Effect of oral nutritional supplementation combined with impedance vectors for dry weight adjustment on the nutritional status, hydration status and quality of life in patients on chronic hemodialysis: A pilot study.

BACKGROUND & AIMS: Protein energy wasting frequently affect hemodialysis patients and contribute to the development of overhydration. The objective of this study was to assess the effect of oral nutritional supplementation (ONS) combined with bioelectrical vector analysis (BIVA) on the nutritional and hydration status and the quality of life (QoL) in hemodialysis (HD) patients. METHODS: Thirty-two chronic HD patients were included in a 6-month randomized pilot study. Patients in SUPL group received a simultaneous intervention consisting of a personalized diet, 245 mL/d ONS and dry weight adjustment through BIVA. Patients in CON group received a personalized diet and dry weight adjustment by BIVA. Anthropometrical, biochemical, dietary, QoL, handgrip strength (HGS) and bioimpedance measurements were performed. Malnutrition Inflammation Score (MIS) was applied. RESULTS: At the end of the intervention, moderate undernutrition decreased by 43.8% in SUPL group while in CON group, severe undernutrition increased by 13% (p < 0.04 between groups). In the adjusted covariance analysis, SUPL compared to CON group, increased HGS (Δ 2.8 Kg vs Δ -1.8 Kg, p = 0.003), serum albumin (Δ 0.29 g/dL vs Δ -0.03 g/dL, p = 0.04) and serum transferrin (Δ 4.7 mg/dL vs Δ -0.7 mg/dL, p = 0.0007). The increase in QoL was significantly higher in SUPL group. Dry weight was achieved in 100% of patients in SUPL and 95% in CON group. CONCLUSIONS: ONS combined with BIVA for dry weight adjustment, improved nutritional status, QoL and achieved dry weight in HD patients.

Evaluation of the MD Anderson tumor score for diffuse large B-cell lymphoma in the rituximab era.

OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is an aggressive heterogeneous lymphoma with standard treatment. However, 30%-40% of patients still fail, so we should know which patients are candidates for alternative therapies. IPI is the main prognostic score but, in the rituximab era, it cannot identify a very high-risk (HR) subset. The MD Anderson Cancer Center reported a score in the prerituximab era exclusively considering tumor-related variables: Tumor Score (TS). We aim to validate TS in the rituximab era and to analyze its current potential role. METHODS: From GELTAMO DLBCL registry, we selected those patients homogeneously treated with R-CHOP (n = 1327). RESULTS: Five-years PFS and OS were 62% and 74%. All variables retained an independent prognostic role in the revised TS (R-TS), identifying four different risk groups, with 5-years PFS of 86%, 71%, 50%, and very HR (28%). With a further categorization of three variables of the original TS (Ann Arbor Stage, LDH and B2M), we generated a new index that allowed an improvement in HR assessment. CONCLUSIONS: (a) All variables of the original TS retain an independent prognostic role, and R-TS remains predictive in the rituximab era; (b) R-TS and additional categorization of LDH, B2M, and AA stage (enhanced TS) increased the ability to identify HR subsets.

Antioxidant dietary fiber isolated from spent coffee (Coffea arabica L.) grounds improves chronotype and circadian locomotor activity in young adults.

Chrononutrition, or the circadian timing of food intake, proposes that nutrients, bioactive compounds, and foods modulate the peripheral clocks with implications on health. We evaluated the effects of biscuits supplemented with the antioxidant dietary fiber isolated from spent coffee grounds as a food ingredient (SCF-B) or a combination of spent coffee grounds and fructooligosaccharides (SC-FOS-B), and a traditional recipe (TB, without added fiber) on the modulation of circadian rhythm in young adults. The repeated intake (21 days/45 g portion) of SCF-B or SC-FOS-B decreased (p < 0.05) the evening chronotypes. SCF-B and SC-FOS-B consumption enhanced the chronodisruption associated with colonic short chain fatty acid production, thus improving the quality and length of sleep. This is the first study on the positive impact of antioxidant dietary fiber obtained from spent coffee grounds on circadian activity improvement in young adults. Further clinical trials and the role of other bioactive compounds as therapeutic candidates for health disturbances related to circadian dysfunction are necessary to confirm the results.

Development of an intervention program to prevent childhood obesity targeted to Mexican mothers of school-aged children using intervention mapping and social cognitive theory.

In Mexico, data from the last National Health and Nutrition Survey (2016) described the increase in the prevalence of overweight and obesity in school-aged children (33.2%). Obesity prevention strategies have not been effective, and currently, Mexico has one of the highest prevalence of childhood obesity. Thus, there is an urgent need to develop strategies that can prevent childhood obesity and also to avoid these children to remain overweight/obese through adulthood. The objective of this study was to provide a step-by-step description of the design, implementation and evaluation of an intervention plan for Mexican mothers of school aged children to promote healthy eating and to prevent childhood obesity. The program Niño Sano Adulto Sano was developed using the Intervention Mapping Approach and the Social Cognitive Theory frameworks to provide Mexican mothers with knowledge and skills to positively modify their children's food behavior, thus preventing future weight gain. The program was developed, piloted and delivered to the target population with positive results on the mothers' nutrition knowledge and children's BMI. Intervention Mapping and Social Cognitive Theory are useful models to design and deliver an intervention that provides a holistic approach to promote healthy eating.

Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of ß2 -microglobulin yields a more accurate GELTAMO-IPI.

The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (ß2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and ß2M as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.

Lycopene Improves Diet-Mediated Recuperation in Rat Model of Nonalcoholic Fatty Liver Disease.

The aim of the present study was to evaluate the synergic effect of lycopene (LYC) treatment with a dietary control in a nonalcoholic fatty liver disease (NAFLD) model induced with a high-fat diet (HFD). Sprague-Dawley rats were fed during 4 weeks with a normal diet (ND·4w) or an HFD (HFD·4w) to produce an NAFLD model. Then, rats from the ND·4w group continued during 4 weeks with the same diet (ND·8w), and rats from HFD were fed during 4 weeks with an ND (HFD·4w+ND·4w) or an ND plus LYC (HFD·4w+ND+LYC·4w). LYC (20 mg/kg) was administered daily by gavage. ND and ND+LYC diets partially reverted the following alterations due to HFD: liver weight, serum low-density lipoproteins (LDL), hepatic total cholesterol (TC), and catalytic activity of hepatic superoxide dismutase, catalase, and glutathione peroxidase, as well as macroscopic and microscopic images of livers. A higher recuperation to reach normality was obtained with ND+LYC in: liver weight, hepatic TC, serum LDL, and, in some instances, macroscopic and microscopic images of livers. Failures to recovery with both NDs were observed for malondialdehyde level and serum aspartate aminotransferase activity. Taken together, the results from this study suggest the potentially protective role of LYC against NAFLD; however, more clinical trials are needed to support this idea.

Total phenolic compounds in milk from different species. Design of an extraction technique for quantification using the Folin-Ciocalteu method.

Milk protects the health of newborns because it contains essential compounds that perform metabolic activities. Despite these benefits, the study of phenolic compounds in milk has been poorly explored. The objective of this study was to develop and validate a technique for extracting total phenolic compounds (TPCs) from a milk matrix and then analyzing them using the Folin-Ciocalteu method. The extraction technique was applied to goat milk and involved the addition of methanol, acetonitrile, and Carrez I and II reagents, after which protein was separated from fat through centrifugation. Subsequently, the technique was applied to goat (69.03±6.23mg GAE/L), cow (49.00±10.77mg GAE/L), sheep (167.6±58.77mg GAE/L) and human milk (82.45±12.3mg GAE/L). The technique showed an acceptable linearity (R(2)=0.9998), limit of detection (6.03mg GAE/L) and quantification (16.2mg GAE/L), repeatability (RSD=4%), reproducibility (RSD=6.8%) and recovery (>85.41%); it is thus effective and can be used in the routine analysis of milk. TPCs obtained from each type of milk indicate a high variability among species and among members of the same species.

The inclusion of a partial meal replacement with or without inulin to a calorie restricted diet contributes to reach recommended intakes of micronutrients and decrease plasma triglycerides: a randomized clinical trial in obese Mexican women.

BACKGROUND: Obesity is a major public health problem in many poor countries where micronutrient deficiencies are prevalent. A partial meal replacement may be an effective strategy to decrease obesity and increase micronutrient intake in such populations. The objective was to evaluate the efficacy of a partial meal replacement with and without inulin on weight reduction, blood lipids and micronutrients intake in obese Mexican women. METHODS: In a randomized controlled clinical trial 144 women (18-50 y) with BMI ≥ 25 kg/m², were allocated into one of the following treatments during 3 months: 1) Two doses/d of a partial meal replacement (PMR), 2) Two doses/d of PMR with inulin (PMR + I) , 3) Two doses/d of 5 g of inulin (INU) and 4) Control group (CON). All groups received a low calorie diet (LCD). Weight, height, hip and waist circumference were measured every 2 weeks and body composition, lipids and glucose concentration and nutrient intake were assessed at baseline and after 3 months. RESULTS: All groups significantly reduced weight, BMI, waist and hip circumference. Differences between groups were only observed in BMI and weight adjusted changes: At 45 days PMR group lost more weight than INU and CON groups by 0.9 and 1.2Kg, respectively. At 60 days, PMR + I and PMR groups lost more weight than in INU by 0.7 and 1Kg, respectively. Subjects in PMR, PMR + I and INU significantly decreased triglycerides. Energy intake was reduced in all groups. Fiber intake increased in PMR + I and INU groups. Some minerals and vitamins intakes were higher in PMR and PMR + I compared with INU and CON groups. CONCLUSION: Inclusion of PMR with and without inulin to a LCD had no additional effect on weight reduction than a LCD alone but reduced triglycerides and improved intake of micronutrients during caloric restriction. PMR could be a good alternative for obese populations with micronutrient deficiencies.

Effect of vitamin A deficiency on the immune response in obesity.

Obesity has been associated with low-grade systemic inflammation and with micronutrient deficiencies. Obese individuals have been found to have lower vitamin A levels and lower vitamin A intake compared with normal-weight individuals. Vitamin A plays a major role in the immune function, including innate immunity, cell-mediated immunity and humoral antibody immunity. It has also been recognised recently that vitamin A has important regulatory functions. Vitamin A status has an important effect on the chronic inflammatory response. Vitamin A deficiency increases a T-helper type 1 (Th1) response, elevates levels of pro-inflammatory cytokines, increases the expression of leptin, resistin and uncoupling proteins (UCP) and promotes adipogenesis. The effect of vitamin A deficiency on obesity might be increasing the risk of fat deposition and also the risk of chronic inflammation associated with obesity. Supplementation with vitamin A in vitro and in animal models has been found to reduce concentrations of adipocytokines, such as leptin and resistin. In conclusion, vitamin A deficiency increases a Th1 response in the presence of obesity and thus, increases the inflammatory process involved in chronic inflammation and fat deposition. The metabolism of leptin and other adipocytokines may play a critical role in the effect of vitamin A deficiency in the inflammatory response observed in obesity.

Effectiveness of the nutritional supplement used in the Mexican Oportunidades programme on growth, anaemia, morbidity and cognitive development in children aged 12-24 months.

OBJECTIVE: To determine the effectiveness of the nutritional supplement developed for the Oportunidades programme on growth, prevalence of anaemia, morbidity and cognitive function of pre-school children. DESIGN: In a randomised, placebo-controlled longitudinal trial, children were assigned to one of three experimental treatment groups: Oportunidades food supplement (OFS), powdered milk (PM) and placebo (PL). Treatments were administered daily for 6 months. Weight, height and Hb were measured in all participants before and after supplementation. Morbidity was assessed two times per week for 6 months using validated questionnaires. The Bayley Scale of Infant Development Test was administered at baseline and after 6 months. SETTING: Three marginal rural communities of the state of Queretaro, Mexico. SUBJECTS: A total of 224 children, mean age 22·4 (SD 5·9) months, were recruited. After the 6-month intervention, 186 completed the study. RESULTS: No differences were found in the adjusted changes of weight, height or anaemia between treatment groups and PL. No differences were found in the number of episodes of gastrointestinal or respiratory disease, nor were there any differences in cognitive performance between treatment and PL groups after 6 months of supplementation. CONCLUSIONS: Daily supplementation of 12-24-month-old children with OFS has no additional benefits in growth, anaemia, morbidity or cognitive performance.

Efficacy of different strategies to treat anemia in children: a randomized clinical trial.

BACKGROUND: Anemia continues to be a major public health problem among children in many regions of the world, and it is still not clear which strategy to treat it is most effective. OBJECTIVE: To evaluate the efficacy and children's acceptance of several recognized strategies to treat anemia. METHODS: Non-breastfed children (n = 577), 6 to 43 mo of age, were screened for the trial; 267 were anemic (hemoglobin < 11.7 g/dL), and 266 of those were randomized into 1 of 5 treatments to received daily either: an iron supplement (IS), an iron+folic acid supplement (IFS), a multiple micronutrient supplement (MMS), a micronutrient-fortified complementary food as porridge powder (FCF), or zinc+iron+ascorbic acid fortified water (FW). The iron content of each daily dose was 20, 12.5, 10, 10 and 6.7 mg respectively. Hemoglobin (Hb), ferritin, total iron, weight and height were measured at baseline and after 4 months of treatment. Morbidity, treatment acceptability and adherence were recorded during the intervention. RESULTS: All treatments significantly increased Hb and total iron concentration; ferritin did not change significantly. Groups MMS, IS and IFS increased Hb (g/dL) [1.50 (95%CI: 1.17, 1.83), 1.48 [(1.18, 1.78) and 1.57 (1.26, 1.88), respectively] and total iron ((µg/dL) [0.15 (0.01, 0.29), 0.19 (0.06, 0.31) and 0.12(-0.01, 0.25), respectively] significantly more than FCF [0.92 (0.64, 1.20)] but not to FW group [0.14 (0.04, 0.24)]. The prevalence of anemia was reduced to a greater extent in the MMS and IFS groups (72% and 69%, respectively) than in the FCF group (45%) (p < 0.05). There were no significant differences in anthropometry or in the number of episodes of diarrhea and respiratory infections among treatment groups. The supplements MMS and IS were less acceptable to children, than IFS, FCF and FW. CONCLUSION: The three supplements IS, ISF and MMS increased Hb more than the FCF; the supplements that contained micronutrients (IFS and MMS) were more effective for reducing the prevalence of anemia. In general, fortified foods were better accepted by the study participants than supplements. CLINICALTRIAL.GOV IDENTIFIER: NCT00822380.

The quantity of zinc absorbed from wheat in adult women is enhanced by biofortification.

Biofortification of crops that provide major food staples to large, poor rural populations offers an appealing strategy for diminishing public health problems attributable to micronutrient deficiencies. The objective of this first-stage human study was to determine the increase in quantity of zinc (Zn) absorbed achieved by biofortifying wheat with Zn. Secondary objectives included evaluating the magnitude of the measured increases in Zn absorption as a function of dietary Zn and phytate. The biofortified and control wheats were extracted at high (95%) and moderate (80%) levels and Zn and phytate concentrations measured. Adult women with habitual diets high in phytate consumed 300 g of 95 or 80% extracted wheat as tortillas for 2 consecutive days using either biofortified (41 mg Zn/g) or control (24 mg Zn/g) wheat. All meals for the 2-d experiment were extrinsically labeled with Zn stable isotopes and fractional absorption of Zn determined by a dual isotope tracer ratio technique. Zn intake from the biofortified wheat diet was 5.7 mg/d (72%) higher at 95% extraction (P < 0.001) and 2.7 mg/d (68%) higher at 80% extraction compared with the corresponding control wheat (P = 0.007). Zn absorption from biofortified wheat meals was (mean +/- SD) 2.1 +/- 0.7 and 2.0 +/- 0.4 mg/d for 95 and 80% extraction, respectively, both of which were 0.5 mg/d higher than for the corresponding control wheat (P < 0.05). Results were consistent with those predicted by a trivariate model of Zn absorption as a function of dietary Zn and phytate. Potentially valuable increases in Zn absorption can be achieved from biofortification of wheat with Zn.

El psicodrama: aperturas teóricas y campos de aplicación / Psicodrama: aberturas teóricas e campos de aplicação / Psychodrama: openings theoretical and application fields

En este artículo recorro algunos temas propios del Psicodrama y el Psicodrama Psicoanalítico. Hago una sucinta referencia a la historia de la representación teatral y dramática como terapéutica y a la historia del psicodrama. Explico a mí entender, cual es el valor de la escena en la clínica y en otros dispositivos Vinculares. Ilustro con tres pequeñas viñetas, forma que adquire el psicodrama en diferentes prácticas. (AU)

Neste artigo percorro alguns dos temas próprios do Psicodrama e do Psicodrama Psicanalítico. Faço uma breve referêcia à história da representação teatral e dramática do ponto de vista terapêutico e a história do psicodrama. Explico, da maneira como a compreendo, qual é o valor da encenação na clínica e em outros dispositivos vinculares. Ilustro, com três pequenas vinhetas, as formas que o psicodrama assume em diferentes práticas. (AU)

In this article I go through some Psychodrama and Psychoanalitic Psychodrama typical subjects. i briefly refer about dramatic and theatre performance as a therapy and about Psychodrama history. I explain according to me the scene value in clinic and other relationships. With 3 small vignettes I illlustrate the shape Psychodrama takes in different practices. (AU)

El psicodrama: aperturas teóricas y campos de aplicación / Psicodrama: aberturas teóricas e campos de aplicação / Psychodrama: openings theoretical and application fields

En este artículo recorro algunos temas propios del Psicodrama y el Psicodrama Psicoanalítico. Hago una sucinta referencia a la historia de la representación teatral y dramática como terapéutica y a la historia del psicodrama. Explico a mí entender, cual es el valor de la escena en la clínica y en otros dispositivos Vinculares. Ilustro con tres pequeñas viñetas, forma que adquire el psicodrama en diferentes prácticas.

Neste artigo percorro alguns dos temas próprios do Psicodrama e do Psicodrama Psicanalítico. Faço uma breve referêcia à história da representação teatral e dramática do ponto de vista terapêutico e a história do psicodrama. Explico, da maneira como a compreendo, qual é o valor da encenação na clínica e em outros dispositivos vinculares. Ilustro, com três pequenas vinhetas, as formas que o psicodrama assume em diferentes práticas.

In this article I go through some Psychodrama and Psychoanalitic Psychodrama typical subjects. i briefly refer about dramatic and theatre performance as a therapy and about Psychodrama history. I explain according to me the scene value in clinic and other relationships. With 3 small vignettes I illlustrate the shape Psychodrama takes in different practices.

Ascorbic acid from lime juice does not improve the iron status of iron-deficient women in rural Mexico.

BACKGROUND: Although ascorbic acid (AA) increases dietary iron bioavailability, there has been no food-based community trial of its efficacy in improving iron status. OBJECTIVE: The objective was to assess the efficacy of 25 mg AA as agua de limón (limeade), consumed with each of 2 daily meals, in improving the iron status of iron-deficient women. DESIGN: Two rural Mexican populations were randomly assigned to an AA or a placebo group, each with 18 iron-deficient women. The AA group was given 500 mL limeade containing 25 mg AA twice a day, 6 d/wk, for 8 mo. The placebo group was given a lime-flavored beverage free of AA or citric acid. Beverages were consumed within 30 min of 2 main daily meals. Data were collected on morbidity (3 times/wk), dietary intake (on 6 d), socioeconomic status, parasites (twice), medical history, and response to treatment. Blood samples at 0, 2, 4, 6, and 8 mo were analyzed for hemoglobin, plasma AA, plasma ferritin, transferrin receptors, and C-reactive protein. RESULTS: AA intake was significantly (P < 0.0001) higher in the AA group, but nonheme iron, heme iron, and phytic acid intakes did not differ significantly. Plasma AA was significantly (P < 0.01) higher in the AA group at 2, 4, 6, and 8 mo. There were no final differences between groups in hemoglobin, plasma ferritin, or transferrin receptor concentrations or in the ratio of transferrin receptors to plasma ferritin after control for initial concentrations. CONCLUSION: Increasing dietary AA by 25 mg at each of 2 meals/d did not improve iron status in iron-deficient women consuming diets high in phytate and nonheme iron.