Comparative efficacy of a 12 week yoga-based lifestyle intervention and dietary intervention on adipokines, inflammation, and oxidative stress in adults with metabolic syndrome: a randomized controlled trial.

The present randomized controlled trial (RCT) evaluated the comparative efficacy of 12 week yoga-based lifestyle intervention (YBLI) and dietary intervention (DI) alone on adipokines, inflammation, and oxidative stress in Indian adults with metabolic syndrome (Met S). A parallel, two arm, RCT was conducted in Integral Health Clinic (IHC), All India Institute of Medical Sciences, India from 2012 to 2014. IHC is an outpatient facility conducting YBLI programs for prevention and management of chronic diseases. Two hundred sixty men and women (20-45 years) visiting the outpatient department of a tertiary care hospital were diagnosed with Met S and randomized 1:1 to receive 12 week YBLI (n = 130) or DI (n = 130). Primary outcomes were change in plasma levels of adipokines (leptin, adiponectin, and leptin:adiponectin ratio), markers of inflammation (tumor necrosis factor [TNF]-α, interleukin [IL]-6), markers of oxidative stress (thiobarbituric acid reactive substances [TBARS], 8-hydroxy-2'-deoxyguanosine [8-OHdG], and superoxide dismutase [SOD]) measured at baseline, 2 weeks, and 12 weeks. YBLI group showed a significant decrease in leptin, leptin:adiponectin ratio, IL-6, 8-OHdG, and TBARS levels, whereas there was a significant increase in adiponectin and SOD levels. No significant changes were noticed in DI alone group. YBLI showed significantly greater reduction in TBARS levels than in DI group, suggestive of reduced oxidative stress in adults with Met S. A 12 week YBLI had a positive impact on oxidative stress versus DI alone in adults with Met S.

Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies.

OBJECTIVES: Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS: We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 µmol/L, and 0%-60% patients achieving sUA target (<360 µmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. CONCLUSIONS: The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42016037937.

Preparation for radioactive iodine therapy is not a risk factor for the development of hyponatremia in thyroid cancer patients.

The aim of this study was to evaluate whether the preparation for radioactive iodine (RAI) therapy by thyroid hormone withdrawal (THW) or a low-iodine diet (LID) can be risk factors for the development of hyponatremia in patients with differentiated thyroid cancer after thyroidectomy.We retrospectively reviewed the medical records and laboratory findings of 326 patients who underwent preparation for RAI therapy after thyroidectomy from 2012 to 2014. Demographic and clinical variables including the method of thyrotropin stimulation and duration of LID were assessed. Serum sodium was measured twice, before operation and before RAI therapy.Hyponatremia was detected in only 3 patients (0.9%) before operation, but in 15 patients (4.6%) before RAI therapy. None of the patients had severe hyponatremia after preparation for RAI therapy. Pre-RAI therapy serum sodium was correlated with the method of thyrotropin stimulation (TWH vs recombinant human thyroid stimulating hormone, P = 0.014) and duration of LID (r = -0.131, P = 0.018); however, the preparation of RAI therapy, THW and LID, did not affect the development of hyponatremia in logistic regression analysis. Preoperative serum sodium was a significant risk factor for hyponatremia during preparation for RAI therapy.Preparation for RAI therapy by THW or LID is not a risk factor for the development of hyponatremia in patients with thyroid cancer. The development of hyponatremia was neither frequent nor severe during preparation for RAI therapy. Physicians should not be greatly concerned about rare life-threatening hyponatremia during preparation for RAI therapy.

[THE POSSIBILITY OF DIET THERAPY AND TYPICAL ERRORS IN THE NUTRITION OF PATIENTS WITH BILIARY TRACT DISEASES].

This lecture for the doctors considered the possibility of using power to influence the basic mechanisms of pathogenesis in diseases of the biliary: cholestatic syndrome, impaired physical-chemical properties of bile, inflammation, biliary tract and intestines motor activity disfunction. The clinical case analyzed typical mistakes in nutrition of patients with disorders of the biliary tract.

[Therapy for obesity--conservative and/or surgical?]. / Adipositastherapie--konservativ und/oder chirurgisch?

On comparing surgical and conservative approaches in therapy for obesity it is accepted that there is a more rapid decline in body weight after surgery than by conservative measures. In contrast to widespread convictions, it has been shown that even in extreme obesity (BMI>60 kg/m²) both a meaningful and a long-lasting reduction of body weight is possible by conservative approach. There is an increasing body of evidence that bariatric surgery, especially malabsorptive and combined forms, causes endocrine disturbances and both vitamin and micronutrient deficiencies. Furthermore, alterations in drug pharmacokinetics are possible. Even bariatric surgeons have stated that surgery neither removes the chronic disease obesity nor is its final therapy.

Polyphenol cytotoxicity induced by the bacterial toxin pyocyanin: role of NQO1.

Pyocyanin is an important bacterial redox-active toxin produced by the opportunistic human pathogen Pseudomonas aeruginosa. The bacterium is a cause of serious infections of the respiratory tract, particularly for those with cystic fibrosis and for those with burn injuries. Pyocyanin induces oxidative stress and causes cells to become prematurely senescent, which compromises tissue remodeling and wound repair. A diverse range of antioxidants have been found useful in preventing oxidant-induced cellular senescence, including quercetin, a common dietary polyphenol. This study evaluated the effectiveness of three common polyphenols (quercetin, (+)-catechin, and (-)-epicatechin) as potential inhibitors of pyocyanin-induced senescence. Whereas at the lowest concentration the polyphenols maintained cellular replicative capacity, in the presence of pyocyanin they unexpectedly displayed concentration-dependent cytotoxicity with a rank order of quercetin>epicatechin>>catechin. On oxidation, polyphenols with B-ring catechol functionality form toxic alkylating quinones that are normally inactivated by cellular antioxidant defense and redox maintenance systems, including reduction by ascorbate and NAD(P)H:quinone oxidoreductase 1 (NQO1). Pyocyanin inhibited cellular NQO1 activity at low micromolar concentrations, but the presence of exogenous ascorbate eliminated pyocyanin-induced polyphenol cytotoxicity. These data indicate that pyocyanin compromises cellular redox maintenance systems, leaving cells susceptible to the adverse effects of otherwise nontoxic redox-active compounds.

Lifestyle and pharmacological approaches to weight loss: efficacy and safety.

CONTEXT: Obesity results from a prolonged small positive energy balance, and its treatment needs to reverse this imbalance. EVIDENCE ACQUISITION: Citations retrieved from PubMed and The Handbook of Obesity 2008 were selected to illustrate the points. EVIDENCE SYNTHESIS: Many different diets have been tried to treat obesity, and weight loss occurs with all of them. There is currently no evidence that clearly supports a superiority of one macronutrient composition for diets used for weight loss. The principal effect seems to be the degree of adherence to the prescribed calorie reduction. Lifestyle strategies to modify eating behavior can be used in individual counseling sessions or in groups, both of which are important in helping patients modify their patterns of eating. Physical activity is particularly important in helping patients maintain a weight loss once achieved and is less valuable for weight loss itself. Food intake is controlled through many different mechanisms, but only a few drugs have been developed that tap these mechanisms. Orlistat, which blocks intestinal lipase, is one; sibutramine, a serotonin-norepinephrine reuptake inhibitor, is a second. Surgical approaches provide the most dramatic weight loss and have been demonstrated to reduce long-term mortality and reduce the incidence of diabetes. CONCLUSIONS: Weight loss can be achieved by many methods, but the surgical procedures appear to be the most durable.

Complications and consequences of epilepsy surgery, ketogenic diet, and vagus nerve stimulation.

Children with medically intractable epilepsy may be candidates for nonpharmacologic therapies such as resective and disconnection epilepsy surgery, the ketogenic diet and its variants, and vagus nerve stimulation. Each of these therapies offers unique advantages and disadvantages, and careful consideration of the risk-benefit analysis must be tailored to each child. The hopeful outcome from each of these therapies is seizure freedom or at least a very significant improvement in seizure control, with few or no adverse effects. However, unfortunate adverse consequences can and do occur. These may be serious and irreversible or more commonly mild and transient. An appreciation of these complications and consequences is necessary for the comprehensive management of these complex patients.

Efficacy and tolerance of sodium phosphates oral solution after diet liberalization.

Bowel cleansing regimens commonly require adherence to liquid diets for 24 to 48 hours before examination, which often leads to poor compliance, reduced cleansing, and ultimately inadequate examinations. The authors investigated the efficacy and tolerability of diet liberalization before bowel cleansing with sodium phosphates oral solution. Two hundred patients were randomized into two treatment groups. One group received the standard light breakfast followed by clear liquids the day before colonoscopy; the second had a normal breakfast followed by a low-residue lunch the day before colonoscopy. Both groups had the same bowel preparation with sodium phosphates oral solution (2 x 45-mL, 7 p.m./6 a.m.). There was no difference in clinical efficacy between the two diet regimens (excellent/good in 93% standard, 95% low-residue). Fewer patients receiving the low-residue diet reported hunger, and more patients receiving the low-residue regimen reported energy to perform usual activities. This study supports offering patients a regular breakfast and a low-residue lunch before bowel cleansing with sodium phosphates oral solution.

The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients.

OBJECTIVES: To evaluate the impact of a 1-year gluten-free diet on bone metabolism and nutritional status in coeliac disease. METHODS: Bone mineral density, serum indices of bone remodelling, clinical and biochemical nutritional assessment were evaluated in 86 consecutive newly-diagnosed, biopsy proven, coeliac disease patients (untreated). A complete reevaluation, including intestinal biopsy, was repeated within 1 year of dietary treatment (treated). RESULTS: Untreated: according to WHO criteria, 34% of patients had a normal bone mineral density, 40% had osteopenia and 26% osteoporosis. Between males and females there were no statistical differences in bone metabolism or in most of the nutritional indices, while, between fertile and postmenopausal women, bone mineral density and several bone metabolism markers were significantly different. Compared to subjects with a normal bone mineral density, osteopenics had higher bone specific alkaline phosphatase (BAP) and Bone-Gla-protein (BGP) values. In patients with a concomitant BAP increase and 25OH vitamin D serum level reduction, bone mineral density and several bone turnover markers were statistically different compared to patients without such a serological pattern. Treated: notwithstanding intestinal biopsy which showed a mucosal recovery in only 57%, gluten-free diet led, even in postmenopausal women, to a significant improvement in bone mineral density, bone metabolism and nutrition, except for folic acid, albumin and pre-albumin serum levels which persisted as abnormal in patients with obdurate mucosal impairment. CONCLUSIONS: Coeliac disease patients are at high risk for developing a low bone mineral density and bone turnover impairment. A gluten-free diet can improve this situation even in postmenopausal women and in patients with incomplete mucosal recovery.

Ketogenic diet in the treatment of refractory epilepsy in childhood.

There has been renewed interest in the ketogenic diet in the treatment of medically refractory seizure disorders in childhood. This article reports the results of a retrospective chart review of 52 patients who were treated with the ketogenic diet. The vast majority (49 of 52) were treated with the classic 4:1 diet. Seizure control improved in 67.3% of patients with complete abolition of seizures in six. Adverse reactions were uncommon and included the development of renal stones, gall bladder stones, and hypoproteinemia in one patient each. Routine biochemical screening during the diet did not identify or prevent adverse events. The authors' experiences with the diet emphasize the need for close ongoing medical and dietary supervision.

Screening for coeliac disease--has the time come for mass screening?

Several recent studies, in particular the Italian SIGEP study, have demonstrated that mass screening for coeliac disease using gliadin and endomysial antibody testing is now a realistic possibility. If mass screening is to receive serious consideration then it must be shown to be (i) effective, (ii) acceptable, and (iii) worthwhile (cost-effective). At present there is insufficient evidence as to the health benefits from treating screen-detected disease and as to the size of the risks associated with having undetected coeliac disease. It is also unclear whether truly asymptomatic screen-detected coeliacs will accept long-term dietary restriction. To answer these questions randomized trials of screening are needed. On current evidence, mass screening cannot be justified. Efficient case-finding may prove as effective and more acceptable.

Metabolismo protéico em pacientes com trauma encefálico submetidos à hiper-alimentaçäo, via enteral, com e sem suplementaçäo parenteral de glicose - Estudo cinético com 15N / Protein metabolism in cranial injury patients submitted to enteral hyperalimentation, with and without parenteral glucose suplementation

Nos últimos anos têm havido inúmeras referências aos benefícios de uma intervençäo nutricional, efetiva e precoce, sobre a mortalidade e morbidade de pacientes traumatizados de crânio. A composiçäo e forma de administraçäo das dietas, ainda é objeto de polêmicas. Foi feita uma proposta de estudo a partir de dieta enteral padräo constituída de 131 gramas de proteína/dia e 1200 kcla de glicose, via enteral, em torno de 7 dias após a lesäo (M1). Os pacientes receberam em um segundo momento, cerca de 4 dias após, (M2), uma suplementaçäo de 1200 kcal de glicose pela via enteral, voltando a receber dieta padräo, com nova avaliaçäo 3 a 4 dias após (M3). Em um período de 2 anos, foram selecionados 28 pacientes do sexo masculino, com trauma encefálico grave, escala de gravidade de Glasgow entre 3 e 6, sem comprometimento pulmonar que implicasse em pressäo parcial de O2 inferior a 70 mmHg, e peso corporal acima de 60 Kg. Dentre os 28 pacientes, 6 complementaram o estudo prosposto. Os pacientes foram acompanhados clinicamente durante toda a fase do experimento. Em cada um dos momentos de análise, M1, M2 e M3, foram feitas análises da excreçäo nitrogenada, proteínas de fase aguda e estudo cinético com 15N-glicina, administrada por via oral e avaliada em um período de 9 horas. Da mesma forma foram feitas determinaçöes da glicemia plasmática, N-amínico e triglicerídeos. Os resultados do estudo demonstraram que a suplementaçäo de glicose no ponto médio do experimento, näo provocou modificaçöes no balanço nitrogenado, cinética protéica ou no comportamento das proteínas de fase aguda. Ficou evidenciado, outrossim, que acompanhando a melhoria do quadro clínico-neurológico, houve normalizaçäo dos valores das proteínas de fase aguda, bem como das taxas de síntese e catabolismo protéicos, incluindo a taxa fracional catabólica e percentual de síntese protéica. A partir dos resultados do experimento, é possível concluir que o hipermetabolismo, a basear-se na análise da cinética protéica, näo persiste além do 13§ dia do período de recuperaçäo pós-trauma. Sugere-se que a dieta enteral, mesmo a volumes reduzidos, deve ser instituída o mais precocemente possível, visando atingir volumes e constituiçäo adequadas, ao final da primeira semana do período de recuperaçäo, e que a suplementaçäo de glicose e.v. à dieta enteral é dispensável para a reduçäo do catabolismo protéico.

Gastrointestinal disturbances with obesity.

Steatosis and steatohepatitis are associated with obesity. Despite florid histological changes, patients with non-alcoholic steatohepatitis generally remain asymptomatic, and it usually runs a relatively benign course. An elevated insulin level may be important in the pathogenesis. There is a marked regression of fatty changes after weight reduction. In obese subjects the risk of developing gallstones is increased due to an increased saturation of gallbladder bile with cholesterol and possible gallbladder stasis. During weight reduction with very low calorie diets the incidence in gallstones increases probably because of an increased saturation of bile during the loss of weight. Ursodeoxycholic acid appears to be a promising prophylactic agent. Chenodeoxycholic acid is not useful for these subjects. There is controversy over whether obesity contributes to gastroesophageal reflux and gastric emptying disturbances. There are changes in gastrointestinal peptide plasma levels in obesity but it is not clear if this contributes to its development. The risk for high-risk colorectal adenomas and carcinomas is reported to be increased in obese males. Vertical banded gastroplasty and gastric bypass procedures are nowadays the surgical options for the treatment of obesity. Nutritional deficiencies, particularly of vitamin B12, folate and iron are common after gastric bypass and must be sought and treated. Dumping is another potential complication of this operation. If stenosis and gastric outlet obstruction develop endoscopic dilatation is a good therapeutic option.

Human infection with Salmonella dublin.

Twenty-seven cases of human infection with Salmonella dublin were identified over a 12-year period at the University of California at San Diego-affiliated hospitals. Important epidemiologic risk factors were the ingestion of unpasteurized dairy products or treatment with nutritional therapy that included raw calf-liver extracts. Nearly all patients had underlying chronic diseases. Like Salmonella choleraesuis, S. dublin infections were associated with a high incidence of bacteremia (91%), metastatic sites of infection (30%), and mortality (26%) relative to other non-typhoidal Salmonellae. This pattern of disease expression may be related to a plasmid-encoded virulence factor common to both of these organisms.

[Physiopathological and nutritional changes in hemodialysis patients and in those who have undergone renal transplantation]. / Le alterazioni fisiopatologiche e nutrizionali nei soggetti emodializzati ed in quelli sottoposti a trapianto renale.

The paper examines the complex metabolic behaviour of patients undergoing hemodialysis and renal transplantation. It underlines the importance of the metabolic and nutritional status of these patients since inadequate nutritional therapy may result in the failure of hemodialysis and/or surgery. Given the complexity of the metabolic syndrome and its bronchopulmonary, cardiovascular and septic complications, it is necessary to monitor the various chemical and clinical parameters in these patients in order to guarantee an optimal recovery and satisfactory survival rate. Fortunately today, by replacing the use of Azathioprine, Cyclosporin--irrespective of its collateral and/or secondary effects--has replaced the use of corticosteroids whose immunodepressive action made it obligatory to start simultaneous prophylactic antibiotic treatment and/or chemotherapy in order to avoid the development of other chance disease. The paper also reports the findings of a retrospective study (1976-1986) which evaluated various physiopathological and metabolic parameters and compared them to data reported in the literature.

Iatrogenic disease in late life.

Iatrogenic diseases are common in the elderly, particularly in the hospitalized patient. Adverse outcomes may be induced by poor communication with patients, inadequate history and examination, and inappropriate use of diagnostic resources. However, even when resources are used appropriately, adverse outcomes do occur, hence the price paid for sophisticated medical and surgical techniques. Medications offer a great potential for adverse reactions, and careful prescribing and knowledge of the pharmacokinetic changes that occur with aging, particularly impaired renal excretion of drugs, together with the use of the minimum number of drugs and maneuvers to improve compliance, can reduce this risk. Complications of surgery should be anticipated and promptly recognized and managed.