Glucan rich nutrition does not increase gut translocation of beta-glucan.

BACKGROUND: (1-3)-b-D-glucan (BDG) is a fungal cell wall component and, in the absence of invasive fungal infection, a novel biomarker for microbial translocation of endogenous fungal products from the gastrointestinal tract into systemic circulation. However, its value as a marker of fungal translocation is limited by a concern that plant BDG-rich food influences blood BDG levels. METHODS: We conducted a pilot clinical trial to evaluate the impact of a standardised oral BDG challenge on blood BDG levels in participants with and without elevated microbial translocation. We enrolled 14 participants including 8 with HIV infection, 2 with advanced liver cirrhosis, and 4 healthy controls. After obtaining a baseline blood sample, participants received a standardised milkshake containing high levels of BDG followed by serial blood samples up to 8 hours after intake. RESULTS: The standardised oral BDG challenge approach did not change the blood BDG levels over time in all participants. We found consistently elevated blood BDG levels in one participant with advanced liver cirrhosis and a single person with HIV with a low CD4 count of 201 cells/mm3 . CONCLUSION: Our findings indicate that BDG blood levels were not influenced by plant origin BDG-rich nutrition in PWH, people with advanced liver cirrhosis, or healthy controls. Future studies are needed to analyse gut mycobiota populations in individuals with elevated blood BDG levels.

Multidisciplinary effort to improve the diagnosis of malnutrition in hospitalized patients.

Malnutrition has been increasingly demonstrated to be common and underrecognized in hospitalized patients. Rates have been demonstrated as high as 55%, but the diagnosis of malnutrition has historically been made in only a minority of inpatients. Laboratory studies, including serum prealbumin level, have been shown to have poor predictive value of malnutrition. In 2014, our institution embarked on a system-wide effort to improve diagnosis of malnutrition in hospitalized patients. We adopted the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) Clinical Characteristics and implemented the Nutrition-Focused Physical Exam/Assessment into clinical practice. Dietitians recorded malnutrition diagnoses in a flow sheet in the electronic medical record (EMR) and alerted the primary team when a patient met criteria for malnutrition. An editable link to malnutrition diagnosis was created in the discharge summary templates in the EMR. Over 4 years, these efforts led to an increase in our rate of diagnosis of malnutrition from 6% to 12%, which was sustained over the last 2 years. We also found that the percentage of inpatients having serum prealbumin levels checked decreased from 13% to 8% over the study period. We found that a system-wide, stepwise approach to improving our diagnosis of inpatients with malnutrition was effective and appears sustainable over the period studied. We noted a behavior change for providers in both documenting the condition and decreasing their utilization of laboratory studies as part of their clinical diagnostic workup, thus avoiding unnecessary laboratory draws and leading to potential cost saving.

Is weight loss possible in patients treated with thiazolidinediones? Experience with a low-calorie diet.

BACKGROUND: Weight gain is a frequent side-effect of thiazolidinediones, possibly related to fluid retention and stimulation of pre-adipocyte differentiation. METHODS: We report our experience with a low-calorie diet (800 cal, sodium content 1500 mmol/day) combined with behavior modification on eight patients treated with thiazolidinediones (six pioglitazone and two rosiglitazone). RESULTS: All patients had reported previous weight gain following treatment with thiazolidinediones. All patients lost weight over 12 weeks in the program with their mean +/- SD body weight falling from 270 +/- 54 lbs (123 +/- 25 kg) to 244 +/- 61 lbs (111 +/- 28 kg) (p < 0.01). The weight loss observed was no different from that observed in 16 age- and gender-matched patients with type 2 diabetes not treated with thiazolidinediones (from 263 +/- 54 lbs (120 +/- 25 kg) to 239 +/- 52 lbs (109 +/- 24 kg); p < 0.01). Glycemic control improved while reducing insulin treatment. Blood pressure control also improved and antihypertensive medications were decreased. The degree and time course of weight loss is no different from that in patients treated with other diabetic therapies and is associated with improved glycemic and blood pressure control. CONCLUSIONS: We conclude that a program of caloric restriction and behavior modification is effective in leading to weight loss in patients treated with thiazolidinediones. This effect is reassuring, since thiazolidinediones stimulate adipogenesis.