RESUMEN
Normal brain cells depend on glucose metabolism, yet they have the flexibility to switch to the usage of ketone bodies during caloric restriction. In contrast, tumor cells lack genomic and metabolic flexibility and are largely dependent on glucose. Ketogenic-diet (KD) was suggested as a therapeutic option for malignant brain cancer. This study aimed to detect metabolic brain changes in patients with malignant brain gliomas on KD using proton magnetic-resonance-spectroscopy (1H-MRS). Fifty MR scans were performed longitudinally in nine patients: four patients with recurrent glioblastoma (GB) treated with KD in addition to bevacizumab; one patient with gliomatosis-cerebri treated with KD only; and four patients with recurrent GB who did not receive KD. MR scans included conventional imaging and 1H-MRS acquired from normal appearing-white-matter (NAWM) and lesion. High adherence to KD was obtained only in two patients, based on high urine ketones; in these two patients ketone bodies, Acetone and Acetoacetate were detected in four MR spectra-three within the NAWM and one in the lesion area -4 and 25 months following initiation of the diet. No ketone-bodies were detected in the control group. In one patient with gliomatosis-cerebri, who adhered to the diet for 3 years and showed stable disease, an increase in glutamin + glutamate and reduction in N-Acetyl-Aspartate and myo-inositol were detected during KD. 1H-MRS was able to detect ketone-bodies in patients with brain tumors who adhered to KD. Yet it remains unclear whether accumulation of ketone bodies is due to increased brain uptake or decreased utilization of ketone bodies within the brain.
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Neoplasias Encefálicas/dietoterapia , Neoplasias Encefálicas/patología , Corteza Cerebral/metabolismo , Dieta Cetogénica/métodos , Adulto , Anciano , Antineoplásicos Inmunológicos/uso terapéutico , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Bevacizumab/uso terapéutico , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/tratamiento farmacológico , Corteza Cerebral/diagnóstico por imagen , Femenino , Glucosa/metabolismo , Ácido Glutámico/metabolismo , Humanos , Procesamiento de Imagen Asistido por Computador , Estudios Longitudinales , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Protones , Índice de Severidad de la EnfermedadRESUMEN
Consumption of polyphenol-rich food and food ingredient such as grape and grape products improved various cardiovascular parameters. In this study, we investigate the effect of dietary daily consumption of red grape cell powder (RGC) on blood pressure (BP) and flow-mediated dilatation (FMD) as well as on oxidative stress in 50 subjects with prehypertension and mild hypertension. The subjects were randomized into groups that consumed 200, 400 mg RGC or placebo daily for 12 weeks. RGC consumption was associated with an improvement of FMD (p = 0.013). There was a significant decrease in lipid peroxidation (p = 0.013) after 12 weeks in a combined RGC-treated group. The diastolic BP decreased significantly in the 200 mg RGC group compared to the placebo group (p = 0.032). Our results indicate that a daily supplementation, of red grape cell powder, for 12 weeks affects endothelial function, diastolic BP and oxidative stress without any adverse effects.
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Presión Sanguínea/efectos de los fármacos , Frutas/química , Hipertensión/tratamiento farmacológico , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/farmacología , Vasodilatación/efectos de los fármacos , Vitis/química , Adulto , Anciano , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Biomarcadores/sangre , Enfermedades Cardiovasculares , Dieta , Suplementos Dietéticos , Método Doble Ciego , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Eritrocitos/metabolismo , Femenino , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Peroxidación de Lípido/efectos de los fármacos , Masculino , Persona de Mediana Edad , Extractos Vegetales/uso terapéutico , Polifenoles/farmacología , Polifenoles/uso terapéutico , PolvosRESUMEN
Background: Chronic pain is prevalent but difficult to treat in patients undergoing hemodialysis (HD). Effective and safe analgesics are limited in this patient population. Our aim in this feasibility study was to evaluate the safety of sublingual oil based medical cannabis for pain management in patients undergoing HD. Methods: In a prospective randomized, double-blind, cross-over design, patients undergoing HD with chronic pain were assigned to one of three arms: BOL-DP-o-04-WPE whole-plant extract (WPE), BOL-DP-o-04 cannabinoid extraction (API) or placebo. WPE and API contained trans-delta-9- tetrahydrocannabinol (THC) and cannabidiol (CBD) in a 1:6 ratio (1:6, THC:CBD). Patients were treated for 8 weeks, with subsequent 2-week wash out, followed by a cross-over to a different arm. The primary endpoint was safety. Results: Eighteen patients were recruited and 15 were randomized. Three did not complete drug titration period due to adverse events (AEs) and one patient died during titration due to sepsis (WPE). Of those who completed at least one treatment period, seven patients were in the WPE arm, five in the API and nine receiving placebo. The most common AEs were sleepiness, which improved after dose reduction or patient adaptation. Most AEs were mild to moderate and resolved spontaneously. Serious AEs considered related to study drug included one episode of accidental overdose (WPE) leading to hallucinations. Liver enzymes were stable during cannabis treatment. Conclusions: Short-term medical cannabis use in patients treated with HD was generally well tolerated. The safety data supports further studies to assess the overall risk-benefit of a treatment paradigm utilizing medical cannabis to control pain in this patient population.
RESUMEN
PURPOSE: To assess the efficacy of ketogenic diet (KD) in adults with refractory epilepsy. METHODS: Eligible subjects were 18-45 years old with at least two monthly focal seizures (with or without secondary generalization) documented by 8 weeks' follow-up. Classic form of KD treatment (90% fat) was planned for 12 weeks: daily seizure diaries were kept and measurements of the urinary ketones were recorded. Blood studies were done monthly and resting energy expenditure (REE), substrate utilization; body composition and quality of life (QOL) were measured before and after intervention. RESULTS: Nine patients were enrolled (average age 28+/-6 years; seven women). Only two subjects concluded the study per protocol due to an early drop-out. The average length of KD treatment was 8+/-4 weeks (two patients completed 12 weeks of KD; feelings of hunger and lack of efficacy resulted in withdrawal of the rest). The two patients who concluded the study had a more than 50% reduction in the frequency of the seizures. The others experienced no improvement. Adherence to the KD protocol (100%) was documented by constant ketonuria and increased fat utilization as indicated by the change in respiratory quotient (p<0.031). The KD increased the cholesterol levels (mainly LDL; p=0.0001). CONCLUSIONS: In our experience with relatively small adult population, adherence to KD is difficult. In patients who had compliance over 3 weeks (6/8), KD does not seem to have a significant effect. Yet, the significant reduction in the two patients who concluded the study per protocol may indicate that some patients may benefit from this diet. Significant increase in LDL levels and the unlikable dietary changes are additional impediments to its implementation among adults with refractory epilepsy.
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Dieta Cetogénica/métodos , Epilepsia/dietoterapia , Absorciometría de Fotón , Adolescente , Adulto , Índice de Masa Corporal , Epilepsia/patología , Femenino , Estudios de Seguimiento , Humanos , Riñón/fisiopatología , Metabolismo de los Lípidos , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Calidad de Vida , Adulto JovenRESUMEN
Background: Thyroid hormones heavily impact energy expenditure, body mass, and body composition. Their role in the state of exogenous subclinical hyperthyroidism in differentiated thyroid carcinoma (DTC) patients, however, is less well defined. The first aim of this study was to assess changes in body weight, body composition, resting energy expenditure (REE), respiratory quotient (RQ), and metabolic parameters in female DTC patients, starting from the phase of a euthyroid state before total thyroidectomy through the subsequent year after thyrotropin (TSH) suppression. The second aim was to assess the relationship between these variables and thyroid function parameters. Methods: This observational case series analyzed changes in body composition, calorimetric, and metabolic parameters of 15 DTC female patients at 5 time points: (1) at initial DTC diagnosis (euthyroid state), (2) at 2-3 weeks after thyroidectomy (hypothyroid state), (3) at 2-3 months of levothyroxine (LT4) treatment (exogenous euthyroid state), (4) after 6-9 months, and (5) after 1 year of TSH suppressive LT4 therapy (exogenous subclinical hyperthyroid state). A generalized estimating equation (GEE) analysis was performed to estimate the longitudinal correlations of the total triiodothyronine (TT3)/free thyroxine (fT4) ratio (as an independent variable) with body composition, metabolic, and calorimetric parameter changes (as dependent variables). Results: REE, REE per kilogram of lean body mass (REE/LBM), pulse, and systolic and diastolic blood pressure were significantly higher after TSH suppressive LT4 therapy. The GEE analysis revealed longitudinal negative correlations between the TT3/fT4 ratio and systolic blood pressure, fasting blood glucose, body mass index, android (abdominal wall and visceral mesentery) fat distribution, trunk, and arm fat distribution, REE, and REE/LBM. There was a positive correlation with RQ. Conclusions: REE, REE/LBM, pulse, and systolic and diastolic blood pressure were significantly higher after thyroidectomy, radioiodine and TSH suppressive therapy in female DTC patients, while no changes were observed in body weight or body composition. A lower TT3/fT4 ratio longitudinally correlated with increases in REE, REE/LBM, abdominal fat distribution, systolic blood pressure, and fasting blood glucose, as well as with decreased RQ. These findings highlight the importance of judicial balancing of the benefits and detriments of TSH suppression with subsequent decreased TT3/fT4 ratios for female DTC patients.
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Composición Corporal , Metabolismo Energético , Hipertiroidismo/metabolismo , Hipotiroidismo/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Neoplasias de la Tiroides/terapia , Tiroidectomía , Tiroxina/uso terapéutico , Adulto , Enfermedades Asintomáticas , Glucemia/metabolismo , Presión Sanguínea , Peso Corporal , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Femenino , Frecuencia Cardíaca , Humanos , Hipertiroidismo/inducido químicamente , Hipotiroidismo/metabolismo , Radioisótopos de Yodo/uso terapéutico , Persona de Mediana Edad , Complicaciones Posoperatorias/metabolismo , Neoplasias de la Tiroides/metabolismo , Tirotropina/metabolismo , Tiroxina/metabolismo , Triglicéridos/metabolismo , Triyodotironina/metabolismoRESUMEN
AIM: To evaluate the effect of a short-term sibutramine intake on energy expenditure and on physiological responses during rest, submaximal exercise and maximal exercise in obese women. METHODS: Fifteen healthy obese female volunteers were randomly assigned to either a placebo (n = 6 - control) or sibutramine group (n = 9 - experimental) under double-blind conditions. Each subject was tested under resting conditions and then performed submaximal and maximal exercise tests. Subjects were retested under identical conditions following a 5-day administration of either sibutramine 10 mg x day(-1) or a placebo. All measurements (i.e. weight, body composition, resting energy expenditure, heart rate, respiratory exchange ratio, ventilation, oxygen consumption, carbon dioxide production, systolic blood pressure, diastolic blood pressure and blood lactate concentration) were analyzed using a 2-way ANOVA with repeated measures. RESULTS: Only heart rate during submaximal exercise was significantly different (higher) following short-term sibutramine administration when compared to placebo (p < 0.05). CONCLUSIONS: These data suggest that a recommended daily dose of 10 mg sibutramine does not affect energy expenditure or other selected cardiopulmonary responses during rest, submaximal exercise or maximal exercise. It is, therefore, suggested that weight loss during sibutramine treatment in humans is achieved mostly via a decrease in energy intake rather than through an increase in energy expenditure and thermogenesis.
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Depresores del Apetito/farmacología , Metabolismo Basal/efectos de los fármacos , Ciclobutanos/farmacología , Ingestión de Energía/efectos de los fármacos , Metabolismo Energético/efectos de los fármacos , Obesidad/tratamiento farmacológico , Pérdida de Peso , Adulto , Análisis de Varianza , Metabolismo Basal/fisiología , Índice de Masa Corporal , Método Doble Ciego , Ingestión de Energía/fisiología , Metabolismo Energético/fisiología , Ejercicio Físico/fisiología , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Persona de Mediana Edad , Obesidad/metabolismo , Resultado del Tratamiento , Pérdida de Peso/efectos de los fármacos , Pérdida de Peso/fisiologíaRESUMEN
Osteoporosis is a systemic skeletal disease that is characterized by reduced bone mass, deterioration of bone tissue and skeletal fragility. The purpose of the current study was to determine whether asymmetrical femur bone mineral density (BMD) is associated with asymmetrical gait and standing. We compared measures of gait and standing asymmetry in subjects with (n=38) and without (n=11) significant left-right differences in BMD. Participants walked for 72m at their comfortable speed and stood quietly for 60s while outfitted with pressure-sensitive insoles. Based on the pressure measurements, indices of standing and gait asymmetry were determined. Gait Asymmetry (GA) indices of maximum ground reaction force (GRF) and stance time were significantly higher in the asymmetrical BMD group, compared to the symmetrical group (p<0.03). During quiet standing, maximal GRF was twice as high in those with BMD asymmetry, compared to those without, although this difference was not statistically significant (p=0.10). These preliminary findings indicate that femur BMD asymmetry and gait asymmetry are interrelated in otherwise healthy adults. Nutrition, metabolism and lifestyle are known contributors to BMD; typically, they affect bone health symmetrically. We suggest, therefore, that the BMD asymmetry may be due to previous changes in the loading pattern during walking that might have led to asymmetric bone deterioration. Future larger scale and prospective studies are needed to identify the mechanisms underlying the relationship between standing, gait and BMD and to explore whether gait training and exercises that target gait symmetry might help to reduce BMD asymmetry.
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Fenómenos Biomecánicos/fisiología , Densidad Ósea/fisiología , Lateralidad Funcional/fisiología , Postura/fisiología , Caminata/fisiología , Soporte de Peso/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Cuello Femoral/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/fisiopatología , Proyectos PilotoRESUMEN
BACKGROUND: It was suggested that acute ingestion of small amounts of fructose can improve glucose homeostasis. AIM: To study the effect of a long-term tri-daily supplementation of catalytic amounts of fructose on glucose tolerance of subjects with type 2 diabetes (NIDDM). METHODS: A double-blind, placebo-controlled study. Twenty-six subjects with uncontrolled NIDDM as indicated by high levels of hemoglobin A1C (Hgb(A1c)) and 2-h postprandial glucose levels >200 mg% were assigned to either fructose or maltodextrin supplementation (7.5 g) tri-daily after each main meal. The subjects were challenged with a fixed meal and blood was drawn for determining levels of glucose, insulin and triglycerides before and 2 h after meal at baseline and 1 month after study entry. Blood was drawn for total cholesterol, high-density and low-density lipoprotein cholesterol (LDL-c), fructosamine and Hgb(A1C) before study entry and at 1, 2 and 3 months into the study. RESULTS: No changes were observed in the difference between postprandial and pre-meal glucose, insulin or triglyceride levels in each group or between groups. No significant statistical differences were found in weight, total cholesterol, LDL-c and high-density lipoprotein cholesterol (HDL-c) in each group or between groups along the study period. After 1 month fructosamin levels decreased in the fructose-supplemented group but not in the maltodextrin-supplemented group (P<0.052). Hgb(A1C) levels decreased with time in both groups but were significantly lower at 2 months in the fructose group as compared to the maltodextrin group (P<0.03). CONCLUSIONS: Subjects with NIDDM may benefit from daily supplementation of catalytic amounts of fructose in their diet.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Fructosamina/sangre , Fructosa/farmacología , Hemoglobina Glucada/análisis , Hipoglucemiantes/farmacología , Anciano , Glucemia/efectos de los fármacos , Metabolismo de los Hidratos de Carbono/efectos de los fármacos , Método Doble Ciego , Femenino , Fructosamina/metabolismo , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/efectos de los fármacos , Humanos , Insulina/sangre , Insulina/metabolismo , Masculino , Persona de Mediana Edad , Periodo Posprandial , Edulcorantes/farmacología , Resultado del Tratamiento , Triglicéridos/sangreRESUMEN
BACKGROUND & AIM: Gastric emptying is determined by food consistency, pH, osmolality, lipid and calorie content as well as the presence of different nutrients in the duodenal lumen. Control of gastric emptying is essential for ensuring optimal digestion. The present study tested the hypothesis that due to its different precipitation properties, gastric emptying of camel's milk may be quicker than that of bovine's milk with the same caloric and fat content. METHODS: Gastric emptying was studied by a scintigraphic technique in a randomized, double blind fashion in 8 volunteers after drinking 450 mL of either cow's milk or camel's milk. RESULTS: No differences in gastric emptying rates were found between the two types of milk. The percentage of retention of the meal after 60 min was 74.6+/-13.2% for cow's milk and 79.8+/-10.8% for camel's milk. The 50% emptying time (T(1/2)) was 131.8+/-37.4 min for cow's milk and 136.8+/-55.8 min for camel's milk. CONCLUSIONS: Camel's milk is most probably not a useful substitute for other types of milk to shorten gastric emptying.
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Camelus , Vaciamiento Gástrico/fisiología , Leche , Adulto , Anciano , Animales , Bovinos , Estudios Cruzados , Método Doble Ciego , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Leche/química , Leche/fisiologíaRESUMEN
BACKGROUND & AIMS: Circulating carotenoid levels decrease progressively in patients receiving long-term enteral tube feeding with carotenoid-free formulas. Low dietary intake and low blood levels of carotenoids are associated with a higher risk of morbidity and mortality from chronic diseases. The aim of this study was to examine the effects of a low dose carotenoid mixture (3-mg/1500kcal) for 3 months on serum carotenoid levels and oxidative stress in patients receiving long-term enteral nutrition as the sole source of nutrition. METHODS: This randomized, double blind, controlled study compared patients receiving enteral nutrition with carotenoids (N=26) and without carotenoids (control group; N=25). RESULTS: Patients on long-term enteral nutrition had low baseline serum carotenoid levels. Three months of enteral feeding enriched with carotenoids significantly (P<0.01) increased serum carotenoid levels compared with the control group. Oxidative stress as measured by NF-kappaB levels was decreased at 3 months compared with the control group (P<0.05). No significant changes in MDA levels were observed during the study period in either group. CONCLUSIONS: This study demonstrated that enteral nutrition containing small amounts of carotenoids (3-mg/1500kcal) in patients requiring long-term enteral feeding normalizes serum carotenoid levels to the lower end of the range found in age-matched controls. The NF-kappaB data indicate a reduction in oxidative stress in these patients. Therefore, the use of formulas containing a mixture of carotenoids should be recommended for long-term enteral nutrition.
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Antioxidantes/administración & dosificación , Carotenoides/administración & dosificación , Carotenoides/sangre , Nutrición Enteral , Estado Nutricional , Estrés Oxidativo , Anciano , Antioxidantes/metabolismo , Método Doble Ciego , Femenino , Humanos , Masculino , Malondialdehído/sangre , FN-kappa B , Estrés Oxidativo/efectos de los fármacos , Factores de TiempoRESUMEN
OBJECTIVE: Undernutrition has been reported in 65-75% of patients with Crohn's disease. The present study aimed at identifying the relative contribution of malnutrition-causing factors in patients with Crohn's disease in remission. METHODS: Sixteen patients with Crohn's disease (age 19-57 y) in remission (Crohn's Activity Disease Index < 150) were included in the study. Their weight was stable for >3 mo and they were off steroids. They all completed 3-d food records and concomitantly collected stools. Self-reported food records were analyzed and energy content in stools was determined by a direct bomb calorimeter. Resting energy expenditure (REE) was studied by indirect calorimetry and body composition by dual-energy X-ray absorptiometry. The study cohort was divided into two groups, with a body mass index (BMI) equal to 18.5 kg/m(2) serving as a cutoff point. RESULTS: Subjects with lower BMIs tended to have less lean body mass (P = 0.006), less bone mineral density (P = 0.006), and lower REE (P = 0.003). No correlation was found between BMI and energy intake but the percentage of malabsorption was negatively correlated with BMI (P = 0.07). When dividing the study based on a BMI of 18.5 kg/m(2), no difference was found in caloric intake or REE between groups but subjects with lower BMIs had significant prominent malabsorption compared with the others (21.1 +/- 9.8% versus 11.7 +/- 3.5%, P = 0.015). CONCLUSION: In the presence of similar energy intake, REE does not seem to contribute to lower BMI, although nutrient malabsorption is higher in malnourished patients with Crohn's disease in remission. We suggest that malabsorption be evaluated in patients with Crohn's disease who fail to gain weight during disease remission to establish their extra caloric requirements.
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Metabolismo Basal/fisiología , Enfermedad de Crohn/metabolismo , Ingestión de Energía/fisiología , Síndromes de Malabsorción/etiología , Delgadez/etiología , Absorciometría de Fotón , Adulto , Composición Corporal/fisiología , Índice de Masa Corporal , Peso Corporal/fisiología , Densidad Ósea/fisiología , Calorimetría Indirecta , Estudios de Cohortes , Enfermedad de Crohn/complicaciones , Registros de Dieta , Metabolismo Energético/fisiología , Femenino , Humanos , Síndromes de Malabsorción/fisiopatología , Masculino , Persona de Mediana Edad , Estado Nutricional , Delgadez/metabolismo , Adulto JovenRESUMEN
The ex vivo production of inflammatory cytokines during fish oil supplementation (n-3 polyunsaturated fatty acids, n-3 PUFA) is a matter of considerable controversy. Studies on human subjects have generally reported decreased lymphocyte proliferation and decreased production of IL-2, interferon-gamma, IL-1beta, IL-6 and TNF-alpha, but other studies showed no effect or even increased production. There are no published reports on ex vivo cytokine production in children on long-term, n-3 PUFA supplementation. The current double-blind study explored cytokine production by peripheral blood mononuclear cells (PBMCs), with and without lipopolysaccharide (LPS) stimulation in children on 12 weeks' supplementation with 300 mg/day of n-3 PUFA. Twenty-one children (aged 8-12 years) were randomized to receive 1 g canola oil (control) or 300 mg n-3 PUFA + 700 mg canola oil in a chocolate spread. Blood was then drawn and PBMCs were separated and cultured for 24 h in a culture medium with or without 10 microg/mL LPS for 5 x 10(6) PBMCs. The pro-inflammatory cytokines, IL-1beta, TNF-alpha and IL-6, and the anti-inflammatory cytokines, IL-10 and IL-1RA, were evaluated by ELISA. The levels of all the cytokines were higher in non-stimulated and LPS-stimulated cultures, from n-3 PUFA-treated subjects as compared to controls. There was no difference in the IL-1beta/IL-1RA ratio between the two groups, with and without LPS stimulation. Nevertheless, the ratio tended to be lower in the treated subjects on both occasions. In conclusion, our results indicate an increased production of both pro-inflammatory and anti-inflammatory cytokines, with and without LPS stimulation, in children on 12 weeks' n-3 PUFA supplementation.
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Citocinas/biosíntesis , Suplementos Dietéticos , Ácidos Grasos Omega-3/farmacología , Células Cultivadas , Niño , Método Doble Ciego , Femenino , Humanos , Leucocitos Mononucleares/inmunología , MasculinoRESUMEN
BACKGROUND: It was suggested that the intestinal microflora may play a role in the pathogenesis of irritable bowel syndrome (IBS). Probiotics may ease symptoms in IBS patients by changing gut microflora, reducing mucosal inflammation and exerting antibacterial effects. AIM: To assess the short- and long-term effects of Lactobacillus reuteri administration on clinical symptoms of IBS. METHODS: This is a double blind, placebo-controlled 6-month trial. Subjects consumed 1x10(8)cfu/tablet twice a day. The clinical severity of the IBS symptoms was evaluated by the Francis Severity score and the IBS quality-of-life score at study entry and then monthly. RESULTS: In total, 54 subjects were randomized for treatment and 39 concluded the study. Both groups (treatment and placebo) improved significantly in all the studied parameters with no significant differences between groups. Two parameters, constipation and passing gases, were marginally different between the main groups (P=0.0714 and 0.0971, respectively). CONCLUSIONS: IBS symptoms did not improve with probiotic treatment with L. reuteri. A strong placebo effect and a lack of uniformity of the IBS population may have hindered a clearer demonstration of the effect.
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Síndrome del Colon Irritable/terapia , Limosilactobacillus reuteri/crecimiento & desarrollo , Probióticos/uso terapéutico , Adolescente , Adulto , Anciano , Estreñimiento/epidemiología , Estreñimiento/etiología , Método Doble Ciego , Femenino , Flatulencia/epidemiología , Flatulencia/etiología , Humanos , Masculino , Persona de Mediana Edad , Efecto Placebo , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
During the last 20 years the role of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) in reducing the risk of colorectal cancer was shown in more than 100 animal studies. Support derives from 23 of 25 epidemiological studies confirming this protective effect. The COX-2 specific inhibitors and the selective apoptotic anti-neoplastic drugs offer the benefit of cancer protection without the gastrointestinal toxicity that was reported for the 'old' drugs. The presence of multiple molecular targets offers the potential for combination. The pivotal question in the puzzle of NSAID chemopreventive treatment should not be 'if' but 'how'. The concept that different food components may initiate or prevent cancer was illustrated by different epidemiological studies and animal models. Yet the chemical and biological complexity of the food, the difficulty in measuring habitual diets and the unavoidable changes in food constituents following a specific change in diet all contribute to this complexity.
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Antiinflamatorios no Esteroideos/farmacología , Neoplasias Colorrectales/prevención & control , Inhibidores de la Ciclooxigenasa/farmacología , Dieta , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Neoplasias Colorrectales/dietoterapia , Neoplasias Colorrectales/tratamiento farmacológico , Inhibidores de la Ciclooxigenasa/uso terapéutico , Carbohidratos de la Dieta/efectos adversos , Grasas de la Dieta/efectos adversos , Fibras de la Dieta/farmacología , Modelos Animales de Enfermedad , Conductas Relacionadas con la Salud , Humanos , Micronutrientes/farmacología , Factores de RiesgoRESUMEN
Calcium supplementation is a widely recognized strategy for achieving adequate calcium intake. We designed this blinded, randomized, crossover interventional trial to compare the bioavailability of a new stable synthetic amorphous calcium carbonate (ACC) with that of crystalline calcium carbonate (CCC) using the dual stable isotope technique. The study was conducted in the Unit of Clinical Nutrition, Tel Aviv Sourasky Medical Center, Israel. The study population included 15 early postmenopausal women aged 54.9 ± 2.8 (mean ± SD) years with no history of major medical illness or metabolic bone disorder, excess calcium intake, or vitamin D deficiency. Standardized breakfast was followed by randomly provided CCC or ACC capsules containing 192 mg elemental calcium labeled with 44Ca at intervals of at least 3 weeks. After swallowing the capsules, intravenous CaCl2 labeled with 42Ca on was administered on each occasion. Fractional calcium absorption (FCA) of ACC and CCC was calculated from the 24-hour urine collection following calcium administration. The results indicated that FCA of ACC was doubled (± 0.96 SD) on average compared to that of CCC (p < 0.02). The higher absorption of the synthetic stable ACC may serve as a more efficacious way of calcium supplementation.
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Carbonato de Calcio/farmacología , Calcio/metabolismo , Absorción Intestinal/efectos de los fármacos , Posmenopausia/fisiología , Carbonato de Calcio/administración & dosificación , Estudios Cruzados , Cristalización , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia/efectos de los fármacosRESUMEN
AIM: To investigate the diet of pouch patients compared to healthy controls, and to correlate pouch patients' diet with disease behavior. METHODS: Pouch patients were recruited and prospectively followed-up at the Comprehensive Pouch Clinic at the Tel Aviv Sourasky Medical Center. Pouch behavior was determined based on clinical, endoscopic and histological criteria. Healthy age- and sex-matched volunteers were selected from the "MABAT" Israeli Nutrition and Public Health Governmental Study and served as the control group. All the participants completed a 106-item food frequency questionnaire categorized into food groups and nutritional values based on those used in the United States Department of Agriculture food pyramid and the Israeli food pyramid. Data on Dietary behavior, food avoidance, the use of nutritional supplements, physical activity, smoking habits, and body-mass index (BMI) were also obtained. Pouch patients who had familial adenomatous polyposis (n = 3), irritable pouch syndrome (n = 4), or patients whose pouch surgery took place less than one year previously (n = 5) were excluded from analysis. RESULTS: The pouch patients (n = 80) consumed significantly more from the bakery products food group (1.2 ± 1.4 servings/d vs 0.6 ± 1.1 servings/d, P < 0.05) and as twice as many servings from the oils and fats (4.8 ± 3.4 servings/d vs 2.4 ± 2 servings/d, P < 0.05), and the nuts and seeds food group (0.3 ± 0.6 servings/d vs 0.1 ± 0.4 servings/d, P < 0.05) compared to the controls (n = 80). The pouch patients consumed significantly more total fat (97.6 ± 40.5 g/d vs 84.4 ± 39 g/d, P < 0.05) and fat components [monounsaturated fatty acids (38.4 ± 16.4 g/d vs 30 ± 14 g/d, P < 0.001), and saturated fatty acids (30 ± 15.5 g/d vs 28 ± 14.1 g/d, P < 0.00)] than the controls. In contrast, the pouch patients consumed significantly fewer carbohydrates (305.5 ± 141.4 g/d vs 369 ± 215.2 g/d, P = 0.03), sugars (124 ± 76.2 g/d vs 157.5 ± 90.4 g/d, P = 0.01), theobromine (77.8 ± 100 mg/d vs 236.6 ± 244.5 mg/d, P < 0.00), retinol (474.4 ± 337.1 µg/d vs 832.4 ± 609.6 µg/d, P < 0.001) and dietary fibers (26.2 ± 15.4 g/d vs 30.7 ± 14 g/d, P = 0.05) than the controls. Comparisons of the food consumption of the patients without (n = 23) and with pouchitis (n = 45) showed that the former consumed twice as many fruit servings as the latter (3.6 ± 4.1 servings/d vs 1.8 ± 1.7 servings/d, respectively, P < 0.05). In addition, the pouchitis patients consumed significantly fewer liposoluble antioxidants, such as cryptoxanthin (399 ± 485 µg/d vs 890.1 ± 1296.8 µg/d, P < 0.05) and lycopene (6533.1 ± 6065.7 µg/d vs 10725.7 ± 10065.9 µg/d, P < 0.05), and less vitamin A (893.3 ± 516 µg/d vs 1237.5 ± 728 µg/d, P < 0.05) and vitamin C (153.3 ± 130 mg/d vs 285.3 ± 326.3 mg/d, P < 0.05) than the patients without pouchitis. The mean BMI of the pouchitis patients was significantly lower than the BMI of the patients with a normal pouch: 22.6 ± 3.2 vs 27 ± 4.9 (P < 0.001). CONCLUSION: Decreased consumption of antioxidants by patients with pouchitis may expose them to the effects of inflammatory and oxidative stress and contribute to the development of pouchitis.
Asunto(s)
Antioxidantes/administración & dosificación , Dieta/efectos adversos , Estilo de Vida , Reservoritis/etiología , Adulto , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Enfermedad Crónica , Dieta Alta en Grasa/efectos adversos , Carbohidratos de la Dieta/efectos adversos , Endoscopía Gastrointestinal , Conducta Alimentaria , Femenino , Frutas , Humanos , Israel , Masculino , Persona de Mediana Edad , Estado Nutricional , Reservoritis/diagnóstico , Reservoritis/prevención & control , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Encuestas y Cuestionarios , VerdurasRESUMEN
Our objective was to describe a group of ALS patients who underwent percutaneous endoscopic gastrostomy (PEG) insertion, with emphasis on the respiratory function, by comparing patients with forced vital capacity (FVC) > 30% versus FVC ≤ 30%, and the effect of respiratory dysfunction on the perioperative complication rate and survival. Thirty consecutive ALS patients in whom FVC status was known underwent PEG insertion at our centre. Twenty of them had FVC > 30% (50.1% ± 20) at the time of the procedure, and 10 had FVC ≤ 30% (20.1% ± 7). Demographic and clinical data were reviewed in each patient. Results showed that all patients had successful PEG insertion without any complications. There was no statistically significant difference between the two FVC groups regarding survival after the date of PEG insertion. In conclusion, in this relatively small patient sample there was no difference in complication rate and survival after PEG insertion between patients with poor respiratory function (FVC ≤ 30%) at the time of the procedure and patients with better respiratory function (FVC > 30%). Therefore, according to our data, PEG insertion may be regarded as safe even in patients with low FVC and should be offered even to patients with respiratory dysfunction.
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Esclerosis Amiotrófica Lateral/cirugía , Gastroscopía/tendencias , Gastrostomía/tendencias , Trastornos Respiratorios/cirugía , Capacidad Vital/fisiología , Esclerosis Amiotrófica Lateral/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Respiratorios/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
UNLABELLED: The goal of the present study was to examine the relationships of depression, anxiety and stress with bone mineral density (BMD). We hypothesized negative relations between those mood variables and BMD in three assessed areas. The study showed association between depression and decreased BMD. The hypothesis regarding anxiety and stress was partially confirmed. INTRODUCTION: In the last decade, the relationship of osteoporosis to psychological variables has been increasingly studied. The accumulating evidence from these studies supports the conclusion that depression is related to decreased BMD. Nevertheless, several studies found no support for this relationship. Moreover, only a small number of studies examined the association between anxiety or stress and decreased BMD. The goal of the present study was to examine the relationships of depression, anxiety and stress with BMD by means of adequate measuring instruments, while controlling for background factors known to be related to BMD decrease (e.g., body mass index, family history). METHOD: The study included 135 post-menopausal female participants, who arrived for BMD screening, between the years 2006 and 2009. Several days prior to the examination, participants completed a series of questionnaires assessing depression and anxiety. BMD was measured using DXA, in spine, right and left hip. RESULTS: The study showed negative associations between depression and BMD variables in the three assessed areas. There were negative correlations between anxiety, stress and spine BMD, as well as a tendency towards negative relations in the right and left hip BMD. Concurrent hierarchical regressions showed that the addition of the three psychological variables increased the explained variance by 68 %. In addition, depression was found to have a unique significant contribution to the explained variance in right and left hip BMD. CONCLUSIONS: The findings provide supporting evidence for the existence of associations between mood variables and decreased BMD. Further research is required for gaining deeper insight into these relationships.
Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Osteoporosis Posmenopáusica/epidemiología , Osteoporosis Posmenopáusica/psicología , Estrés Psicológico/epidemiología , Afecto/efectos de los fármacos , Anciano , Antidepresivos/uso terapéutico , Ansiedad/diagnóstico , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/psicología , Depresión/diagnóstico , Depresión/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia/psicología , Valor Predictivo de las Pruebas , Análisis de Regresión , Estrés Psicológico/diagnósticoRESUMEN
Levan is a commonly used dietary fiber of the fructans group. Its impact on health remains undetermined. This double blind controlled study aimed to investigate the effect of 8 weeks' daily consumption of 500 mL of natural orange juice enriched with 11.25 g of levan compared to the same amount of natural orange juice without levan on weight, gastrointestinal symptoms and metabolic profiles of 48 healthy volunteers. The statistical analyses compared between- and within-group findings at baseline, 4 weeks and study closure. The compared parameters were: weight, blood pressure, blood laboratory tests, daily number of defecations, scores of stool consistency, abdominal pain, bloating, gas, dyspepsia, vomiting and heartburn. Despite a higher fiber level recorded in the study group, there was no significant difference in the effect of the two kinds of juices on the studied parameters. Both juices decreased systolic and diastolic pressures, increased sodium level (within normal range), stool number, and bloating scores, and decreased gas scores. In conclusion, levan itself had no effect on weight, gastrointestinal symptoms or metabolic profile of healthy volunteers. Its possible effect on obese, hypertensive or hyperlipidemic patients should be investigated in further studies.
Asunto(s)
Bebidas , Citrus sinensis , Suplementos Dietéticos , Fructanos/administración & dosificación , Tracto Gastrointestinal/fisiopatología , Metaboloma , Dolor Abdominal/fisiopatología , Adulto , Área Bajo la Curva , Presión Sanguínea , Peso Corporal , Método Doble Ciego , Dispepsia/fisiopatología , Femenino , Pirosis/fisiopatología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Vómitos/fisiopatologíaRESUMEN
OBJECTIVE: Increased metabolic rate may play a role in cancer cachexia, especially when caloric intake is significantly reduced. We studied the effect of tumor load on resting energy expenditure (REE) in patients with pancreatic cancer after normalizing for their daily caloric intake and body composition. METHODS: The cross-sectional study included 45 patients with pancreatic cancer (15 postoperation) and 75 controls. Resting energy expenditure was measured by indirect calorimetry, body composition was measured by dual-energy x-ray absorptiometry, and energy intake was measured by 3-day food records. RESULTS: There were no differences between pancreatic cancer patients who underwent surgery and those who did not in any of the anthropometric or metabolic parameters tested. Body mass index, lean body mass, body fat percentage, and energy intake were significantly lower in patients with pancreatic cancer (P < 0.0001) compared with healthy controls. Resting energy expenditure and the respiratory quotient were significantly lower in patients (P < 0.0001 and P < 0.025, respectively). There were no differences in REE between patients and controls when normalized by lean body mass. Respiratory quotients were significantly lower in patients who underwent surgery and in those who did not compared with controls. CONCLUSIONS: Pancreatic cancer does not increase REE above the normal levels nor does tumor burden contribute to increasing REE. Decreased daily energy intake of our patients may have reduced measured REE.