P < 0.0001). Hepatic campesterol, stigmasterol, and ß-sitosterol were highest in SO10 (P < 0.0001). Hepatic FA (P < 0.03) and ω-6/ω-3 FA ratio (P < 0.0001) were higher in the SO groups. Neutral lipid accumulation (P = 0.3) and liver histology (P = 0.16) were not different between groups. Univariate predictors of bile flow were: campesterol (r = -0.77, P = 0.001), ß-sitosterol (r = -0.74, P = 0.002), stigmasterol (r = -0.74, P = 0.002), ω-6 FA (r = -0.72, P = 0.002), and ω-3 FA (r = 0.59, P = 0.02). Only campesterol independently predicted bile flow. CONCLUSIONS: ML and FO lipid emulsions reduce cholestasis in association with lowered hepatic phytosterol and lipid content. Lower hepatic phytosterol and ω-6 FA content, and higher ω-3 FA content are hepatoprotective. Multivariate analysis suggests reduced phytosterol accumulation may best explain the hepatoprotective effect of fish oil-containing lipids.

Diet quality of children post-liver transplantation does not differ from healthy children.

Little has been studied regarding the diets of children following LTX. The study aim was to assess and compare dietary intake and DQ of healthy children and children post-LTX. Children and adolescents (2-18 years) post-LTX (n=27) and healthy children (n=28) were studied. Anthropometric and demographic data and two 24-hour recalls (one weekend; one weekday) were collected. Intake of added sugar, HFCS, fructose, GI, and GL was calculated. DQ was measured using three validated DQ indices: the HEI-C, the DGI-CA, and the DQI-I. Although no differences in weight-for-age z-scores were observed between groups, children post-LTX had lower height-for-age z-scores than healthy children (P<.01). With the exception of vitamin B12, no significant differences in energy and macronutrient (protein, carbohydrate, and fat), added sugar, HFCS, fructose, GI, GL, and micronutrient intakes and DQ indices (HEI-C, DGI-CA, and DQI-I) between groups were observed (P>.05). The majority of children in both groups (>40%) had low DQ scores. No significant interrelationships between dietary intake, anthropometric, and demographic were found (P>.05). Both healthy and children post-LTX consume diets with poor DQ. This has implications for risk of obesity and metabolic dysregulation, particularly in transplant populations on immunosuppressive therapies.

Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease.

PURPOSE: Patients with diabetes (DM) and chronic kidney disease (CKD) are at increased risk for suboptimal bone health. The study objective was to investigate the relationships between vitamin D (vitD), vitamin K1 (vitK1), and calcium intake with bone mineral density (BMD) and vitamin D status in an ambulatory population with DM and CKD. METHODS: Adults (age 18-80 years; n = 62) with DM and CKD (stages 1-4) were recruited from the Northern Alberta Renal Program. Primary outcome variables included vitD, vitK1, and calcium intake; serum 25(OH)D, 1,25(OH)2D; and BMD as measured by dual X-ray absorptiometry. Statistical significance was determined at P < 0.05. RESULTS: Participants met the estimated average requirement or adequate intake for vitD, vitK1, and calcium intake in 73% (n = 45), 66% (n = 39), and 52% (n = 31), respectively, with a combined intake of micronutrient supplementation and diet. Participants had serum 25(OH)D concentrations ≥75 nmol/L (n = 41), normal BMDs (n = 48), and 66% (n = 41/62) were taking vitD supplements (>1000 IU/D). BMD was positively influenced by serum 25(OH)D. However, serum 25(OH) ≥100 nmol/L was associated with lower BMD (absolute and T-scores) for whole-body and spine (P ≤ 0.05). VitK1 intake (≥200 µg/day) was associated with higher whole-body and femoral-neck BMDs (absoluteand T-scores; P ≤ 0.05). CONCLUSION: VitD status and BMD in adults with DM and CKD was influenced by vitD supplementation and vitK1 intake.

Parental Health Beliefs, Socio-demographics, and Healthcare Recommendations Influence Micronutrient Supplementation in Youth with Celiac Disease.

To identify parental influences affecting micronutrient supplementation in children and adolescents (2-18 years of age) with Celiac Disease (CD), a multi-method (survey, focus groups) study was conducted. A 35-item questionnaire consisting of open- and closed-ended questions was launched nationally via Canadian Celiac Association internet sites. Five focus groups were conducted using a semi-structured interview guide. The survey and semi-structured interview guide content was vetted for face and content validity. Thematic analyses were conducted on the focus group content and open-ended survey questions, and χ(2) and Fischer's exact analysis were performed on closed-ended survey data. Survey respondents were predominantly mothers (97%) of female children (80 F, 49 M) between the ages of 9-12 (31%) with CD, residing in western provinces (55%) with a combined family income ≥$100 000/year (63%). Seventy-seven percent of parental respondent's children or adolescents consumed micronutrient supplements, for 1-5 years (52%), 7 days a week (65%), as both multi-vitamin and single vitamin preparations (40%). Parental influences on child micronutrient use included health beliefs and knowledge, parental supplement use, supplement characteristics, age of child (above or below 13 years), household routines, and provincial residential status (P < 0.05). Parents relied on health professional recommendation (69%; MD, RD) and the internet (21%) as sources of information regarding child micronutrient supplementation. Parental health beliefs and knowledge, socio-demographic factors, and practitioner recommendation influence micronutrient supplement use in children and adolescents with CD.

Assessing Nutritional Quality and Adherence to the Gluten-free Diet in Children and Adolescents with Celiac Disease.

PURPOSE: Little is known regarding nutritional adequacy of the gluten free diet (GFD) in children and adolescents with celiac disease (CD). The study aim was to examine macro- and micronutrient intake in children with CD. METHODS: A cross-sectional study was conducted in children and adolescents (4-18 years of age) with CD (n = 32) and healthy controls (n = 32). Macro- and micronutrient intake, and glycemic index (GI) and glycemic load (GL) intake was assessed using validated measures. Diet quality was assessed using the Canadian Healthy Eating Index (HEI-C) and the Alberta Nutrition Guidelines. Values are shown as mean ± SE. RESULTS: Age (10.4 ± 0.7 years vs 8.7 ± 0.7 years; P = 0.06), weight-for-age z score (P = 0.27), and height-for-age z score (P = 0.23) were not different between groups. CD children consumed more fibre (15.9 ± 1.2 g per day(CD) vs 10.8 ± 0.8 g per day (controls); P < 0.001), had higher GI (CD: 54 ± 2 vs 48 ± 1; P < 0.01) and GL (CD: 118 ± 8 vs 93 ± 7; P = 0.02), and lower folate (146.7 ± 15.3 (CD) vs 245.4 ± 21.8 µg per day (controls); P < 0.001) than controls. No differences in HEI-C scores (≤ and > 80) were observed between groups (P > 0.05). CONCLUSION: Children with CD had high intakes of fibre, GI, and GL and lower intakes of folate. This has implications for dietary counselling in this population.

Investigation of cost and availability of gluten-free food in Jeddah, KSA.

Objective: The prevalence of celiac disease (CD) in KSA is progressively increasing. Consistent adherence to a gluten-free (GF) diet is the only effective CD treatment. The availability and cost of GF food are important factors in adherence to a GFD. The objective of this study was to investigate the cost and availability of GF food in a sample of local stores and supermarkets across Jeddah province in KSA. Method: Eleven supermarkets in Jeddah, KSA, ranging from high budget/quality supermarkets to low-budget stores, were visited. Eight food categories were evaluated, including flour, breakfast cereals, breads, pastas, and snacks (e.g., biscuits, cookies, snack bars, and chips). The availability and cost of GF and gluten containing (GC) items within these food categories were recorded. Each item included in these food categories was counted, and the overall average price was calculated. Results: A total of 233 GF and 24 GC products were found. Supermarket 1 had the highest availability of GF foods (n = 90), followed by supermarket 2 (n = 34), supermarket 3 (n = 30), supermarket 4 (n = 23), supermarket 5 (n = 21), supermarket 6 (n = 18), supermarket 7 (n = 9), and supermarket 8 (n = 8). The median price per 100 g was significantly greater for GF than GC products (p < 0.05). The cost of GF products was significantly higher than that of GC products (p < 0.05); consequently, GF foods were twice as expensive as their GC counterparts. Conclusion: The availability of GF products was limited, and GF products were more expensive than standard GC products. High cost and limited availability are major roadblocks to GFD adherence among people with CD. Governmental organizations must cooperate with healthcare providers and food industries to ensure that GF foods are widely available and affordable for people with CD, to minimize financial pressure and improve health quality.

Evaluating attitudes toward soft drink consumption among adults in Saudi Arabia: Five years after selective taxation implementation.

Objective: Saudi Arabia (SA) ranked first in soft drink consumption in the Middle East. A decrease in consumption was recorded after a selective 50% increased taxation policy in 2018. This study aimed to assess soft drinks consumption patterns among Saudi Arabian adults and examine the association between different attitudes and patterns post-taxation. Methods: This cross-sectional study was conducted from October 2022 to March 2023, involving 1,935 Saudi adults aged 20-60 residing in Saudi Arabia. Participants completed online surveys using a validated questionnaire assessing sociodemographic characteristics, soft drink consumption patterns, and attitudes toward soft drinks. Chi-square and odds ratio (OR) tests were used to assess associations between sociodemographic characteristics, soft drink consumption frequency/quantity, and change in consumption patterns owing to selective taxation. Additionally, t-tests, Spearman's coefficient, and hierarchical multiple linear regression were used to measure differences in attitudes and linear relationships. Results: Overall, 7.5% of the participants reported daily soft drink consumption, with 51.8% of these consuming less than one can per day and 41.2% consuming one can per day. Most (66.2%) reported no change in consumption post-taxation. Attitudes toward soft drink consumption varied significantly, with most agreeing on its health risks but also enjoying the drinks. Multiple regression analysis identified age, education, income, consumption frequency/quantity, and impact of taxation as significant predictors of overall attitudes toward soft drinks. Conclusions: After taxation, 20% of participants reduced soft drink consumption, underscoring the importance of addressing taxation and intrinsic motivations to foster lasting changes in attitudes and behaviors towards soft drinks.

Nutritional Knowledge, Attitudes, and Practices among Family Physician Practitioners in Gulf Countries (Bahrain, Kuwait, Saudi Arabia, and UAE).

Family physicians serve as pivotal points of contact within global healthcare systems. Nutrition plays a significant role in lifestyle and preventive medicine. With the rise of chronic and non-communicable diseases in Gulf Cooperation Council (GCC) countries, these physicians advise patients and the public on diet-related conditions. This descriptive cross-sectional study assessed the nutritional knowledge and practices across the GCC. Combining survey data from multiple GCC sites, a sample of family physicians was generated. Registered GCC family physicians received email invitations containing participant information, informed consent forms, and a self-administered online questionnaire. Analysis of data from four GCC countries involving 8751 family physicians and nutrition experts revealed an average nutrition knowledge score of 62%. Nearly all participants recognized the importance of nutrition in preventing and treating chronic diseases. Common nutritional practices included recommending regular exercise (92%), referring patients to dietitians for nutrition-related concerns (70%), and providing nutrition advice (68.6%). GCC family physicians underscore the significance of nutrition in preventing and managing chronic ailments. Therefore, incorporating nutritional counseling into their practices is essential. This study highlights the need to integrate nutrition education into medical curricula and ongoing professional development, given that only 62% of GCC family physicians correctly answered nutrition-related questions.

The influence of a diabetes awareness program on diabetes knowledge, risk perception, and practices among university students.

AIM: To compare diabetes mellitus (DM) knowledge, risk perception, and health practices before and after a mass awareness program among Princess Nourah bint Abdulrahman University students, Riyadh, Saudi Arabia. METHODS: A DM awareness program was conducted between November 2020 and February 2021 in three phases (total 13 weeks). The program comprised educational messages, short videos, virtual lectures, and peer-to-peer education. A total of 558 participants (before group, n = 360; after group, n = 198) were included in the study. RESULTS: Majority of the students had normal body mass index (BMI). The knowledge scores were significantly higher after the program (median 16, quartile range 13-18) than before (median 14, quartile range 12-16) (p < 0.001). No significant differences were observed in risk perception between the two groups (p > 0.05). In addition, increased moderate practice score and decreased poor practice score (p < 0.001) were observed. Factors influencing DM knowledge were higher education and awareness. Factors influencing health practices were higher BMI and knowledge after the program. CONCLUSION: DM awareness program improved DM knowledge and health practices among university students.

Health-Related Quality of Life in Individuals with Crohn's Disease: A Sample from Saudi Arabia.

BACKGROUND: This study was conducted to compare health-related quality of life between adults with Crohn's disease (CD) and healthy controls (CONs). METHODS: A comparative cross-sectional study was conducted on adults with CD and CONs in Saudi Arabia (aged 18-60 years). Sociodemographic data (area of residence, education level, employment, and marital status) were collected from both groups, as well as additional information including disease onset, treatment, and symptomology from the CD group. The validated Arabic version of the quality of life tool was used to assess health-related quality of life. RESULTS: A total of 109 CD patients and 370 CONs participated in this study. The patients with CD had significantly lower health-related quality of life scores for physical functioning [CD 75 (50-90), CON 85 (60-95)], role physical [CD 50 (0-100), CON 100 (50-100)], role emotional [CD 67 (0-100), CON 67 (33-100)], vitality [CD 50 (30-58), CON 50 (40-60)], social functioning [CD 63 (50-75), CON 75 (50-88)], bodily pain [CD 70 (45-90), CON 80 (68-100)], and general health [CD 55 (40-65), CON 65 (55-75)]. The physical and mental domain scores were lower in the CD group [63 (52-75) and 51 (32-69)] than CONs group [75 (63-85) and 63 (55-72)], respectively (p<0.02). CONCLUSION: The CD group had a lower health-related quality of life than the CONs.

Prevalence, patterns, and attitude regarding dietary supplement use in Saudi Arabia: Data from 2019.

Dietary supplements are products containing dietary elements including vitamins, minerals, amino acids, herbs, or botanicals. They can aid consumers with low dietary intake and quality, as well as those with high demands, by boosting nutritious value. A cross-sectional study was conducted among adults living in Saudi Arabia aged between 18-60 years old using online self-administered questionnaire. Information regarding sociodemographic characteristics, use and type of dietary supplements, and attitude toward and patterns of dietary supplement use was collected. The chi-square test, Pearson correlations, and the independent t-test were used. In total, 531 participants (115 men and 416 women) were included. Approximately half of the participants (51.8%, n = 275) used dietary supplements. Participants who were using dietary supplements were significantly younger (29.16 ± 9.32 years), more highly educated (85.5%, n = 235), and worked in the health sector (63.7%, n = 100). Herbal supplement use was associated with older age and female sex. Single mineral supplements were used more frequently by married, female, pregnant, or breastfeeding participants and those not working in the health sector. Fatty supplements were used more frequently by participants with a higher level of education. Regarding the attitude toward dietary supplement use, women, single participants, and health care workers showed a significant positive attitude. In-depth investigation into the amount of and reasons for dietary supplement use in the health sector is required. Additionally, educating pregnant and breastfeeding women on the importance of dietary supplements is necessary.

The use of social media to search for weight reduction information: Assessment of the perception among a sample of Saudi adults.

Objective: To assess the patterns, prevalence, and perceptions of the benefits and risks of using social media as a source of weight loss information among Saudi adults. Methods: In this cross-sectional study, convenient snowball sampling was used to recruit Saudi adults. A self-report questionnaire containing the following five sections was distributed: sociodemographic information, the pattern of social media use, use of social media to obtain weight loss information, perception of benefits, and perception of risks of using social media. A Chi-square test was used to identify differences according to participants' demographics. Results: A total of 420 Saudi adults were included in the study. Most Saudi adults (43.3%) used social media for more than four hours a day, and 88.6% used WhatsApp. The prevalence of social media use for weight loss information was 89.2% among Saudi adults. Significant associations were found between the use of social media for weight loss information and age (<33 years old) and monthly income (<5000 Saudi Arabian Riyal) (p ≤ 0.012). Of the participants, 71.7% believed that social media is "always" or "frequently" an easily acceptable way to obtain weight loss information. Moreover, 36% of Saudi adults believed that weight loss information on social media could be scientifically inaccurate, and 61% believed that it could be posted solely for marketing and financial purposes. Conclusion: The findings of this study show that Saudi adults have a high prevalence of social media use to obtain weight loss information. The benefits and risks of using social media as a source of weight loss information were also perceived to be high among Saudi adults.