The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: The results of previously published meta-analyses showed that dietary fiber could reduce the levels of p-cresyl sulfate, blood urea nitrogen, and creatinine in patients with chronic kidney disease (CKD). However, these results were based on some trials with pre-post design and randomized controlled trials of low quality. Additionally, it has been suggested that the dosage and duration of fiber supplementation and patients' characteristics potentially influence the effect of dietary fiber in reducing uremic toxins, but it would appear that no research has provided reliable evidence. DESIGN AND METHODS: We searched PubMed, Web of Science, and Cochrane Library. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was quantified by I2. Publication bias was evaluated by Egger's test. RESULTS: Ten randomized controlled trials involving 292 patients with CKD were identified. Dietary fiber supplementation can significantly reduce the levels of indoxyl sulfate (SMD = -0.55, 95% CI = -1.04, -0.07, P = .03), p-cresyl sulfate (SMD = -0.47, 95% CI = -0.82, -0.13, P < .01), blood urea nitrogen (SMD = -0.31, 95% CI = -0.58, -0.03, P = .03), and uric acid (SMD = -0.60, 95% CI = -1.02, -0.18, P < .01), but not on reducing creatinine (SMD = -0.31, 95% CI = -0.73, 0.11, P = .14). In subgroup analyses, the reduction of indoxyl sulfate was more obvious among patients on dialysis than patients not on dialysis (P for interaction = .03); the reduction of creatinine was more obvious among patients without diabetes than those with diabetes (P for interaction <.01). CONCLUSIONS: This meta-analysis indicates that dietary fiber supplementation can significantly reduce the levels of uremic toxins in patients with CKD, with evidence for a more obvious effect of patients on dialysis and without diabetes. These findings inform recommendations for using dietary fiber to reducing the uremic toxin among CKD patients in clinical practice.

Effect of voluntary breathing exercises on stable coronary artery disease in heart rate variability and rate-pressure product: a study protocol for a single-blind, prospective, randomized controlled trial.

BACKGROUND: At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients' anxiety and other negative emotions. METHODS: This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. DISCUSSION: This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. TRIAL REGISTRATION: Chinese Clinical Trials Registry, 1900024043 . Registered on 23 June 2019.

A Randomized Controlled Trial to Compare the Effect of Peanuts and Almonds on the Cardio-Metabolic and Inflammatory Parameters in Patients with Type 2 Diabetes Mellitus.

A low carbohydrate diet (LCD), with some staple food being replaced with nuts, has been shown to reduce weight, improve blood glucose, and regulate blood lipid in patients with type 2 diabetes mellitus (T2DM). These nuts include tree nuts and ground nuts. Tree nut consumption is associated with improved cardio-vascular and inflammatory parameters. However, the consumption of tree nuts is difficult to promote in patients with diabetes because of their high cost. As the main ground nut, peanuts contain a large number of beneficial nutrients, are widely planted, and are affordable for most patients. However, whether peanuts and tree nuts in combination with LCD have similar benefits in patients with T2DM remains unknown; although almonds are the most consumed and studied tree nut. This study sought to compare the effect of peanuts and almonds, incorporated into a LCD, on cardio-metabolic and inflammatory measures in patients with T2DM. Of the 32 T2DM patients that were recruited, 17 were randomly allocated to the Peanut group (n = 17) and 15 to the Almond group (n = 15) in a parallel design. The patients consumed a LCD with part of the starchy staple food being replaced with peanuts (Peanut group) or almonds (Almond group). The follow-up duration was three months. The indicators for glycemic control, other cardio-metabolic, and inflammatory parameters were collected and compared between the two groups. Twenty-five patients completed the study. There were no significant differences in the self-reported dietary compliance between the two groups. Compared with the baseline, the fasting blood glucose (FBG) and postprandial 2-h blood glucose (PPG) decreased in both the Peanut and Almond groups (p < 0.05). After the intervention, no statistically significant differences were found between the Peanut group and the Almond group with respect to the FBG and PPG levels. A decrease in the glycated hemoglobin A1c (HbA1c) level from the baseline in the Almond group was found (p < 0.05). However, no significant difference was found between the two groups with respect to the HbA1c level at the third month. The peanut and almond consumption did not increase the body mass index (BMI) and had no effect on the blood lipid profile or interleukin-6 (IL-6).In conclusion, incorporated into a LCD, almonds and peanuts have a similar effect on improving fasting and postprandial blood glucose among patients with T2DM. However, more studies are required to fully establish the effect of almond on the improvement of HbA1c.

The Effect of Low-Carbohydrate Diet on Glycemic Control in Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: In China, a low-fat diet (LFD) is mainly recommended to help improve blood glucose levels in patients with type 2 diabetes mellitus (T2DM). However, a low-carbohydrate diet (LCD) has been shown to be effective in improving blood glucose levels in America and England. A few studies, primarily randomized controlled trials, have been reported in China as well. METHOD: Firstly, we designed two 'six-point formula' methods, which met the requirements of LCD and LFD, respectively. Fifty-six T2DM patients were recruited and randomly allocated to the LCD group (n = 28) and the LFD group (n = 28). The LCD group received education about LCD's six-point formula, while the LFD group received education about LFD's six-point formula. The follow-up time was three months. The indicators for glycemic control and other metabolic parameters were collected and compared between the two groups. RESULTS: Forty-nine patients completed the study. The proportions of calories from three macronutrients the patients consumed met the requirements of LCD and LFD. Compared to the LFD group, there was a greater decrease in HbA1c level in the LCD group (-0.63% vs. -0.31%, p < 0.05). The dosages of insulin and fasting blood glucoses (FBG) in the third month were lower than those at baseline in both groups. Compared with baseline values, body mass index (BMI) and total cholesterol (TC) in the LCD group were significantly reduced in the third month (p < 0.05); however, there were no statistically significant differences in the LFD group. CONCLUSIONS: LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM. In addition, the six-point formula is feasible, easily operable, and a practical educational diet for Chinese patients with T2DM.

Meta-Analysis of Efficacy and Safety of Low-Intensity Warfarin Therapy for East Asian Patients With Nonvalvular Atrial Fibrillation.

For patients with nonvalvular atrial fibrillation (NVAF) receiving warfarin therapy, the target international normalized ratio range of 2.0 to 3.0 is recommended by Western countries. However, this treatment carries a higher risk of bleeding which suggests more researches on whether low-intensity warfarin therapy (range <2.0 to 3.0) is suitable for East Asian patients. Three databases were searched from inception to April 21, 2016. Studies that reported thromboembolic and hemorrhagic events in low- and standard-intensity warfarin groups were included. Finally, seven studies were included in the analysis. There was a significantly decreased risk of hemorrhagic events (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.43 to 0.82, p = 0.002) with no statistically increased risk of thromboembolic events (OR 1.14, 95% CI 0.80 to 1.62, p = 0.47) in the 1.5 to 2.0 group compared with that of the 2.0 to 3.0 group. Meanwhile, there was no significant difference of cardiovascular mortality (OR 1.58, 95% CI 0.89 to 2.83, p = 0.12) between the 2 groups. Further analysis showed there was no significance in thromboembolic events (OR 1.15, 95% CI 0.83 to 1.60, p = 0.40), major bleeding events (OR 0.74, 95% CI 0.50 to 1.09, p = 0.13), and cardiovascular mortality (OR 1.45, 95% CI 0.79 to 2.65, p = 0.23) between 1.5 to 2.5 and 2.0 to 3.0 groups. Although no significant difference was found in hemorrhagic events (OR 0.76, 95% CI 0.57 to 1.01, p = 0.06), there was a decreased trend in it. In conclusion, low-intensity warfarin therapy can achieve reduced hemorrhage without increasing thromboembolism for East Asian patients with NVAF receiving warfarin therapy.

Meta-Analysis of Effects of Voluntary Slow Breathing Exercises for Control of Heart Rate and Blood Pressure in Patients With Cardiovascular Diseases.

Rising heart rate (HR) and elevated blood pressure (BP) cause a greater frequency of cardiovascular events. Many patients cannot maintain target HR and BP using pharmacological therapies. To evaluate the effectiveness of voluntary slow breathing exercises in reducing resting HR and BP, we searched Embase (1974 to April 2016), PubMed (1966 to April 2016), the Cochrane Central Register of Controlled Trials (issue 4, April 2016), and PEDro (www.pedro.org.au; 1999 to April 2016). The primary outcome was the mean change in HR at rest. Secondary outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as compliance with the breathing training. Finally, we included 6 studies consisting of 269 subjects. Practice of the breathing exercises resulted in statistically significant HR reduction (mean difference: -1.72 beats/min, 95% CI -2.70 to -0.75). Reductions were seen in SBP (mean difference: -6.36 mm Hg, 95% CI -10.32 to -2.39) and DBP (mean difference: -6.39 mm Hg, 95% CI -7.30 to -5.49) compared with the controls. Trial durations ranged from 2 weeks to 6 months. In conclusion, the existing evidence from randomized controlled trails demonstrates that short-term voluntary slow breathing exercises can reduce resting HR, SBP, and DBP for patients with cardiovascular diseases.