Perceived Access to Healthcare of Indigenous Peoples in Canada With Rheumatoid Arthritis and Their First-Degree Relatives.

OBJECTIVE: There are complex and interrelated factors that lead to inequitable healthcare delivery in Canada. Many of the factors that underlie these inequities for Canada's geographically dispersed Indigenous peoples remain underexamined. METHODS: A cohort of 831 First Nations (FN) individuals from urban and remote communities were recruited into a longitudinal study of rheumatoid arthritis (RA) risk from 2005 to 2017. Data from each participant's initial enrollment visit were assessed using a survey that captured concerns with healthcare access. RESULTS: We found that remote participants with RA reported poor access compared to remote first-degree relatives (FDRs; P < 0.001); this difference was not observed for urban participants with RA. We observed substantial differences based on sex; female participants perceived access to care to be more difficult than male participants in both urban and remote cohorts (P < 0.001). We also observed that male participants with RA reported poor access to care compared to male FDRs. Importantly, access to care in remote communities appeared to improve over the duration of the study (P = 0.01). In a logistic regression analysis, female sex, remote location, and older age were independent predictors of poor access to care. Predictors of poor access in participants with RA also included female sex, remote location, and older age. CONCLUSION: FN peoples living in remote communities, particularly those with an established RA diagnosis, report more problems accessing health care. Sex-based inequities exist, with FN female individuals reporting greater difficulties in accessing appropriate health care, regardless of RA diagnosis. Addressing these sex-based inequities should be a high priority for improving healthcare delivery.

Dietary potassium liberalization with fruit and vegetables versus potassium restriction in people with chronic kidney disease (DK-Lib CKD): a clinical trial protocol.

BACKGROUND: Potassium regulation in the body is primarily done in the kidney. In addition to this, hyperkalemia, occurs in approximately 10% of individuals with chronic kidney disease (CKD) and is associated with elevated all-cause mortality. Individuals with CKD are often told to restrict dietary potassium (K), however, this recommendation is based on low quality evidence. Reduced quality of life, limited dietary choices and nutritional deficiencies are all potential negative outcomes that may occur when restricting dietary K in CKD patients. There is a need for randomized controlled trials investigating the impact of dietary K modification on serum K concentrations in people with CKD. METHODS: A randomized 2-period crossover design comparing a liberalized K fruit and vegetable diet where participants will be required to consume ~ 3500 mg of dietary K daily, to a standard K restricted diet where participants will be required to consume < 2000 mg of dietary K daily. All participants will begin on a liberalized K run-in period for 2 weeks where they will receive fruit and vegetables home deliveries and for safety will have clinical chemistry, including serum potassium measurements taken after 1 week. Participants will then be randomized into either liberalized K or standard K diet for six weeks and then crossover to the other intervention for another 6 weeks after a 2-week washout period. DISCUSSION: 30 male and female CKD outpatients, ≥ 18 years of age, who have an estimated glomerular filtration rate (eGFR) between 15 and 45 ml/min/1.73m2 and serum K between 4.5 and 5.5 mEq/L. This design would have greater than 80% power to detect a difference of 0.35 mEq/L serum K between groups. Anthropometric measurements, clinical chemistry, dietary recalls, physical function assessments, as well as a quality of life assessments will also be measured in this trial. These findings will provide high quality evidence for, or against, recommendations for dietary K restriction in individuals living with CKD. The removal of K restriction could provide individuals living with CKD more dietary choice leading to improved dietary status and quality of life. TRIAL REGISTRATION: This trial has received approval from the University of Manitoba Research Ethics board (HS25191 (B2021:104)).

Recent evidence for the effects of nonnutritive sweeteners on glycaemic control.

PURPOSE OF REVIEW: By replacing sugar, nonnutritive sweeteners (NNSs) are thought to aid in weight management and decrease insulin resistance. We reviewed the latest randomized clinical trials (RCTs) investigating the effects NNSs on glycaemic control. RECENT FINDINGS: Six RCTs addressed this topic between 2017 and 2018; the majority tested artificial NNS (sucralose or aspartame), with only one testing natural NNS (stevia and monk fruit extract). Most found no effect of NNS on blood glucose, insulin, gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) levels; however, two trials showed an effect of sucralose on the acute insulin response. SUMMARY: We are still incapable of reaching a definite judgement on which types of NNS, if any, impact glycaemic control. There is a need for more research to overcome the limitations of recent RCTs, related to sample size, intervention duration, dose, form of NNSs used, and inclusion of males or female participants only. Future studies should also compare different NNS types with each other, and include the increasingly popular 'natural' NNS.

Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies.

BACKGROUND: Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects. METHODS: We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points. RESULTS: From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m2; 95% confidence interval [CI] -1.10 to 0.36; I2 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I2 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome. INTERPRETATION: Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners. Protocol registration: PROSPERO-CRD42015019749.

Fatty Acid Composition in Feeds and Plasma of Canadian Premature Infants.

OBJECTIVES: The objective of the present exploratory study was to investigate how the fatty acid (FA) composition of different food sources for preterm infants including breast milk (BM), formula (F), human milk fortifiers (HMFs), and total parenteral nutrition (TPN) impacted preterm infant's plasma FA. The associations between FA content of plasma with antioxidant enzyme activity and cognition were also evaluated. METHODS: Thirty-two premature infants were included in the present study. Five different feeds (BM, F, BM + F, BM + HMF, and TPN) were provided. Foods and preterm infant plasma samples were collected at the same time on the same day biweekly where possible. Separation and identification of the plasma and food FA methyl esters were performed by gas-liquid chromatography. Antioxidant enzymes were measured. The Bayley Scale of Infant Development version III was used to evaluate cognition. RESULTS: In food sources, BM contained significantly lower stearic acid (C18:0) (P < 0.05), oleic acid (C18:1n9) (P < 0.01), linoleic acid (C18:2n6) (P < 0.01), α-linoleic acid (C18:3n3) (P < 0.01), and arachidonic acid (C20:4n6) (P < 0.05) compared with the F. Palmitic acid (C16:0) was significantly higher (P < 0.05) in the BM + HMF compared with the BM. Stearic acid (C18:0) was significantly higher (P < 0.05) in the BM + F and BM + HMF compared with the BM. In the plasma lauric acid (C12:0) (P < 0.05) and myristic acid (C14:0) (P < 0.001) were higher in the BM-fed babies compared with the F-fed or TPN-recipient groups. Antioxidant enzymes, activities and cognition scores did not differ by feeding groups, however the study may not have been powered to detect these differences. CONCLUSIONS: The type, and therefore quality, of fatty acids is an important consideration when selecting what is fed to premature infants because differences in feed fatty acids were seen in some plasma fatty acids in the study.

Hemp seed protein and its hydrolysate compared with casein protein consumption in adults with hypertension: a double-blind crossover study.

BACKGROUND: The effects of consuming hemp seed protein (HSP) as well as its hydrolysate-derived bioactive peptide (HSP+) on blood pressure (BP) has not, to our knowledge, been investigated in humans. OBJECTIVES: We aimed to investigate how consumption of HSP and its hydrolysate modulates 24-h systolic (SBP) and diastolic BP (DBP) and plasma biomarkers of BP compared with casein. METHODS: In a double-blind, randomized, crossover design trial, 35 adults who had mild hypertension with SBP between 130 and 160 mmHg and DBP ≤110 mmHg were recruited. Participants were randomly assigned to varying sequences of 3 6-wk treatments, 50 g casein/d, 50 g HSP/d, or 45 g HSP plus 5 g HSP-derived bioactive peptides/d (HSP+), separated by a 2-wk washout period. Treatment effects were assessed with a linear mixed model with repeated measures. RESULTS: Compared with casein, after HSP+ consumption, 24-h SBP and 24-h DBP decreased from 135.1 and 80.0 mmHg to 128.1 ± 1.6 (P < 0.0001) and 76.0 ± 1.4 mmHg (P < 0.0001), respectively, whereas these values were 133.5 ± 1.6 and 78.9 ± 1.4 mmHg after HSP consumption (P < 0.0001). There were no differences between the HSP and HSP+ consumption in plasma angiotensin-converting enzyme (ACE) activity, renin, or nitric oxide (NO) concentrations. However, these 2 treatments were able to lower both ACE and renin activities and raise NO concentration in plasma compared with casein. CONCLUSIONS: These results suggest that hemp protein consumption, as well as in combination with bioactive peptides, may have a role in the dietary management of hypertension. This trial was registered at clinicaltrials.gov as NCT03508895.

Plasma noncholesterol sterols: current uses, potential and need for standardization.

PURPOSE OF REVIEW: Noncholesterol sterols (NCSs) in plasma encompass endogenous cholesterol precursors and exogenous phytosterols and cholesterol metabolites, which are used as surrogate measures of cholesterol synthesis and cholesterol absorption, respectively. The ratios of cholesterol synthesis to cholesterol absorption surrogates are also utilized to assess the overall balance of cholesterol metabolism, with higher values representing more synthesis and lower values more absorption. The objective of this review is to focus on recent findings using plasma NCSs and their potential in customizing dietary and pharmacological hypolipidemic therapies. RECENT FINDINGS: NCSs are often used to assess the impact of pharmacological and dietary interventions on cholesterol metabolism. Various forms of dyslipidemia have been characterized using NCSs, and NCSs may be a valuable tool in selecting appropriate treatment therapies. NCSs levels are affected by genetic, dietary and physiological factors and have been related to cardiovascular disease risk. SUMMARY: The expanded use of plasma NCSs is currently limited by the lack of standardized methodology. However, noncholesterol sterols are still a valuable research tool for the overall assessment of cholesterol metabolism and may have clinical potential in the personalization of diet and medicine.

A clinically managed weight loss program evaluation and the impact of COVID-19.

Introduction: With the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute. Methods: This was a prospective evaluation of a newly established program between January 2019-August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio. Results: Greater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p < 0.001 vs. 1.75 ± 4.43 kg n = 9, p = 0.02). Completers pre-COVID-19 demonstrated improvements in waist circumference, Framingham risk score, blood pressure, hemoglobin A1C, and body fat percentage. Conclusions and implications: Though the sample size was small to show definitve evidence, the results may suggest the program worked well prior to the pandemic but the pandemic created barriers to weight-loss for participants.

The Hans Kai trial: study protocol of a mixed methods randomized controlled trial evaluating a peer-led health promotion program for adults with or without noncommunicable diseases.

BACKGROUND: A significant proportion of Canadian adults is impacted by chronic noncommunicable diseases. These conditions may be improved by peer-led health promotion interventions that target modifiable risk factors; however, to date, there is mixed evidence on the effectiveness of these interventions. Unlike other health promotion programs, Hans Kai is grounded in a holistic model of health that simultaneously addresses multiple determinants of health at different levels of human ecology. In Hans Kai, a set of informational sessions that are delivered in a group setting by healthcare professionals are followed by regular peer-led group meetings in a self-governed support group setting that is designed to promote implementation of newly learned health competences. The Hans Kai trial described here aims to evaluate the efficacy of the Hans Kai program in promoting the health and wellbeing of its participants and investigate the experiences of the Hans Kai participants and facilitators. METHODS: This research will involve a mixed methods trial combining an experimental component with a qualitative component. The experimental component will involve a 6-month 2-group parallel superiority randomized controlled trial (RCT) in which 105 participants will be randomly assigned to two conditions, an intervention group (n = 70) that will participate in the Hans Kai program and a control group (n = 35) that will have access to standard care using a computer-generated random sequence; blinding will not occur. The RCT will test the impact of the program on several health outcomes and will be followed by a 12-18-month observational follow-up study that will provide data on the long-term durability of the 6-month RCT health outcomes. The qualitative component will investigate the experiences of program participants (n = 30) and facilitators (n = 15) to identify the main strengths and limitations of Hans Kai, uncover potential implementation issues, and elucidate the mechanisms through which the program works. The population of interest will include adults aged 18 + with or without chronic health conditions who self-report an interest in taking control of their own health and improving their lifestyle. In the RCT, all outcomes of interest will be measured using a multi-method approach, involving self-report questionnaires and objective indicators, and within-subject mean changes in outcomes over time between the two groups will be compared to address the RCT aims. Similarly, in the qualitative component, a multi-method approach, involving in-depth individual interviews, photovoice, and online surveys, will be used to reach a deeper and more nuanced understanding of the program strengths, how the program works, and for which people it is more effective. Adaptable components of the program will also be investigated and modified according to the feedback provided by the RCT participants. In the mixed methods integration of evidence, the qualitative findings will be used to explain the quantitative RCT results. DISCUSSION: The RCT findings will help support the further development and use of Hans Kai as well as other peer-led health promotion interventions. TRIAL REGISTRATION: United Stated Clinical Trial Registry ClinicalTrials.gov (registration# NCT03949725; Protocol version 2, June 22nd, 2022).

Reducing Dietary Acid With Fruit and Vegetables Versus Oral Alkali in People With Chronic Kidney Disease (ReDACKD): A Clinical Research Protocol.

Background: Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet. Objective: This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate. Design: A 2-arm, open-label, dual-center, randomized controlled feasibility trial. Setting: Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia. Participants: Adult participants with G3-G5 CKD and metabolic acidosis. Measurements: Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial. Methods: A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg. Limitations: Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail. Conclusions: This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis. Trial Registration: This study is registered on clinicaltrials.gov with the identifier NCT05113641.

Contexte: Les personnes atteintes d'insuffisance rénale chronique (IRC) courent le risque de développer une acidose métabolique, laquelle est associée à une progression plus rapide de l'IRC et à un besoin accru de dialyse. La prise de bicarbonate de sodium par voie orale (la norme actuelle de traitement de l'acidose métabolique) est mal tolérée, ce qui se traduit par une faible adhérence. Les fruit et légumes basiques ou alcalifiants ont un potentiel de traitement alternatif pour l'acidose métabolique, car il a été démontré qu'ils peuvent réduire la charge acide provenant de l'alimentation. Objectif: cet essai permettra d'évaluer la faisabilité d'un traitement alimentaire de l'acidose métabolique, en misant sur la consommation de fruit et légumes basiques ou alcalifiants, par rapport à la prise de bicarbonate de sodium par voie orale. Type d'étude: essai de faisabilité contrôlé, randomisé, ouvert, à deux bras, mené dans deux centres. Cadre: deux sites canadiens, soit une clinique de néphrologie à Winnipeg (Manitoba) et une autre à Halifax (Nouvelle-Écosse). Sujets: des patients adultes atteints d'IRC de stade G3-G5 et d'acidose métabolique. Mesures: les participants seront soumis à des mesures initiales et devront se présenter à cinq visites d'étude réparties sur 12 mois. Au cours de chacune, les patients subiront une mesure des critères de faisabilité, une mesure de la pression artérielle, un bilan sanguin et urinaire, un test de lever de chaise à cinq répétitions (STS5 ­ Five Times Sit to Stand Test) et devront répondre à des questionnaires évaluant la qualité de vie et les symptômes. Les participants devront également utiliser un outil en ligne de rappels alimentaires de 24 heures autoadministrés et automatisés (ASA24 ­ Automated Self-Administered 24-hours) au début, à mi-parcours et à la fin de l'essai. Méthodologie: 40 patients admissibles seront randomisés (1:1) dans le groupe expérimental (fruit et légumes basiques ou alcalifiants) ou dans le groupe témoin (bicarbonate de sodium) avec une dose quotidienne initiale de 1 500 mg. Limites: l'utilisation d'outils d'évaluation alimentaire autoadministrés, le manque de supervision de la consommation des traitements à l'étude et la possible déception du groupe témoin de ne pas recevoir de fruit et légumes constituent des limites pour cette étude. Nous prévoyons cependant adopter des pratiques appropriées pour surmonter ces possibles limites. Ces pratiques sont discutées plus en détail dans le manuscrit. Conclusion: cette étude produira des données sur la consommation de fruit et légumes basiques ou alcalifiants comme traitement alimentaire pour l'acidose métabolique en contexte d'IRC. Ces données seront utilisées pour concevoir un futur essai multicentrique visant à ralentir la progression de l'IRC chez les personnes atteintes d'acidose métabolique. Enregistrement de l'essai: Cette étude a reçu l'approbation du Conseil d'éthique de la recherche en santé de l'Université du Manitoba (HS24768 [B2021:025]) et est enregistrée sur ClinicalTrials.gov avec l'identifiant NCT05113641.

Early programming of adult blood pressure in the low birth weight Yucatan miniature pig is exacerbated by a post-weaning high-salt-fat-sugar diet.

We previously demonstrated that intra-uterine growth-restricted (IUGR) Yucatan miniature pigs develop modestly elevated blood pressure (BP) as young adults. The present study evaluated the effects of a post-weaning Western-style, high-salt-fat-sugar (HSFS) diet on early programming of BP. IUGR piglets (3 d old, 0·77 (sem 0·04) kg, n 6) were paired with normal weight (NW) same-sex littermates (1·14 (sem 0·03) kg, n 6) and fed milk replacer for 4 weeks. A third littermate was left with the sow (SF; 1·01 (sem 0·05) kg, n 6). When 4 weeks old, all pigs were placed on a HSFS diet ad libitum for 5 h/d. When 11 months old, telemeters were implanted to measure BP in pigs before (4·5% NaCl) and after (0·5% NaCl) a 7 d reduced salt challenge. At necropsy, nephron numbers were determined. Before sexual maturity, IUGR pigs had greater relative feed intake (P<0·05), and experienced catch-up growth with greater adiposity, with correlations between adiposity and BP (P<0·05). Adult IUGR pigs had 26-34% fewer nephrons and higher diastolic BP (107·7 (sem 4·9) mmHg, P = 0·044) than NW (97·2 (sem 1·8) mmHg) and SF (98·9 (sem 5·3) mmHg) pigs. Systolic BP was similar among the three groups, but was significantly elevated compared with levels previously reported for a control diet. Salt restriction reduced BP in all groups (P<0·05), but with no differences (P>0·05) in the degree of salt sensitivity among groups. In conclusion, a post-weaning Western-style diet exacerbates early programming of diastolic BP in Yucatan miniature swine, whereas systolic BP is more sensitive to postnatal diet.

Metabolic and genetic factors modulating subject specific LDL-C responses to plant sterol therapy.

Reducing intestinal cholesterol absorption with plant sterol consumption is a well-characterized strategy to lower LDL-C and potentially reduce cardiovascular disease risk. However, over 50 years of clinical research demonstrate that there is significant heterogeneity in the individual LDL-C lowering response to plant sterol therapy. A clear understanding of why plant sterols work effectively in some individuals but not in others will ensure optimal integration of plant sterols in future personalized nutritional lipid-lowering strategies. This review will examine the current knowledge base surrounding the metabolic and genetic determinants of LDL-C lowering in response to plant sterol consumption.

Paying the price? Academic work and parenting during COVID-19.

Introduction: The shift to remote working/learning to slow transmission of the SARS-CoV-2 virus has had widespread mental health impacts. We aimed to describe how the COVID-19 pandemic impacted the mental health of students and faculty within a health sciences faculty at a central Canadian university. Methods: Via an online survey, we queried mental health in the first four months of the COVID-19 pandemic quantitatively (scale: 1 (most negative)-100 (most positive)) and qualitatively. Results: The sample (n = 110) was predominantly women (faculty 39/59; [66.1%]; students 46/50; [92.0%]). Most faculty were married/common law (50/60; [84.8%]) and had children at home (36/60; [60.0%]); the opposite was true for most students.Faculty and students self-reported comparable mental health (40.47±24.26 and 37.62±26.13; respectively). Amongst women, those with vs. without children at home, reported significantly worse mental health impacts (31.78±23.68 vs. 44.29±27.98; respectively, p = 0.032).Qualitative themes included: "Sharing resources," "spending money," "few changes," for those without children at home; "working at home can be isolating," including the subtheme, "balancing act": "working in isolation," "working more," for those with children at home. Discussion: Amongst women in academia, including both students and faculty, those with children at home have disproportionately worse mental health than those without children at home.

Introduction: Le virage vers le travail et l'enseignement à distance pour ralentir la transmission du virus SRAS-CoV-2 a eu des répercussions étendues sur la santé mentale. Notre étude vise à décrie l'impact de la pandémie de la COVID-19 sur la santé mentale des étudiants et du corps professoral au sein Faculté des sciences de la santé d'une université du centre du Canada. Méthodes: Un questionnaire en ligne a été administré pour récolter des données qualitatives et quantitatives (échelle : de 1 [le plus négatif] à 100 [le plus positif] à l'égard de la santé mentale des participants au cours des quatre premiers mois de la pandémie. Résultats: L'échantillonnage (n = 110) était majoritairement composé de femmes (membres du corps professoral : 39/59 ou 66,1 %; étudiantes 46/50 ou 92,0 %). La plupart des répondants du corps professoral étaient mariés ou en union libre (50/60 ou 84,8 %) et avaient des enfants à la maison (36/60 ou 60,0 %). Le contraire était vrai pour la plupart des étudiants. L'état de santé mentale déclaré par le corps professoral et les étudiants était comparable (40,47±24,26 et 37,62±26,13 respectivement). Parmi les femmes, autant celles qui avaient des enfants à la maison que celles qui n'en avaient pas, ont déclaré que leur santé mentale était nettement moins bonne (31,78±23,68 contre 44,29±27,98 respectivement; p = 0,032).Pendant l'analyse des données qualitatives, on a identifié les thèmes « le partage de ressources ¼, « les dépenses ¼ et « peu de changements ¼ pour les répondants qui n'avaient pas d'enfants à la maison alors que les thème « le télétravail accentue l'isolement ¼, ainsi que lessous-thèmes « maintien de l'équilibre : travailler en isolement'' et ''travailler plus ¼ ont émergé pour ceux qui avaient des enfants à la maison. Discussion: Parmi les femmes œuvrant dans le milieu universitaire, qu'elles soient étudiantes ou membres du corps professoral, la santé mentale de celles qui ont des enfants à la maison est davantage affectée que celle des femmes qui n'en ont pas.

The Effects of Resistant Starch Consumption in Adult Patients With Chronic Kidney Disease: A Systematic Review.

Background: Resistant starches (RSs) are not digested by human digestive enzymes and pass through the upper digestive tract to become substrates for colonic bacteria. Resistant starch supplementation has shown promising results in altering the microbiota of animal models of chronic kidney disease (CKD). Resistant starch consumption may influence the production of uremic toxins in CKD. Objective: To conduct a systematic review to determine whether the consumption of RS reduces the progression of kidney disease in adult patients with CKD. Design: We included randomized controlled trials comparing RS supplementation to placebo, no treatment, or standard care. Cochrane Central, Embase, MEDLINE, Web of Science, and CINAHL databases were searched. There was no limitation on publication date, but only English manuscripts were included. The search was conducted in July 2020. Patients: Adult outpatient populations with CKD, using any recognized diagnostic criteria. Measurements: The primary outcome was change in glomerular filtration rate (GFR) from baseline through the end of the trial in patients not on dialysis; secondary outcomes included change in uremic toxin concentrations (p-cresol/p-cresyl sulfate [p-CS], indoxyl sulfate [IS]) and inflammatory markers (tumor necrosis factor alpha [TNF-α], C-reactive protein [CRP], interleukin 6 [IL-6]) from baseline through the end of the trial, and changes in self-reported symptom scores. Methods: The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias in included studies. The systematic review results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: We identified 4 unique studies, reported in 9 publications that met our inclusion criteria, including a total of 215 enrolled participants. Results were calculated using data from the longest reported follow-up time. The primary outcome of changes in kidney function markers was only studied in 1 trial; this trial reported an increase in creatinine and a decrease in blood urea nitrogen; no changes in GFR were reported. A review of the secondary outcomes showed an overall decline in IS, TNF-α, and IL-6, in RS groups, but with mixed results in p-CS and CRP/high-sensitivity CRP. Safety data showed that RS was well tolerated with no reports of excessive side effects. Limitations: We determined a meta-analysis was not feasible due to clinical heterogeneity between study populations and differences in reported outcomes in the included studies. Conclusion: There is limited and inconsistent evidence on the impact of RS in adult patients with CKD. Further research is needed to determine the safety and efficacy of RS supplementation in this population.

Contexte: Les amidons résistants ne sont pas dégradés par les enzymes digestives humaines; ils traversent le tube digestif supérieur et deviennent des substrats pour les bactéries du côlon. La supplémentation en amidons résistants a montré des résultats prometteurs dans la modification du microbiote chez les modèles animaux d'insuffisance rénale chronique (IRC). Dans ce contexte, la consommation d'amidons résistants pourrait avoir une incidence sur la production de toxines urémiques. Objectif: Procéder à une revue systématique afin de déterminer si la consommation d'amidons résistants limite la progression de la maladie chez les adultes atteints d'IRC. Conception de l'étude: Ont été inclus les essais contrôlés randomisés qui comparaient la supplémentation en amidons résistants à un placebo, à l'absence de traitement ou aux soins courants. La recherche a été effectuée en juillet 2020 dans les bases de données Cochrane Central, Embase, Medline, Web of Science et CINAHL. La date de publication n'était pas limitée, mais seuls les articles rédigés en anglais ont été inclus. Sujets: Des adultes atteints d'IRC et suivis en ambulatoire, selon tout critère de diagnostic reconnu. Mesures: Le principal critère d'évaluation était un changement dans le taux de filtration glomérulaire entre le début et la fin de l'essai chez les patients non dialysés. Les résultats secondaires comprenaient un changement, entre le début et la fin de l'essai, dans les concentrations de toxines urémiques (sulfate de p-crésol/crésyle, sulfate d'indoxyle) et de marqueurs d'inflammation (TNFα, CRP, IL-6), ainsi que dans les scores de symptômes auto-déclarés. Méthodologie: L'outil de Risque de Biais de la Collaboration Cochrane a été utilisé pour évaluer le risque de biais dans les études incluses. Les résultats de la revue systématique sont présentés conformément aux directives PRISMA. Résultats: Quatre études uniques, présentées dans neuf publications et portant sur un total de 215 patients, répondaient à nos critères d'inclusion. Les résultats ont été calculés à partir des données de la plus longue période de suivi rapportée. Un seul de ces essais avait examiné le critère principal d'évaluation, soit un changement dans les marqueurs de la fonction rénale. On y rapportait une augmentation du taux de créatinine et une diminution du taux de l'urée dans le sang. Aucun changement dans le débit de filtration glomérulaire n'avait été signalé. Un examen des résultats secondaires a révélé une diminution globale du sulfate d'indoxyle, du TNF alpha et d'IL-6 dans les groupes de patients qui prenaient des suppléments d'amidon résistants, mais des résultats mitigés en ce qui concerne les taux de p-CS et de CRP/hsCRP. Les données de sécurité montraient que les amidons résistants étaient bien tolérés, aucun effet secondaire important n'ayant été rapporté. Limites: Une méta-analyse n'était pas réalisable en raison de l'hétérogénéité clinique entre les populations étudiées et des différences dans les résultats rapportés dans les études incluses. Conclusion: Les données sur les effets d'une supplémentation en amidons résistants chez les adultes atteints d'IRC sont limitées et manquent d'uniformité. D'autres recherches examinant la sécurité et l'efficacité d'une supplémentation en amidons résistants dans cette population sont nécessaires.

A randomized double-blind cross-over trial to study the effects of resistant starch prebiotic in chronic kidney disease (ReSPECKD).

BACKGROUND: Chronic kidney disease (CKD) is associated with a reduced quality of life and an increased risk of kidney failure, cardiovascular events, and all-cause mortality. Accumulation of nitrogen-based uremic toxins leads to worsening of symptoms in individuals with CKD. Many uremic toxins, such as indoxyl and p-cresol sulphate, are produced exclusively by the gut microbiome through the proteolytic digestion of aromatic amino acids. Strategies to reduce the production of these toxins by the gut microbiome in individuals with CKD may lessen symptom burden and delay the onset of dialysis. One such strategy is to change the overall metabolism of the gut microbiome so that less uremic toxins are produced. This can be accomplished by manipulating the energy source available to the microbiome. Fermentable carbohydrates which reach the gut microbiome, like resistant starch (RS), have been shown to inhibit or reduce bacterial amino acid metabolism. This study aims to investigate the effects of resistant potato starch (RPS) as a prebiotic in individuals with CKD before the onset of dialysis. METHODS: This is a double-blind, randomized two-period crossover trial. Thirty-six eligible participants will consent to follow a 26-week study regimen. Participants will receive 2 sachets per day containing either 15 g of RPS (MSPrebiotic, resistant potato starch treatment) or 15 g cornstarch (Amioca TF, digestible starch control). Changes in blood uremic toxins will be investigated as the primary outcome. Secondary outcomes include the effect of RPS consumption on symptoms, quality of life and abundance, and diversity and functionality of the gut microbiome. DISCUSSION: This randomized trial will provide further insight into whether the consumption of RPS as a prebiotic will reduce uremic toxins and symptoms in individuals who have CKD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04961164 . Registered on 14 July 2021.

Many authors of publicly available top-selling nutrition books in Canada are without clinical nutrition credentials, do not cite evidence, and promote their own services or products.

The accuracy of books as public nutrition resources varies substantially; whether authors of publicly available nutrition books possess related experience, cite scientific evidence, or have other financial incentives has not been assessed thoroughly. This study aimed to determine if publicly available top-selling nutrition books are written by authors who (1) have relevant expertise, (2) cite scientific evidence, and (3) benefit financially in other ways. Best-selling nutrition books were gathered from Amazon Canada. Differences in scientific citations and financial incentives were compared between authors with and without credentials. Authors who were Doctor of Medicine (MD), registered dietitians (RD), chiropractors, or naturopathic doctors had more in-text citations (56% versus 25%; p = 0.014) and cited more scientific articles (83% versus 50%; p = 0.0045) compared to all other authors. The majority of authors of publicly available top-selling nutrition books in Canada did not have MD/RD credentials. Many of the authors promoted their own services or products, regardless of credentials.

Genosets for APOE and CYP7A1-rs3808607 variants do not predict LDL cholesterol lowering upon intervention with plant sterols in a randomized, double-blind, placebo-controlled trial.

BACKGROUND: The consumption of 2 g/d plant sterols (PSs) reduces circulating LDL cholesterol by ≤10%. The degree of LDL cholesterol lowering was associated with specific apolipoprotein E [APOE, Reference SNP (rs)429358] and cholesterol 7α-hydroxylase (CYP7A1, rs3808607) genosets in previous post hoc analyses of randomized controlled trials. However, because post hoc analyses do not conform to the randomization model, there is a greater potential that the findings could be due to type I error, thus warranting validation through an a priori-designed intervention trial. OBJECTIVES: The GenePredict Plant Sterol study (GPS) was designed to validate associations of LDL cholesterol lowering with specific APOE and CYP7A1 genosets through a priori recruitment of individuals carrying prespecified genosets. METHODS: A 2-center, double-blind, placebo-controlled, randomized 2-period crossover dietary intervention with 2 g/d PS for 28 d with a minimum 28-d washout was undertaken from July 2017 to December 2019. A priori recruitment of individuals with slightly elevated LDL cholesterol was based on genosets of APOE isoforms and CYP7A1 rs3808607. Randomization was performed with stratification by sex and genoset. RESULTS: The recruitment target of 64 participants with prespecified genosets could not be reached, despite the screening of 477 individuals; 42 participants completed the intervention trial. Reductions in LDL cholesterol were similar across all 3 genosets (-0.298 ± 0.164, -0.357 ± 0.115, -0.293 ± 0.109 mmol/L; P = 0.0002 overall; P = 0.9126 for treatment × genoset), providing evidence that the shortfall in recruitment might not have stopped the trial from meeting the objective. CONCLUSIONS: APOE and CYP7A1 genotypes did not influence the efficacy of LDL cholesterol reductions upon dietary intervention with PSs. Findings of previous post hoc analyses could not be validated in a trial using a priori genotype-based recruitment. Obtaining adequate numbers of participants is challenging in trials using genoset-based recruitment, even for common variants.

Dietary Patterns and Perceptions in Older Adults With Chronic Kidney Disease in the Canadian Frailty Observation and Interventions Trial (CanFIT): A Mixed-Methods Study.

Background: People living with chronic kidney disease (CKD) have identified diet as an important aspect of their life and care. Understanding current consumption patterns in this population, and how they relate to patient perspectives of dietary recommendations, may help identify and design potential dietary intervention strategies in CKD. Objective: To investigate the dietary intake patterns of people with advanced-stage CKD, as well as subjective perspectives regarding dietary recommendations from participants and their caregivers. Design: Mixed-methods study with a sequential explanatory design. Setting: Manitoba, Canada. Participants: Individuals with late-stage CKD (CKD stages G4-G5, including dialysis) participating in the Canadian Frailty Observation and Interventions Trial (CanFIT). Methods: First, quantitative data were collected via a cross-sectional dietary assessment, using three 24-hour dietary recalls, a 36-question short diet questionnaire (SDQ), and a Nutrition Quality of Life (NQoL) tool (n = 59). Second, qualitative data were collected during 2 focus groups (n 1 = 12 and n 2 = 7) held with a subsample of individuals who had completed the dietary surveys, along with their caregivers. Focus groups explored topics related to diet and CKD; transcribed data were analyzed thematically. In the interpretation stage, the qualitative findings were combined with the quantitative results to help explain the latter and reach a deeper understanding of the subjective experiences of adults with CKD. Results: Quantitatively, nearly all (48/51; 94%) participants (mean age 70.8 ± 10.8 years) reported energy intakes below recommendations and most (86%) did not achieve recommended fiber intake. In addition, 15/21 (71%) of patients on dialysis had low protein intake. Qualitatively, 2 themes were identified: (1) Lacking/Needing dietary guidance-incomplete "information overload," and (2) Experiencing difficulty in adapting to restrictions. Within the former theme, participants spoke of getting too much information at once, often at the wrong time. Within the latter theme, participants spoke of a loss of appetite, and cheating on their dietary recommendations. Limitations: Potential recall bias recalling dietary patterns, small sample size limiting generalizability, self-selection bias. Conclusion: Despite the reported lifestyle changes made by individuals with CKD, which negatively impacted their lives, many had suboptimal nutrition, especially in terms of energy and fiber. In addition, those on dialysis were not eating enough protein, which could be due to changing dietary recommendations as CKD progresses. Qualitative findings provided additional insight into how requisite CKD-dietary changes were perceived and how participants coped with these changes. The timing and delivery of the dietary education within CKD care in Manitoba may not be working for people with CKD as they progress through the disease.

Contexte: Les personnes atteintes d'IRC mentionnent le régime alimentaire comme un aspect important de leur vie et de leurs soins. Mieux comprendre les habitudes alimentaires actuelles de cette population et leur lien avec la façon dont les patients perçoivent les recommandations diététiques pourrait contribuer à orienter et concevoir de potentielles stratégies d'intervention diététique en contexte d'IRC. Objectif: Examiner les habitudes alimentaires des personnes atteintes d'IRC à un stade avancé, ainsi que les perspectives subjectives des participants et de leurs soignants sur les recommandations alimentaires. Conception: Étude par méthode mixte avec une conception séquentielle explicative. Cadre: Manitoba, Canada. Sujets: Les personnes atteintes d'IRC de stade avancé (stades G4-G5, y compris les patients sous dialyse) qui participent à l'essai CanFIT (Canadian Frailty Observation and Interventions Trial). Méthodologie: Des données quantitatives ont d'abord été colligées au moyen d'une évaluation transversale du régime alimentaire pour trois périodes de 24 heures, d'un questionnaire abrégé de 36 questions sur le régime alimentaire et d'un outil évaluant la qualité de vie liée à l'alimentation (n=59). Des données qualitatives ont ensuite été recueillies lors de deux groupes de discussion (n1 = 12 et n2 = 7) avec un sous-échantillon constitué de personnes ayant terminé les enquêtes sur l'alimentation et leurs soignants. Les groupes de discussion ont examiné des sujets liés à l'alimentation et à l'IRC; les données transcrites ont été analysées par thème. Au stade de l'interprétation, les résultats qualitatifs ont été combinés aux résultats quantitatifs pour aider à expliquer ces derniers et mieux comprendre les expériences subjectives des adultes atteints d'IRC. Résultats: Quantitativement, presque tous les participants (48/51; 94 %) (âge moyen: 70,8 ans ±10,8 ans) ont signalé des apports énergétiques inférieurs aux recommandations et la plupart (86 %) n'atteignaient pas l'apport recommandé en fibres. Sur les 21 patients sous dialyse, 15 (71 %) consommaient peu de protéines. Qualitativement, deux thèmes ont été dégagés: 1) le manque/besoin de directives alimentaires ­ « surcharge d'information ¼ ou information incomplète; 2) la difficulté de s'adapter aux restrictions. Pour le premier thème, les participants ont mentionné recevoir trop d'informations en même temps, souvent au mauvais moment. Pour le deuxième thème, les participants ont parlé de perte d'appétit et de tricherie par rapport aux recommandations alimentaires. Limites: Un possible biais de rappel pour les habitudes alimentaires; petite taille de l'échantillon qui limite la généralisabilité; biais d'auto-sélection. Conclusion: Malgré les changements signalés par les personnes atteintes d'IRC, lesquels ont eu des répercussions négatives sur leur vie, nombre d'entre elles avaient un régime alimentaire sous-optimal, surtout en ce qui concerne l'énergie et les fibres. En outre, les patients sous dialyse ne consommaient pas suffisamment de protéines, ce qui peut être attribuable aux changements dans les recommandations alimentaires au fur et à mesure que l'IRC progresse. Les résultats qualitatifs ont permis de mieux comprendre la façon dont les restrictions alimentaires nécessaires à l'IRC ont été perçues par les participants, et la façon dont ceux-ci ont fait face à ces changements. Le moment et le mode de prestation de l'information diététique dans le cadre des soins de l'IRC au Manitoba ne conviennent peut-être pas aux personnes atteintes d'IRC à mesure qu'elles progressent dans leur maladie. Enregistrement de l'essai: L'enregistrement n'est pas nécessaire pour cet essai.

Acute effects of hemp protein consumption on glycemic and satiety control: results of 2 randomized crossover trials.

Research investigating hemp protein consumption on glycemic response is limited. The effects of hemp protein consumption on blood glucose (BG), insulin, and satiety compared with soybean protein and a carbohydrate control were examined. Two acute randomized repeated-measures crossover experiments were conducted. In both, participants consumed the following isocaloric treatments: 40 g of hemp protein (hemp40), 20 g of hemp protein (hemp20), 40 g of soybean protein (soy40), 20 g of soybean protein (soy20), and a carbohydrate control. In experiments 1 (n = 27) and 2 (n = 16), appetite and BG were measured before (0-60 min, pre-pizza) and after a pizza meal (80-200 min, post-pizza). In experiment 1, food intake was measured at 60 min by ad libitum meal; in experiment 2 a fixed meal was provided (based on body weight) and insulin was measured pre-pizza and post-pizza. In both experiments, BG response was affected by treatment (p < 0.01), time (p < 0.001) and time-by-treatment (p < 0.001) from 0-200 min. Protein treatments lowered 0-60-min BG overall mean and area under the curve compared with control (p < 0.05) dose-dependently. In experiment 2, hemp40 and soy40 lowered (p < 0.05) overall mean insulin concentrations compared with hemp20, soy20, and control pre-meal. Results suggest that hemp protein, like soybean, dose-dependently lowers postprandial BG and insulin concentrations compared with a carbohydrate control. Clinical trial registry: NCT02366598 (experiment 1) and NCT02458027 (experiment 2). Novelty: Hemp protein concentrate dose-dependently leads to lower postprandial BG response compared with a carbohydrate control. No differences were seen between hemp and soy protein.