Diet-induced hyperoxaluria: A case based mini-review.

INTRODUCTION: Oxalate nephropathy (ON) is a rare condition involving the precipitation of calcium oxalate crystals within the nephrons. Primary hyperoxaluria involves enzymatic defects in the metabolism of glyoxylate, while secondary hyperoxaluria includes dietary and malabsorption-related etiologies. CASE PRESENTATION: We discuss the case of a White male in his 80s who presented to the hospital with acute kidney injury on chronic kidney disease stage 4 in the setting of a new antibiotic prescription. Creatinine had increased to 4.2 mg/dL from a baseline of 2.2 mg/dL, with no etiology identified on urinalysis or renal ultrasound. Renal biopsy then revealed an acute tubular injury with intraluminal calcium oxalate crystals deposits, confirming a diagnosis of ON. DISCUSSION: A detailed history revealed an excessive dietary intake of oxalate-rich foods, including nuts, and daily ingestion of 2 g of vitamin C. The patient was counselled on adjusting his diet and stopping vitamin C supplementation, which led his creatinine to return close to baseline 2 months post-discharge. CONCLUSION: Thorough history-taking enables early recognition and timely interventions to possibly avoid hyperoxaluria from progressing to end-stage kidney disease (ESRD).

Family-Based Interventions for Pediatric Obesity: A Comprehensive Systematic Review and Meta-Analysis of Their Effectiveness.

Genetics can influence obesity, and when it affects both parents and children, there is a high risk of developing cardiometabolic diseases. Studies have indicated that family-based treatment (FBT) is a cost-effective and successful option for achieving significant weight changes in both children and parents. While specialized clinics offer FBT, primary care settings, where most pediatric care takes place, may not have the necessary resources or expertise to provide intensive behavioral interventions for childhood obesity. Based on early findings, FBT could potentially have a positive impact on siblings as well, as when treated children and parents experience behavioral changes, it can also have a beneficial effect on their untreated siblings. Parents play a crucial role in shaping their children's behavior, and siblings often have a stronger influence on them than their parents or friends. For our meta-analysis, we utilized three graphical models created using RevMan 5.4, based on the selected articles. To develop our systematic review, we thoroughly analyzed a total of 10 articles. The subgroup analysis within these studies assessed the effectiveness of FBT for overweight children, revealing no significant differences between groups (p=0.77). This suggests that based on their BMI, FBT may not have a statistically significant impact on weight loss in overweight children. However, each study reviewed showed statistical significance (p<0.05). The findings of our meta-analysis underscore the need for more robust evidence and larger randomized controlled trials (RCTs) to enhance our understanding of FBT's benefits in pediatric obesity. This will be crucial for reducing the rising prevalence of obesity and maintaining lower incidence rates.

Mucosal bleeding while on venovenous extracorporeal membrane oxygenation in the setting of vitamin C deficiency.

A major complication with extracorporeal membrane oxygenation (ECMO) is bleeding which can occur in up to 40% of cases and can be life-threatening. Minor bleeding may be overlooked and under-reported. While some of the underlying mechanisms such as platelet injury and anticoagulation therapy have been identified, several other factors are still under-researched. Here, we describe a unique case of a subtle mucosal membrane bleeding that is found to be associated with vitamin C deficiency while on treatment with ECMO. Investigating vitamin C levels may be useful in understanding causes of bleeding in some patients on ECMO therapy, particularly if there are risk factors for malnutrition.

Exploring the Impact of Personalized Nutritional Approaches on Metabolism and Immunity: A Systematic Review of Various Nutrients and Dietary Patterns.

The systematic review investigates the impact of different nutrients and dietary patterns on metabolism and immunity to answer the research question: "Can personalized nutritional approaches boost immunity?" The importance of diet in supporting the immune system has come to light in today's environment, where a strong immune system is crucial for protection against infectious illnesses, as highlighted by the COVID-19 pandemic. This systematic review adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Four databases were screened for relevant data published in 2022-2023: PubMed, PubMed Central (PMC), MEDLINE, and Cochrane Library. Inclusion and exclusion criteria were utilized, and 13 papers were finalized after screening and employing the quality appraisal tool Cochrane Bias assessment for randomized controlled trials (RCT). Personalized nutrition can strengthen immunity and enhance overall health by adjusting dietary recommendations and following a person's genetic makeup, lifestyle, and health state. An adequate supply of vitamins, minerals, proteins, and fatty acids as well as an optimum caloric intake are essential for immune health, and individual requirements can vary significantly due to genetic factors, lifestyle choices, and underlying health conditions. Personalized nutrition considers these factors, enabling tailored dietary recommendations to address specific nutrient needs and optimize nutrient intake, leading to better health outcomes. The review concludes that personalized nutrition is more effective than a one-size-fits-all approach in boosting immunity, and its potential impact on health and immune function is highly important.

Nutritional Calorie Labeling and Menu Ordering Practices Among US Adults With Chronic Illnesses.

BACKGROUND: The relationship between diet and the management of chronic illnesses is well established. However, it is unknown the extent to which people with chronic illnesses pay attention to nutritional information and act upon the information obtained. We evaluated the menu ordering practices of adults with chronic illnesses. METHODS: We analyzed the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytic cohort included 3,154 respondents (weighted population size=228,464,822) who answered questions regarding a personal history of diabetes, hypertension, heart disease, and obesity. They also answered questions about their nutritional habits regarding whether they noticed caloric information at fast-food or sit-down restaurants and how that information influenced their dietary choices. RESULTS: Among respondents with these chronic illnesses, only obese patients were significantly more likely to pay attention to caloric information (OR=1.56; 95%CI: 1.06-2.31). However, noticing the calorie information was not associated with ordering less calories among all categories of respondents with chronic illnesses. CONCLUSION: US adults with chronic illnesses do not pay sufficient attention to the calorie information of their diet. Furthermore, awareness of the calorie information did not influence their dietary choices. Healthcare professionals should incorporate dietary counseling into the management of chronic illnesses of their patients.

Anorexia Nervosa With Intermittent Fever Due to Diet-Induced Thermogenesis: A Case Report.

Diet-induced thermogenesis, influenced primarily by protein intake, generates energy from food. Herein, we present the case of anorexia nervosa in a 30-year-old woman, who developed intermittent fever while transitioning from continuous to intermittent tube feeding, with an increase in protein intake. Extensive investigations ruled out infection- or drug-related causes, indicating that intermittent fever resulted from diet-induced thermogenesis due to high protein administration. Recognizing the potential for diet-induced thermogenesis in cases of fever during tube feeding is crucial to avoid unnecessary antibiotic use and prevent the discontinuation of essential medications.

The Effects of Two Servings of a Thermogenic Supplement on Metabolism, Hemodynamic Variables, and Mood State Outcomes in Young Overweight Adults.

Introduction We examined if acute ingestion of a novel thermogenic supplement influences resting energy expenditure (REE), mood, and hemodynamic function. Methods Forty-six adults completed this randomized, placebo-controlled, double-blind, crossover study. Participants underwent two conditions: placebo (PL) and treatment (TX) containing 300 mg of caffeine and 3 g of acetyl-L-carnitine. REE, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and mood states were assessed at baseline and 30, 60, and 120 minutes post-ingestion. Data were analyzed using repeated measures analysis of variance. Results A significant condition-by-time interaction was observed for REE. At the 30-, 60-, and 120-minute post-ingestion timepoints, REE was 202 ± 26, 238 ± 40, and 209 ± 29 kcal/d greater in the TX condition compared to PL. No significant differences were observed for SBP and HR but a significant interaction indicated that DBP was elevated at 30 minutes in the TX vs. PL, though values remained within normal ranges. Significant interactions were observed for perceived alertness, concentration, energy, and focus, with increases in TX. Conclusion These data provide evidence that acute consumption of the thermogenic dietary supplement OxyShred (EHPlabs, Salt Lake City, Utah, USA) stimulates increases in REE that are sustained for ≥ two hours, along with increasing perceived alertness, concentration, energy, and focus. Changes in hemodynamic function are minimal and within normal ranges.

Multiple micronutrient deficiencies as a long-term complication of bariatric surgery.

Micronutrient deficiencies may develop as a long-term complication of bariatric surgery due to alteration of gut anatomy and disruption of normal gut absorption. Inadequate repletion of essential vitamin and mineral deficiencies can lead to multisystem dysfunction. We present a case of a woman in her 50s, with a history of Roux-en-Y gastric bypass over 10 years ago, who presented with generalised weakness and a diffuse desquamating rash. A punch biopsy performed was compatible with nutritional deficiency. Labs revealed low levels of micronutrients A, B1, B6, C, E, zinc and copper. The patient received intravenous micronutrients and an oral regimen, which improved her symptoms. Unfortunately, the patient died from cardiac arrest secondary to pulmonary oedema. This report highlights the importance of high suspicion of micronutrient deficiency in patients with a history of bariatric surgery and maintaining lifelong nutritional follow-up.

Unraveling the Interplay: Exploring the Links Between Gut Microbiota, Obesity, and Psychological Outcomes.

This narrative review delves into the complex and intricate mechanisms of the gut-brain axis. Gut microbiota has gained immense importance in the treatment of various diseases. The therapeutic potential of gut-microbial modulation is slowly coming to light. With good preclinical evidence, some human studies shed light on the translation potential of gut-microbial modulation. The concept of gut-microbial modulation has been studied for over a few decades. The relationship between gut microbiota and various homeostatic mechanisms is fascinating. Over the years, we have started understanding the immense role of gut microbiota in various homeostatic mechanisms. There are a good number of clinical studies that have shown the therapeutic potential of gut-microbial modulation in obesity and psychological diseases, especially depression and anxiety. The gut-microbial modulation can be achieved by dietary factors or supplementation. In this review, we explore the mechanisms by which prebiotics, probiotics, and synbiotics alter the gut-brain axis. The review limits its discussion to the most recent clinical studies that have shown promise as therapeutic strategies.

Relationship of Vitamin B12 Levels With Different Degrees of Obesity and Diabetes Mellitus.

INTRODUCTION: The potential influence of micronutrient status on obesity should be considered. Nevertheless, previous research examining the relationship between serum vitamin B12 levels and obesity has yielded inconclusive results. The objective of this study was to investigate the associations between serum vitamin B12 levels and obesity and diabetes mellitus (DM) in a population consisting of persons aged 18 years and older. METHODS: A retrospective case-control research was undertaken on a sample of 1024 individuals aged 18 years and older who were admitted to a tertiary healthcare facility (Recep Tayyip Erdogan University Education and Research Hospital, Rize) for either overweight-related issues or routine check-ups. The primary objective of this study was to assess the B12 levels of these individuals. The researcher recorded the body mass index (BMI) and history of DM for all subjects. RESULTS: The study comprised a total of 1024 participants, consisting of 834 females and 190 males. The levels of vitamin B12 in women were found to be 308±113 pg/mL, while in men, the levels were 304±125 pg/mL. The results of the statistical analysis indicate that there is no statistically significant disparity in vitamin B12 levels between males and females (p=0.748). There was a statistically significant positive correlation seen between age and B12 levels; however, the magnitude of this connection was found to be minor (p=0.000, R2=0.017). The study findings revealed that out of the 1,024 individuals evaluated, 179 individuals exhibited B12 levels below 200, while 845 individuals displayed vitamin B12 levels above 200. The study findings indicated that there was no statistically significant distinction observed in the occurrence of obesity and DM in relation to vitamin B12 deficiency (p = 0.938, p = 0.08, respectively). CONCLUSION: The results of this study offer empirical support for the notion that there is no significant difference in vitamin B12 levels between individuals afflicted with obesity and diabetes and those unaffected by these conditions. Interestingly, it was shown that serum B12 levels exhibited a modest increase with advancing age.

Relationship Between Body Mass Index and Body Fat Percentage in a Group of Indian Participants: A Cross-Sectional Study From a Tertiary Care Hospital.

Background Body mass index (BMI) is an important indicator of overweight and obesity. Unlike BMI, body fat percentage (BF%) can be utilized to estimate body composition regardless of weight and height. The association between BMI and BF%, as well as the impact of age and gender, may help estimate the prevalence of obesity more clearly. This study aimed to assess the relationship between BMI and BF%, examine the effect of age and gender on this relationship, and establish the linearity/curvilinearity of this relationship. Methodology The body composition analysis of 1,150 participants in various institutional events (institution foundation day) during 2019 and 2023 was performed using the Accuniq bio-electrical impedance analyzer (BIA) (Accuniq, Netherlands). The participants included undergraduate, postgraduate medical, and PhD students, as well as employees of All India Institute of Medical Sciences, New Delhi. Age groups were categorized as under 17 years, young adults (18-25 years), adults (26-44 years), middle-aged adults (45-59 years), and older adults (≥60 years). Pearson's correlation coefficient (r) was used for analyzing the relationship between BMI and BF%. To assess the effect of age and gender on this relationship, multiple regression analysis was applied, and polynomial regression was applied to test its linearity. The data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Males made up a larger proportion of the participants (56.3%; 647). The mean age of the participants was 36.5 ± 13.6 years. The mean BMI and BF% were 24.7 ± 4.0 kg/m2 and 29.1 ± 8.7%, respectively. A significant and moderate positive correlation (r = 0.630, p < 0.01) was observed between BMI and BF%. The mean ± SD of BMI and BF% had a directly proportional relationship with age. Among both genders, females showed a greater correlation (r = 0.852). Both age and gender had a significant effect on this relationship, with gender impacting more than age (ß = 0.488, p < 0.000). The curvilinear nature of the relationship between BMI and BF% was demonstrated with the female model showing a more precise fit (R2 = 0.72, standard error of the estimate = 3.3%). Conclusions The relationship between BMI and BF% was significant and positive in this group of Indians. This relationship was significantly impacted by age and gender and was curvilinear in nature. Females had a higher association than males between BMI and BF%. The study suggests that BMI, BF%, and the effects of age and gender should be taken into consideration when predicting obesity.

Nutrition Literacy: What Are Young Adults With Type-1 Diabetes Missing?

INTRODUCTION: This study evaluated the nutrition literacy and perceived emotional burden of disease in young adults with type-1 diabetes. All participants are current or past members of the non-profit organization The Diabetes Link, formally known as the College Diabetes Network. The Diabetes Link is a 501(c)(3) nonprofit organization working to connect and support young adults with type-1 diabetes through the transitional periods of their lives, most commonly the transition from high school to college. Previous research shows that there is a significant uptick in glycated hemoglobin (HbA1c) levels in people with type-1 diabetes between the ages of 18 and 24, a period associated with many transitional events. While there are numerous hypothesized reasons why HbA1c levels spike during these ages, the lack of nutritional knowledge is frequently highlighted as a root cause of this increase. METHODS: Participants were asked to complete a 40-question survey via Google Forms (Google LLC, Mountain View, California, United States) that contained questions pertaining to their treatment, dietary habits, confidence in healthcare professionals to provide nutrition advice, and overall feelings toward their diagnosis of type-1 diabetes. The survey also included four questions aimed at evaluating the participants' carbohydrate-counting skills to determine a basis of their nutritional knowledge. A binary logistic regression was performed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States) to assess the influences of the burden and carbohydrate-counting knowledge on the participants' diabetes care, eating habits, and emotional outlook on nutrition. RESULTS: Data from this study show that the participants who scored high on the carbohydrate-counting quiz were 2.389 times more likely to avoid eating because of an out-of-range blood sugar level (p-value = 0.05), and the participants who reported higher levels of burden were 9.325 times more likely to avoid social gatherings because of food (p-value = 0.002).  Conclusion: Results from this study demonstrate that the emotional burden associated with eating and not nutrition knowledge could contribute to the previously listed spike in HbA1c levels.

Clinical characteristics, prognosis, and surgical outcomes of patients with non-HBV and non-HCV related hepatocellular carcinoma: three-decade observational study.

BACKGROUND: The incidence of non-hepatitis B virus, non-hepatitis C virus hepatocellular carcinoma (non-B non-C-HCC) is increasing worldwide. We assessed the clinical characteristics and surgical outcomes of non-B non-C-HCC, versus hepatitis B (HBV-HCC) and hepatitis C (HCV-HCC). METHODS: Etiologies, fibrosis stages, and survival outcomes were analyzed of 789 consecutive patients who underwent surgery from 1990 to 2020 (HBV-HCC, n = 149; HCV-HCC, n = 424; non-B non-C-HCC, n = 216). RESULTS: The incidence of hypertension and diabetes mellitus was significantly higher in patients with NON-B NON-C-HCC than in those with HBV-HCC and HCV-HCC. Significantly more advanced tumor stages were observed in patients with non-B non-C-HCC; however, better liver function and lower fibrosis stages were observed. Patients with non-B non-C-HCC had significantly worse 5-year overall survival than patients with HBV-HCC; overall survival was comparable between patients with non-B non-C-HCC and HCV-HCC. Patients with HCV-HCC had significantly worse 5-year recurrence-free survival than patients with HBV-HCC and non-B non-C-HCC. In patients with non-B non-C-HCC, overall survival was comparable among three periods (1990-2000, 2001-2010, and 2011-2020) despite significant improvement in patients with HBV-HCC and HCV-HCC. CONCLUSION: The prognosis of non-B non-C-HCC was similar to that of HBV-HCC and HCV-HCC regardless of tumor progression at surgery. Patients with hypertension, diabetes mellitus, and dyslipidemia require careful systematic follow-up and treatment.

Correlation of Serum Asprosin Levels With Normalized Protein Catabolic Rate in Patients Receiving Peritoneal Dialysis Treatment.

Background Peritoneal dialysis patients are malnourished due to loss of protein in the dialysate and inadequate dialysis, although they take additional calories every day during treatment. Many parameters are used to assess nutritional status, with normalized protein catabolic rate (nPCR) being one of the most common. Asprosin, a novel adipokine secreted by adipose tissue, peaks during fasting and induces hepatic glucose release through the activation of the G-protein-cAMP-PKA pathway, which has been indicated to have a curative effect on chronic inflammation. In this study, we aimed to investigate the relationship between asprosin levels and nutritional parameters in patients receiving peritoneal dialysis treatment as well as to investigate the applicability of more practical tests. Methodology A total of 70 peritoneal dialysis patients, 35 female (59%) and 24 male (41%), were included in the study. The mean age of the patients was 53 ± 14 years (range = 18-80 years), and the median peritoneal dialysis duration was 31.5 months (range = 20-56.2 months). The most common etiologic cause was hypertension (37%). Patients over 18 years of age who had been receiving peritoneal dialysis treatment for at least 24 months were included in the study. The correlation between patients' nPCR levels and serum asprosin, body mass index, and lipids was evaluated. Results The correlation between the level of nPCR and the serum asprosin level, body mass index, and lipids was evaluated. Patients with nPCR <0.815 were considered malnourished, and factors affecting malnutrition were determined by univariate analysis. Among the factors affecting malnutrition according to univariate analysis, those with p-value <0.05 were analyzed by multivariate analysis. Low asprosin level was one of the independent factors affecting malnutrition in patients (Exp(B) = 0.944, 95% confidence interval (CI) = 0.896-0.994). Other independent factors affecting malnutrition were Kt/V (Exp(B) = 0.018, 95% CI = 0.001-0.550) and residual renal function (Exp(B) = -0.004, 95% CI = 0.993-0.999). Conclusions There is a need for more accessible tests and reliable parameters to evaluate dialysis and nutritional deficiency in peritoneal dialysis patients. One possible hormone that could serve as a guide is asprosin.

Weight Loss Effects of Glucagon-Like Peptide-One Receptor Analog Treatment in a Severely Obese Patient During Hospital Admission.

Obesity is considered an independent risk factor for increased hospital length of stay and can be an obstacle to a safe discharge. Although typically prescribed in the outpatient setting, initiating glucagon-like peptide-one receptor agonists (GLP-1RAs) in the inpatient setting can be efficacious in reducing weight and increasing functional status. We report the use of GLP-1RA therapy with liraglutide and subsequent transition to subcutaneous semaglutide weekly in a 37-year-old female with severe obesity, weighing 694 lbs (314 kg) with a body mass index (BMI) of 108 kg/m2. Multiple medical and socioeconomic factors impaired the patient from being safely discharged and ultimately led to prolonged hospitalization. The patient received 31 consecutive weeks of GLP-1RA therapy in the inpatient setting along with a very low-calorie diet (800 kcal/day). Initiation and up-titration doses were completed using liraglutide for a total of five weeks. Subsequently, the patient was transitioned to receive weekly semaglutide and completed 26 weeks of therapy. At the end of week 31, the patient's weight decreased by 174 lbs (79 kg), or 25% of baseline weight, and BMI decreased from 108 to 81 kg/m2. GLP-1RAs offer a promising avenue for weight loss interventions in patients with severe obesity in addition to lifestyle modifications. The weight loss observed in our patient at the halfway point of the total treatment duration is a milestone in the pathway to gaining functional independence and meeting the criteria for future bariatric surgery. Semaglutide, a GLP-1RA, can be an effective intervention for severely obese patients with BMI greater than 100 kg/m2.

Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions.

Cirrhosis predisposes to abnormalities in energy, hormonal, and immunological homeostasis. Disturbances in these metabolic processes create susceptibility to sarcopenia or pathological muscle wasting. Sarcopenia is prevalent in cirrhosis and its presence portends significant adverse outcomes including the length of hospital stay, infectious complications, and mortality. This highlights the importance of identification of at-risk individuals with early nutritional, therapeutic and physical therapy intervention. This manuscript summarizes literature relevant to sarcopenia in cirrhosis, describes current knowledge, and elucidates possible future directions.

Hyperkalemic periodic paralysis with paramyotonia and the anaesthetic implications.

Hyperkalemic periodic paralysis (HyperKPP) is a rare disease with significant anaesthetic implications. We compare two perioperative courses in the same patient. The first surgery resulted in paralysis and a protracted hospitalisation, while the second surgery resulted in a same-day discharge. Various anaesthetic techniques may be used; however, clear communication surrounding optimisation both for home medications (eg, continuing potassium wasting diuretics) and avoidance of triggering medications (primarily: depolarising neuromuscular blockers), along with thermoregulation and glucose management plans, is critical and best performed early by an anaesthetic precare clinic. Our cases highlight the physiological underpinnings in managing patients with HyperKPP.

Hypertriglyceridaemia in pregnancy: an unexpected diagnosis and its management.

A woman in her 30s with gestational diabetes presented at 36 weeks' gestation with reduced fetal movements and diminishing insulin requirements. In view of her gestation, she was induced and incidentally found to have profound hyponatraemia. Further biochemical investigations confirmed severe hypertriglyceridaemia and hypercholesterolaemia. This raises the possibility of secondary causes such as familial dysbetalipoproteinemia and polygenetic hypertriglyceridaemia. She was successfully managed by aggressive dietary modification. This involved a supervised fast followed by a fat-free diet. A fenofibrate was proposed but declined due to our patient's wish to breastfeed. Management required considerable input from the multidisciplinary team. Treatment options to consider are aggressive dietary restriction of fat or the addition of a cholesterol-lowering medication, such as a fibrate. In refractory cases, a supervised fast may be required or, in cases where complications have arisen, apheresis. The patient and her baby made a good recovery with no long-lasting health implications.