Sleep disorders related to nutrition and digestive diseases: a neglected clinical condition.

Sleep disturbances often result from inappropriate lifestyles, incorrect dietary habits, and/or digestive diseases. This clinical condition, however, has not been sufficiently explored in this area. Several studies have linked the circadian timing system to the physiology of metabolism control mechanisms, energy balance regulation, and nutrition. Sleep disturbances supposedly trigger digestive disorders or conversely represent specific clinical manifestation of gastrointestinal (GI) diseases. Poor sleep may worsen the symptoms of GI disorders, affecting the quality of life. Conversely, short sleep may influence dietary choices, as well as meal timing, and the circadian system drives temporal changes in metabolic patterns. Emerging evidence suggests that patients with inappropriate dietary habits and chronic digestive disorders often sleep less and show lower sleep efficiency, compared with healthy individuals. Sleep disturbances may thus represent a primary symptom of digestive diseases. Further controlled trials are needed to fully understand the relationship between sleep disturbances, dietary habits, and GI disorders. It may be also anticipated that the evaluation of sleep quality may prove useful to drive positive interventions and improve the quality of life in a proportion of patients. This review summarizes data linking sleep disorders with diet and a series of disease including gastro-esophageal reflux disease, peptic disease, functional gastrointestinal disorders, inflammatory bowel diseases, gut microbiota alterations, liver and pancreatic diseases, and obesity. The evidence supporting the complex interplay between sleep dysfunction, nutrition, and digestive diseases is discussed.

Nutritional management in renal transplant recipients: A transplant team opportunity to improve graft survival.

AIMS: The nutritional management of renal transplant recipients (RTR) represents a complex problem either because the recovery of renal function is not complete and for the appearance of "unavoidable" metabolic side effects of immunosuppressive drugs. Nevertheless, it remains a neglected problem, whereas an appropriate dietary intervention could favorably affect graft survival. DATA SYNTHESIS: Renal transplantation is associated with steroids and calcineurin inhibitors administration, liberalization of diet after dialysis restrictions, and patients' better quality of life. These factors predispose, from the first months after surgery, to body weight gain, enhanced post transplant diabetes, hyperlipidemia, metabolic syndrome, with negative consequences on graft outcome. Unfortunately, specific guidelines about this topic and nutritional counseling are scarce; moreover, beyond the low adherence of patients to any dietary plan, there is a dangerous underestimation of the problem by physicians, sometimes with inadequate interventions. A prompt and specific nutritional management of RTR can help prevent or minimize these metabolic alterations, mostly when associated with careful and repeated counseling. CONCLUSIONS: A correct nutritional management, possibly tailored to enhance patients' motivation and adherence, represents the best preventive maneuver to increase patients' life and probably improve graft survival, at no cost and with no side effects.

Emerging concepts on the role of epigenetics in the relationships between nutrition and health.

Understanding the physiological and metabolic underpinnings that confer individual differences in responses to diet and diet-related chronic disease is essential to advance the field of nutrition. This includes elucidating the differences in gene expression that are mediated through programming of the genome through epigenetic chromatin modifications. Epigenetic landscapes are influenced by age, genetics, toxins and other environmental factors, including dietary exposures and nutritional status. Epigenetic modifications influence transcription and genome stability are established during development with life-long consequences. They can be inherited from one generation to the next. The covalent modifications of chromatin, which include methylation and acetylation, on DNA nucleotide bases, histone proteins and RNA are derived from intermediates of one-carbon metabolism and central metabolism. They influence key physiological processes throughout life, and together with inherited DNA primary sequence, contribute to responsiveness to environmental stresses, diet and risk for age-related chronic disease. Revealing diet-epigenetic relationships has the potential to transform nutrition science by increasing our fundamental understanding of: (i) the role of nutrients in biological systems, (ii) the resilience of living organisms in responding to environmental perturbations, and (iii) the development of dietary patterns that programme physiology for life-long health. Epigenetics may also enable the classification of individuals with chronic disease for specific dietary management and/or for efficacious diet-pharmaceutical combination therapies. These new emerging concepts at the interface of nutrition and epigenetics were discussed, and future research needs identified by leading experts at the 26th Marabou Symposium entitled 'Nutrition, Epigenetics, Genetics: Impact on Health and Disease'. For a compilation of the general discussion at the marabou symposium, click here http://www.marabousymposium.org/.

Growth patterns of Palestinian children from birth to 24 months.

BACKGROUND: Growth faltering in early life can adversely affect health in later childhood and adulthood. Growth monitoring of children can provide evidence to help formulate effective strategies to address growth problems but such information on Palestinian children is lacking. OBJECTIVES: This study aimed to determine the growth patterns of children under 2 years in Gaza, Palestine. METHODS: This retrospective cohort study was conducted in 2014 in 10 randomly selected primary health care clinics in 5 governorates of Gaza. Weight and length data were obtained from the health cards of children born in 2012, and z-scores were calculated and compared with the WHO Growth Standard (2006). RESULTS: A total of 2 632 children's cards were included at the beginning of the study. Weight-for-age and weight-forlength decreased from birth to 6 months to about -0.40 SD but increased afterwards to -0.11 SD and 0.34 SD at 24 months respectively. Length-for-age declined after 6 months, reaching -0.85 SD at 24 months. At 6 months, the prevalence of underweight and stunting were 5% and 9% but at 24 months, the prevalence was 4% and 20% respectively. Wasting was highest at 6 months (10%) but decreased to 3% at 24 months. Significantly more girls were stunted at 9, 12 and 18 months (P < 0.001), underweight at 24 months (P < 0.05) and wasted at 12 months (P < 0.05). Early life faltering in length was more pronounced than weight, with stunting occurring in one fifth of boys and girls by 2 years of age. CONCLUSIONS: Preventive strategies are urgently needed to address early life causes of undernutrition, particularly stunting, in Palestinian children in Gaza.

Nutrition Support Therapy.

In most addictions, serious nutritional deficiencies of major proteins, fats, vitamins and minerals exist which prevent their capability to digest carbohydrates efficiently. This review aims to point out some treatment approaches in nutrition management for alcohol addiction, drug addiction, food addiction, Internet addiction and sex addiction, according to existing literatures.

Nutritional Deficiencies and Sarcopenia in Heart Failure: A Therapeutic Opportunity to Reduce Hospitalization and Death.

There is an expanding prevalence pool of heart failure (HF) due to the increasing prevalence of survivors of myocardial infarction, diabetes, hypertension, chronic kidney disease, and obesity. There is increasing interest in the role of nutrition in all forms of HF, given observations concerning micro- and macronutrient deficiencies, loss of lean body mass or sarcopenia, and their relationships with hospitalization and death. This review examines the relationships among loss of lean body mass, macro- and micronutrient intake, and the natural history of HF, particularly in the elderly, in whom the risks for all-cause rehospitalization, infection, falls, and mortality are increased. These risks are potentially modifiable through strategies that improve nutrition in this vulnerable population.

Influence hypervitaminosis D3 on hemodynamic presentation of experimental copper intoxication.

As a component of various enzymes, it refers to copper essential trace elements, but the excessive consumption of the metal leads to the development of the pathogenic effects of xenobiotics on the functional condition of the cardiovascular system. However, the works devoted to the study of the effectiveness of prophylactic calcium in a copper toxicity, is not in the current literature. The purpose: study the effect of long-term toxicity of copper on the functional state of the cardiovascular system and its reactivity in experimental hypercalcemia. Methods: Experimental hypercalcemia model was created by forming a pilot hypervitaminosis D, by introducing «Akvadetrim¼ atraumatic preparation through a probe into the stomach in the dose 3000 IU (0.2 ml) / 100 g of body weight for 30 days. Chronic copper poisoning model created by intragastric administration of copper sulfate solution at a dosage of 20 mg/kg (in terms of metal) for 30 days, daily one time a day. The study of the functional state of the cardiovascular system is to determine the mean arterial pressure, specific peripheral vascular resistance, stroke index, cardiac index, the reactivity of the renin-angiotensin system and adrenoreactivity cardiovascular system. Results: The experimental study revealed that long-term copper poisoning leads to the development of hypertension due to an increase in total peripheral vascular resistance, along with the marked decline in the pumping function of the heart. Experimental hypercalcemia simulated by intragastric administration of vitamin D promotes more pronounced toxic effects of copper sulfate on the cardiovascular system. Conclusion: Copper poisoning of the body is characterized by the development of hypertension and the condition of artificial hypercalcemia potentiates the cardiotoxic effects of copper.

Hypervitaminosis D and Metastatic Calcification in a Colony of Inbred Strain 13 Guinea Pigs, Cavia porcellus.

A commercial diet fed to a colony of inbred strain 13 guinea pigs for approximately 6 weeks was subsequently recalled for excessive levels of vitamin D. Twenty-one of 62 animals exhibited clinical signs, including anorexia, lethargy, and poor body condition. Nine affected and 4 clinically normal animals were euthanized for further evaluation, including serum chemistry, urinalysis, and gross and/or histopathology. Macroscopic findings included white discoloration in multiple organs in 8 animals, and microscopic evaluation confirmed multiorgan mineralization in tissues from 7 animals. Serum 25-hydroxyvitamin D levels were elevated in 10 animals. Serum inorganic phosphorus and alkaline phosphatase levels were increased in all exposed animals; however, total calcium and ionized calcium levels were not significantly higher in exposed animals than in control strain 13 guinea pigs from a different institution. The data support a diagnosis of hypervitaminosis D with metastatic calcification. Following the diet recall, the remaining guinea pigs increased their food intake and regained body condition. Diagnostic testing of 8 animals euthanized approximately 3 months after returning to a normal diet demonstrated that serum parathyroid hormone remained significantly lower, and ionized calcium and ionized magnesium were significantly higher, in recovered animals compared to controls and exposed animals. These results indicate that diagnostic tests other than serum calcium are necessary for a diagnosis of hypervitaminosis D in guinea pigs.

Nutritional status in chronic obstructive pulmonary disease and systemic sclerosis: two systemic diseases involving the respiratory system.

This study aimed to assess and compare the nutritional status and life quality of patients with chronic obstructive pulmonary disease (COPD) and systemic sclerosis (SSc). Thirty patients with stable COPD and 32 patients with SSc were examined. In all patients, the following parameters were measured: fat mass, fat-free mass, total body water, FEV1, and blood gases. COPD patients' life quality was assessed with St. George's Respiratory Questionnaire, and in SSc patients with a Quality of Life Questionnaire. The results show that among COPD patients 13% had normal body weight, 60% were obese, and 27% were overweight. In SSc patients, 59% had normal body weight, 31% were overweight, 1 patient was obese, and 2 were underweight. The mean life quality score in COPD patients was 57.3±16.5, while that in SSc patients was 35.8±18.2. COPD patients had a statistically significant lower life quality than SSc patients. The mean value of FEV1 was 45.5±12.2% pred. in COPD patients, and 86.8±21.2% pred. in the SSc group. We conclude that nutritional disorders are more frequent in COPD patients compared to those with SSc.

Insulin-like growth factor-I (IGF-I) and clinical nutrition.

IGF-I (insulin-like growth factor-I) is a peptide hormone, produced predominantly by the liver in response to pituitary GH (growth hormone), which is involved in a wide variety of physiological processes. It acts in an endocrine, paracrine and autocrine manner to promote growth. The production of IGF-I signals the availability of nutrients needed for its anabolic actions. Recently, there has been growing interest in its role in health and disease. IGF-I has long been known to be regulated by nutrition and dysregulated in states of under- and over-nutrition, its serum concentrations falling in malnutrition and responding promptly to refeeding. This has led to interest in its utility as a nutritional biomarker. A considerable evidence base supports utility for measurement of IGF-I in nutritional contexts. Its concentration may be valuable in providing information on nutritional status, prognosis and in monitoring nutritional support. However, it is insufficiently specific for use as a screening test for under nutrition as its serum concentration is influenced by many factors other than nutritional status, notably the APR (acute-phase response) and endocrine conditions. Concentrations should be interpreted along with clinical findings and the results of other investigations such as CRP (C-reactive protein). More recently, there has been interest in free IGF-I which holds promise as a nutritional marker. The present review covers nutritional regulation of IGF-I and its dysregulation in disease, then goes on to review recent studies supporting its utility as a nutritional marker in clinical contexts. Although not currently recommended by clinical guidelines, it is likely that, in time, measurement of IGF-I will become a routine part of nutritional assessment in a number of these contexts.

Effects of perinatal undernutrition on the development of neurons in the rat insular cortex.

The insular cortex (IC) of the rat is a major area for the convergence and integration of olfactory, gustatory, and visual information, and at present it is unclear if perinatal undernutrition interferes with the structure and function of the IC neurons. Golgi-Cox-stained cells of the IC were studied in control and undernourished Wistar rats at 12, 20, and 30 days of age. Pregnant dams were undernourished by the reduction of a balanced diet during a part of the gestational period (G6-G18). After parturition (P1-P23) pups remained for 12 hours with a normal and 12 hours with a nipple-ligated dam. Undernutrition significantly reduced the number, and the arborization of the dendritic arbors, and the perimeter, and cross-sectional area of perikarya. The IC neuronal morphology appearances suggest a possible mechanism for the impairment in information processing of complex phenomena such as taste sensation and hedonic response.

The discovery and characterization of riboflavin.

The first observation of a pigment in milk with yellow-green fluorescence can be traced to the English chemist Alexander Wynter Blyth in 1872, but it was not until the early 1930s that the substance was characterized as riboflavin. Interest in accessory food factors began in the latter half of the 19th century with the discovery of the first vitamin, thiamin. Thiamin was water soluble and given the name vitamin B(1). However, researchers realized that there were one or more additional water-soluble factors and these were called the vitamin B-2 complex. The search to identify these accessory food factors in milk, whole wheat, yeast, and liver began in the early 1900s. As there is no classical nutritional disease attributable to riboflavin deficiency, it was the growth-stimulating properties of the food extracts given to young rats that provided the tool with which to investigate and eventually extract riboflavin. Riboflavin was the second vitamin to be isolated and the first from the vitamin B-2 complex; the essential nature of the vitamin as a food constituent for man was shown in 1939.

Family and infant characteristics in relation to age at walking in Turkey.

The purpose of this study was to assess the onset of independent ambulation relative to possible relationships with maternal and infant characteristics. In a cross-sectional study, the health files of 1,553 Turkish children aged 12-23 months were selected by the multistage sampling method in the Nomenclature of Territorial Units for Statistics (NUTS) regions coded as low, medium and high malnutrition levels in Turkey. Children were selected from health centers by systematic sampling technique in each region. Kaplan-Meier analysis and estimated mean values were used for data description; log-rank test and the Cox multivariable regression analysis were applied for data analysis. Maternal education level, occupation, region of residence, gestational iron supplementation, child's gender, child's nutritional status, and presence of anemia in the infant during the survey period demonstrated significant relationships with walking unassisted in the univariate analysis. However, multivariable analysis showed that high maternal education, absence of parental consanguinity and appropriate weight-for-age Z score were positively associated with earlier age of walking. These findings showed the importance of improvement in girls' education, prevention of postnatal growth retardation and improvement in diet quality for children's gross motor development. In addition, counseling programs should be given to decrease the rate of parental consanguinity.

Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study.

INTRODUCTION: Symptom experiences and their interference with life are not well-researched in head and neck cancer patients. The aim of the study was to explore and understand the experience of receiving treatment for head and neck cancer with particular focus on symptom experiences over a one year period from diagnosis. METHODS: A qualitative study design was used with a heterogeneous sample of 16 patients with head and neck cancer. Interviews, conducted at four time points over 12 months, provided a total of 50 interview datasets. RESULTS: Key themes derived include nutritional concerns, tiredness, and experiences related to the radiotherapy mask and regaining normality. These data highlight issues of importance in the first year of living with head and neck cancer: impact of nutritional changes on the lives of patients, including weight loss, dysphagia, xerostomia and taste changes; debilitation from ongoing fatigue; unpreparedness for and distress from the radiotherapy mask; and attempts to maintain a normal life amidst the interference of symptoms. CONCLUSION: Multitude of symptoms impact the patients' life, particularly nutritional symptoms and fatigue, and interfere with the patients' survivorship and quality of life. The changing nature of symptoms over the first year from diagnosis in head and neck cancer patients and the identified issues in the attempt to normalize their lives need to be incorporated more fully into the supportive care of head and neck cancer patients in order to improve their experience and enhance their survivorship.

Hippocampal plasticity in rats submitted to a gastric restrictive procedure.

Bariatric surgery has been the most effective therapeutic intervention for morbidly obese patients. However, recent evidence has shown that this procedure may cause serious neurological complications such as Wernicke encephalopathy, depression, and memory impairment. With this in mind, we conducted an experimental study to investigate whether weight-reduction surgery would promote morphological changes in the hippocampal formation, a brain region linked to cognitive and emotional processes. To do so, the present study evaluated the hippocampal expression of parvalbumin interneurons in rats submitted to a gastric restrictive procedure (experimental phytobezoar). Our results demonstrated that rats with gastric-reduced capacity presented a significant increase in the expression of the parvalbumin interneurons in the hippocampal CA1 and CA3 subfields. These data are the first experimental evidence that restrictive bariatric surgery may alter hippocampal cytoarchitecture.

[The hygienic features of nutrition and elemental status in the children of the Orenburg region].

The paper analyzes the trace element status in the children residing in Orenburg and the Sakmarsky District, Orenburg Region. The study was conducted among 2nd-3rd-form pupils. Their hair samples were used as a biosubstrate to ascertain the trace element status; chemical elements were determined in accordance with guidelines 4.1.1482-03 and 4.1.1483-03 approved by the Ministry of Health of the Russian Federation in 2003. The studies ascertained the children's trace element profiles that are indicative of the high prevalence of imbalance in the hair content of elements among the rural children in the presence of inadequate nutrition in both rural and urban schoolchildren.

Patients with PWS and related syndromes display differentially methylated regions involved in neurodevelopmental and nutritional trajectory.

BACKGROUND: Prader-Willi syndrome is a rare genetic neurodevelopmental disorder caused by a paternal deficiency of maternally imprinted gene expression located in the chromosome 15q11-q13 region. Previous studies have demonstrated that several classes of neurodevelopmental disorders can be attributed to either over- or under-expression of specific genes that may lead to impairments in neuronal generation, differentiation, maturation and growth. Epigenetic changes that modify gene expression have been highlighted in these disorders. One recent study focused on epigenetic analysis and compared patients with PWS with patients with other imprinting disorders. No study, however, has yet focused on epigenetics in patients with PWS specifically by comparing the mutations associated with this syndrome. OBJECTIVE: This study investigated the epigenetic modifications in patients with PWS and patients with PWS-related disorders caused by inactivation of two genes of the PWS chromosomal region, SNORD116 and MAGEL2. Our approach also aimed to compare the epigenetic modifications in PWS and PWS-related disorders. METHODS: We compared genome-wide methylation analysis (GWAS) in seven blood samples from patients with PWS phenotype (five with deletions of the PWS locus, one with a microdeletion of SNORD116 and one with a frameshift mutation of MAGEL2 presenting with Schaaf-Yang syndrome), as well as two control patients. Controls were infants that had been studied for suspicion of genetic diseases that was not confirmed by the genetic analysis and the clinical follow-up. RESULTS: The analysis identified 29,234 differentially methylated cytosines, corresponding to 5,308 differentially methylated regions (DMRs), which matched with 2,280 genes. The DMRs in patients with PWS were associated with neurodevelopmental pathways, endocrine dysfunction and social and addictive processes consistent with the key features of the PWS phenotype. In addition, the separate analysis for the SNORD116 and MAGEL2 deletions revealed that the DMRs associated with the SNORD116 microdeletion were found in genes implicated in metabolic pathways and nervous system development, whereas MAGEL2 mutations mostly concerned genes involved in macromolecule biosynthesis. CONCLUSION: The PWS is associated with epigenetic modifications with differences in SNORD116 and MAGEL2 mutations, which seem to be relevant to the different associated phenotypes.

Chronic Nutrition Impact Symptoms Are Associated with Decreased Functional Status, Quality of Life, and Diet Quality in a Pilot Study of Long-Term Post-Radiation Head and Neck Cancer Survivors.

BACKGROUND: As a result of tumor location and treatment that is aggressive, head and neck cancer (HNC) survivors experience an array of symptoms impacting the ability and desire to eat termed nutrition impact symptoms (NISs). Despite increasing cancer survival time, the majority of research studies examining the impact of NISs have been based on clinical samples of HNC patients during the acute phase of treatment. NISs are often chronic and persist beyond the completion of treatment or may develop as late side effects. Therefore, our research team examined chronic NIS complications on HNC survivors' functional status, quality of life, and diet quality. METHODS: This was a cross-sectional study of 42 HNC survivors who were at least 6 months post-radiation. Self-reported data on demographics, NISs, quality of life, and usual diet over the past year were obtained. Objective measures of functional status included the short physical performance battery and InBody© 270 body composition testing. NISs were coded so a lower score indicated lower symptom burden, (range 4-17) and dichotomized as ≤10 vs. >10, the median in the dataset. Wilcoxon rank sum tests were performed between the dichotomized NIS summary score and continuous quality of life and functional status outcomes. Diet quality for HNC survivors was calculated using the Healthy Eating Index 2015 (HEI-2015). Wilcoxon rank sum tests examined the difference between the HNC HEI-2015 as compared to the National Health and Nutrition Examination Survey (NHANES) data calculated using the population ratio method. RESULTS: A lower NIS score was statistically associated with higher posttreatment lean muscle mass (p = 0.002). A lower NIS score was associated with higher functional (p = 0.0006), physical (p = 0.0007), emotional (p = 0.007), and total (p < 0.0001) quality of life. Compared to NHANES controls, HNC survivors reported a significantly lower HEI-2015 diet quality score (p = 0.0001). CONCLUSIONS: Lower NIS burden was associated with higher lean muscle mass and functional, physical, emotional, and total quality of life in post-radiation HNC survivors. HNC survivors reported a significantly lower total HEI-2015 as compared to healthy NHANES controls, providing support for the hypothesis that chronic NIS burden impacts the desire and ability to eat. The effects of this pilot study were strong enough to be detected by straight forward statistical approaches and warrant a larger longitudinal study. For survivors most impacted by NIS burden, multidisciplinary post-radiation exercise and nutrition-based interventions to manage NISs and improve functional status, quality of life, and diet quality in this survivor population are needed.

Should we continue to use the Cockcroft-Gault formula?

BACKGROUND/AIMS: Although the National Kidney Disease Education Program recommends use of the modification of diet in renal disease (MDRD) formula to estimate the glomerular filtration rate (GFR), most drug-dosing recommendations and clinical practices employ the Cockcroft-Gault (CG) formula. The quality score of the original MDRD study was better than that of the original CG study, although the imprecision sources were very similar between the formulas. To address whether CG should be abandoned in favour of MDRD in chronic kidney disease (CKD) management, we performed a literature review on the topic. METHODS: We reviewed 27 articles comparing CG and MDRD in terms of bias, precision, accuracy, and the risk of misclassifying by two CKD stages. RESULTS: In the chronic renal disease population, MDRD was more precise, safer and more accurate than CG at predicting the GFR, with two exceptions: CG was clearly superior in CKD patients with a normal serum creatinine (SCr) and results were discordant in patients with advanced renal failure. In diabetic populations with normal and near-normal GFR, the decline in renal function in diabetics was better screened by CG. In diabetics with renal impairment, MDRD is more accurate than CG. In healthy patients, in subjects with normal SCr and in elderly patients, MDRD was not superior. Based on the risk of misclassifying by ≥2 CKD stages, neither formula could be safely applied in diabetic, low body mass index, advanced liver disease, chronic heart failure, or hospitalized patients. CONCLUSIONS: CG still has an interest in screening the decline in renal function in subjects with normal SCr who are at risk, such as diabetics and stage 1 and 2 CKD patients, as well as healthy subjects enrolled in clinical trials and pharmacokinetic studies. Thus, it may be early to replace CG by MDRD in drug studies. CG still is the better formula in the elderly. Both formulas are not safe in some populations.

A nutritional strategy for reducing disease and obesity risks.

Overweight and obesity are the most common nutritional disorders in our age and are becoming more and more common worldwide. The most harmful consequences of an incorrect diet leading to overweight or obesity are a series of cardio-vascular diseases often leading to disability and death. In recent years various studies have shown that a reduction in caloric intake is the main factor involved in reduction of pathology risk. In this article, a nutrition strategy, based on the Zone diet by US biochemist Dr. Barry Sears is proposed. It underlines the importance of choosing certain types of foods over others, their beneficial physiological effects on the human body and how they can reduce the risk of heart disease and cancer.