Prevalence of Helicobacter pylori infection among Slovenian children and adolescents: A prospective cohort study.

BACKGROUND: Helicobacter pylori (H. pylori) infection is primarily acquired in childhood and is notably influenced by socioeconomic variances across different geographical regions. The aim of this study is to assess the prevalence of H. pylori infection in Slovenian children and to identify potential risk factors that facilitate the infection. MATERIALS AND METHODS: Between 2019 and 2022, we conducted a multi-center prospective cross-sectional study among healthy children residing in three different administrative regions in Slovenia. H. pylori infection status was determined using a monoclonal antibody-based stool antigen test (SAT). A standardized questionnaire was designed to evaluate the influence of various H. pylori-associated risk factors, including demographics and socioeconomic, housing and sanitation conditions. RESULTS: During the 3-year period, we recruited a total of 421 children and adolescents (age range 2-18 years, mean age 10.29 ± 4.95 years). Overall, 46 (10.9%) were diagnosed with H. pylori infection. No associations were found between H. pylori prevalence rates and increasing age, sex, parental education level, country of birth of the child or their parents, number of household members, household income, having a dishwasher, owning a pet, duration of breastfeeding, fruit intake frequency, drinking tap water, and handwashing practices. The only parameters associated with an increased risk of infection were the location of the school (p < 0.001) and living in an urban area (p = 0.036). The odds of infection were approximately 4.77 times higher if the child attended school in the Central Slovenian compared to other regions (OR = 4.77; 95% CI 0.87-2.34). CONCLUSIONS: This is the first study providing information on the prevalence of H. pylori infection among Slovenian children and adolescents. Using SAT, we have shown that the burden of H. pylori infection in our pediatric population is low; however, it seems to depend on regional rather than socioeconomic factors.

Associations of Dietary Intake with Cardiovascular Risk in Long-Term "Plant-Based Eaters": A Secondary Analysis of a Cross-Sectional Study.

A plant-based diet rich in whole foods and fiber is beneficial for cardiovascular (CV) health. This impact is often linked to specific food groups and their preparation methods, reflecting the overall dietary pattern. However, research on the long-term effects of a carefully designed plant-based diet on adults transitioning from a typical Western lifestyle is limited. Notably, studies on people managing CV risk factors effectively are scarce. As part of a cross-sectional study, we examined 151 individuals committed to a long-term, well-designed plant-based diet and active lifestyle. We investigated how specific food groups and macronutrient intake are related to various CV health markers. In this secondary analysis, our comprehensive approach encompassed several methods: 3-day weighted dietary records, fasting blood lipid and blood pressure measurements, body composition assessments, and evaluations of lifestyle status. We adjusted our analysis for multiple variables, such as age, sex, current body mass index, smoking status, physical activity, and time (years) following the plant-based diet. Our findings revealed several associations between macronutrient intake (per 50 g) and CV risk markers, although these associations were generally weak. Individuals who consumed more whole grains and fruits had lower levels of total, low-density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C) cholesterol. We also found associations between the intake of legumes and nuts/seeds and reduced HDL-C levels. These findings suggested that these food groups might influence the lipid profile, contributing to CV health in a plant-based diet. A greater intake of spices/herbs was associated with lower uric acid levels, while diets rich in plant-based fast food and pasta (made from white flour) were associated with higher uric acid levels. A greater intake of various macronutrients, such as fiber, carbohydrates (from whole-food sources), proteins, and different types of fats (saturated fatty acids [SFAs], monounsaturated fatty acids [MUFAs], and polyunsaturated fatty acids [PUFAs]), was associated with lower levels of total cholesterol, LDL-C (only for carbohydrates), and HDL-C. We found a unique negative correlation between PUFA intake and LDL-C, suggesting that PUFAs might significantly affect LDL-C levels. In contrast, increased fiber, protein and SFA consumption were associated with increased uric acid levels. These findings support the impact of dietary patterns on CV risk factors, highlighting that even small amounts of unhealthy food groups can significantly influence specific CV risk markers, regardless of the overall diet.

Nutritional Status of Slovene Adults in the Post-COVID-19 Epidemic Period.

Background: Monitoring nutritional status data in the adult population is extremely important to mediate their health status. Unfortunately, for Slovenia (2.1 million European Union citizens), data on the body composition status of the general adult population are currently rare or nonexistent in scientific journals. Furthermore, dietary intake was last assessed several years before the COVID-19 epidemic period. Methods: We randomly recruited 844 adult Slovenes from all regions of Slovenia. The primary aim of the cross-sectional study was to examine body composition status (using a medically approved electrical bioimpedance monitor) during the post-COVID-19 epidemic period. In addition, we assessed dietary intake (using a standardized food frequency questionnaire) and compared the obesity propensity for both sexes separately using the body mass index (BMI) and body fat percentage (FAT%) obesity classification of the World Health Organization. Results: Regarding BMI classification, 43% of the whole sample was overweight (28%) or obese (15%), and there were more older adults than adults (64% vs. 42%, p < 0.001). The average FAT% of adult females and males was 26.9% and 19.5% (p < 0.001), respectively, while for older adult females and males, it was 32.7% and 23% (p < 0.001). In addition, a comparison of the proportions of obese people between the two cut-off obesity classifications (BMI vs. FAT%) showed a significantly underestimated proportion of obese female participants based on BMI classification (13% vs. 17%, p = 0.005). In terms of the dietary intake of the assessed nutrients in comparison with the national dietary reference values for energy and nutrient intake, the participants, on average, had lower intake than the recommended values for carbohydrates, fiber, vitamins C, D and E (for males) and calcium, and higher intake than the recommended values for total fat, saturated fatty acids, cholesterol, sodium and chloride (for males). Conclusions: The results urgently call for the need to not only improve the overall national nutritional status but also for regular national monitoring of body composition and dietary intake statuses.

Arterial Stiffness in Renal Transplant Recipients: 5-Year Follow-up.

BACKGROUND: Chronic kidney disease is a risk factor for cardiovascular diseases. After renal transplant, some traditional and chronic kidney disease-specific risk factors vanish, but new risk factors emerge. This retrospective study aimed to define the long-term impact of renal transplant and diabetes mellitus on arterial stiffness, evaluated by measuring pulse wave velocity (PWV) and augmentation index (AI) and on myocardial perfusion, evaluated by subendocardial viability ratio (SEVR). METHODS: PWV, AI, and SEVR were evaluated noninvasively by applanation tonometry using SphygmoCor in the first 4 weeks after kidney transplant and 4 to 5 years thereafter. RESULTS: A total of 48 graft recipients (18 women, 30 men; mean ± standard deviation age, 47.9 ± 11.8 years) were included. The follow-up period was 57.4 ± 8.0 months. PWV did not change significantly during the follow-up period (9.1 ± 1.8m/s and 8.7 ± 1.8m/s, respectively; P = .137). In the subgroup of patients without diabetes mellitus, we observed a trend of PWV reduction, whereas in the subgroup of patients with diabetes we observed the trend of PWV increase. The duration of smoking before transplant correlated significantly with PWV (P = .012). AI in the whole group increased significantly during the study period (from 18.3% ±10.3% to 25.9% ±9.4%; P < .01) as well as SEVR (from 134.9 ± 23.1 to 155.4 ± 28.6; P = .001). CONCLUSIONS: PWV, reflecting the central vessel stiffness, did not change significantly in the whole group during the follow-up period. The AI, which indicates systemic stiffness, increased significantly within 5 years after transplant, indicating the progression of vascular processes of elastic and muscular arteries. Significant increases in the SEVR values in both diabetics and nondiabetics indicate the long-term favorable effect of kidney transplant on myocardial perfusion.

Nutritional, Cardiovascular Health and Lifestyle Status of 'Health Conscious' Adult Vegans and Non-Vegans from Slovenia: A Cross-Sectional Self-Reported Survey.

The study aim was to investigate differences in nutritional, cardiovascular and lifestyle status of 'health conscious' subjects. In a partial 'lock-down' during the COVID-19 pandemic period, we performed a web-based, cross-sectional study. We compared 80 self-selected subjects (51 vegans, 67% females, and 29 non-vegans, 55% females, p = 0.344). Nutritional status was assessed by bio-electrical impedance and standardized food frequency questionnaires (i.e., contribution of nutrients from foods and supplementation, combined and separate). Serum lipid concentrations and blood pressure (BP) were assessed from annual or initial examination reports, while sociodemographic, economic, and lifestyle statuses were obtained by standardized questionnaires. Finally, a multivariate linear regression model was used to estimate the relationship between total fiber and saturated fatty acid (SFA) intake and low-density lipoprotein cholesterol (LDL cholesterol) values. The vegans had a significantly lower body mass index (22.8 ± 2.4 vs. 26.6 ± 3.6 kg/m2, p < 0.001) and body fat % (19.3 ± 7.3 vs. 25.8 ± 8.2%, p < 0.001) than the non-vegans. There were significant differences between vegans and non-vegans in energy intake, and most macronutrient (10/12) and micronutrient (15/23) intakes in units/day. Both diets were well designed, with high fiber and low SFA and free sugar intake but remained insufficient in n-3 long chain polyunsaturated fatty acids (for vegans), vitamin D, calcium, sodium (for vegans) and iodine. Vegans also had a significantly lower lipid profile and BP than non-vegans, except for high-density lipoprotein cholesterol. However, both groups met targeted recommendations. Furthermore, fiber and SFA intake and age explained 47% of the variance in LDL cholesterol. In conclusion, 'health conscious' vegans and non-vegans with comparable lifestyle statuses had significant differences in dietary intake, body composition and cardiovascular health status.

Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes.

OBJECTIVE: Nutritional status is important for health and competitive achievement. This area remains understudied among elite-level female athletes and is appropriate for research. We examined nutritional status and cardiovascular health markers of two groups of female athletes of the same age and competition period, involved in weight-bearing and a non-weight-bearing sport: gymnasts (n = 17) and swimmers (n = 14); mean age 17.4 and 16.6 years. METHODS: Body composition and dietary intake were assessed by bioelectrical impedance and Food Frequency Questionnaire. The concentrations of serum micronutrients (B12, 25-hydroxyvitamin D (25 (OH) D), calcium, magnesium, phosphorus, potassium, and iron), blood lipids, and blood pressure (BP) were measured. Setting and Participants. A cross-sectional study of 31 athletes from Slovenia. RESULTS: Gymnasts had higher body mass index (21.5 vs. 20.1 kg/m2, p=0.043) and lower fat free mass (42.4 vs. 46.6 kg, p=0.024) than swimmers and comparable body fat percentage (22.5 vs. 22.8%). Both groups had low intake of carbohydrates, fibre, polyunsaturated fats, protein (only gymnasts), and micronutrients (11/13 micronutrients gymnasts and 4/13 swimmers) and high intake of free sugars and saturated fats. Both groups also had significantly lower-than-recommended serum levels of 25 (OH) D. All cardiovascular risk factors were within recommended ranges. Gymnasts had higher LDL cholesterol (2.7 vs. 2.2 mmol/L, p < 0.011), and swimmers had higher systolic BP (126 vs. 107 mmHg, p < 0.001). CONCLUSIONS: Dietary intake especially in gymnasts was suboptimal, which may reflect in anthropometric and cardiovascular marker differences between gymnasts and swimmers.

Nutrient and Food Intake of Participants in a Whole-Food Plant-Based Lifestyle Program.

OBJECTIVE: We evaluated the nutrient adequacy of a well-planned supplemented whole-food plant-based (WFPB) diet as a component of an ongoing community lifestyle optimization program. We investigated the contributions of nutrients from foods and supplements and plant-based meal replacement (SMR) separately (foods, SMR) and combined (vs recommendations) as well as food group intake, both according to sex. METHOD: Our cross-sectional study included 151 healthy, active participants (aged 39.6 years) who were on a Western-type diet when they voluntarily joined our WFPB lifestyle program (0.5-10 years ago). We assessed diet using 3-day weighed dietary records (foods, S, and MR). After we standardized nutrient intake to 2000 kcal/d, we calculated the contribution of macro- and micronutrients from foods and SMR separately and combined (foods + SMR) (vs central European Recommendations), as well as food group intake, both according to sex. RESULTS: All macro- and micronutrient intake (total: from foods plus SMR) exceeded the reference values, except for calcium (95% and 82% in females and males) and vitamin D (both sexes, in summertime). Compared with male participants, female participants consumed (i.e., from foods and SMR together) significantly larger amounts of 23 (/25) micronutrients (8 [/25] from foods and 22 [/25] from SMR). The diet was primarily composed of the following (by mass in descending order): unprocessed vegetables/fruits, whole grains, legumes, potatoes, nuts/seeds, MR, and spices/herbs. CONCLUSIONS: Participants in our WFPB lifestyle program ingested a nutrient-rich WFPB diet and targeted supplementation. The presented ongoing community WFPB lifestyle program ensures a healthy, balanced, and environment-friendly dietary pattern for participants who are compliant.

Dietary Intakes and Cardiovascular Health of Healthy Adults in Short-, Medium-, and Long-Term Whole-Food Plant-Based Lifestyle Program.

An effective lifestyle strategy to reduce cardiovascular diseases risk (CVD) factors is needed. We examined the effects of a whole-food plant-based (WFPB) lifestyle program on dietary intake and cardiovascular (CV) risk factors in 151 adults (mean 39.6 (SD 12.5) years). Adherence was categorised into short-, medium- and long-term (years: (0.5-<2), (2-<5) and (5-10)), for both genders separately. Dietary intakes were assessed, fasting blood lipids and blood pressure (BP) were measured, and % participants reaching guideline recommended targets for LDL-cholesterol, triglycerides and BP in the primary CVD prevention was assessed. There were no statistically significant differences in intakes of energy and most nutrients among participants (both genders), that were short-, medium- and long term in our program. Diet was mainly composed of unprocessed vegetables/fruits, whole grains, legumes, potatoes, and nuts/seeds. LDL-cholesterol, triglycerides, systolic and diastolic BP were within targets for: 93%, 97%, 88% and 95% participants, respectively. In females (vs. males), total- and HDL-cholesterol were higher (mean): 3.8 (SD 0.7) vs. 3.4 (SD 0.9), p = 0.002 and 1.5 (SD 0.3) vs. 1.1 (SD 0.2) mmol/L, p < 0.001), systolic BP was lower (113 (SD 11) vs. 120 (SD 10) mmHg, p = 0.001), while there was no difference in diastolic BP (71 (SD 9) vs. 72 (SD 8) mmHg, p = 0.143). More females vs. males reached target triglycerides (99% vs. 91%, p = 0.021) and systolic BP (92% vs. 79%, p = 0.046), while similar females and males reached target LDL-cholesterol (94% vs. 91%, p = 0.500) and diastolic BP (93% vs. 100%, p = 0.107). Participation in our WFPB lifestyle program is associated with favourable dietary intakes, safety markers, and CV risk factor profiles.

Estimation of glomerular filtration rate based on dry lean body mass in kidney transplant recipients
.

AIM: The use of glomerular filtration rate (GFR) estimating equations is not always reliable, especially in specific populations, such as patients with transplanted kidney. The purpose of this study was to improve the performance of GFR equations by taking into account dry lean body mass. MATERIALS AND METHODS: A prospective clinical study included 100 patients with kidney graft. Estimated GFR (eGFR) with Chronic Kidney Disease Epidemiology Collaboration equations with serum creatinine concentration (CKD-EPI Cr), serum cystatin C concentration (CKD-EPI CysC), or both (CKD-EPI Cr-CysC) were compared with measured GFR with 51Cr-EDTA clearance (mGFR 51Cr-EDTA). Dry lean body mass (body mass without fat mass and water) was measured with bioimpedance analysis. RESULTS: All of the eGFRs overestimated mGFR 51Cr-EDTA by a significant degree (shown as bias ± SD in mL/min/1.73m2 with 30% accuracy in parentheses): CKD-EPI Cr 15.1 ± 15.3 (50%), CKD-EPI CysC 8.0 ± 16.6 (56%), CKD-EPI Cr-CysC 10.3 ± 13.4 (55%). Dry lean body mass significantly correlated with mGFR 51Cr-EDTA (R = 0.241; p = 0.016) and all biases except the bias of CKD-EPI CysC. Considering the dry lean body mass and preexisting equations with creatinine, we developed two new equations with better performance and statistically insignificant bias: Corrected CKD-EPI Cr -1.43 ± 13.6 (67%) and Corrected CKD-EPI Cr-CysC -1.64 ± 13.4 (77%). CONCLUSION: Dry lean body mass improves the performance of GFR equations in our kidney transplant cohort.

The Influence of Maternal Levels of Vitamin D and Adiponectin on Anthropometrical Measures and Bone Health in Offspring.

BACKGROUND: From the conception onward, certain parameters associated with maternal health may affect foetal body composition, growth and bone mineral content. The objective of the study was to determine the association between maternal vitamin D and adiponectin status with the anthropometrical measures of newborns, and bone health status measured by Quantitative Ultrasound (QUS) at birth. METHODS: Circulating 25OHD and adiponectin concentration were measured in 73 pregnant women. Correlations with the anthropometrical measures and bone health status in their infants were studied. Bone health was evaluated using QUS with the measurements of speed of sound (SOS, in m/s) and Z score on the right tibia. RESULTS: There was no significant association between maternal 25OHD and newborn's anthropometrical measures at birth (weight p=0.35, length p=0.59 and head circumference p=0.47). There was a significant negative correlation between a maternal serum adiponectin and a) weight of infants at birth (R= -0.37, p=0.002); b) birth length (R= -0.31, p=0.008) and c) head circumference (R= -0.29, p=0.014). There was no significant correlation between maternal 25OHD blood levels during pregnancy and SOS in newborns (p=0.48). Additionally, a correlation between maternal adiponectin concentration during pregnancy and SOS in newborns was not significant (p=0.82). CONCLUSION: Although a high prevalence of low 25OHD level among pregnant women was found, maternal vitamin D status did not influence growth and bone health of their offspring at birth. Maternal adiponectin levels in plasma showed an inverse relationship with anthropometrical measures of infants at birth, while no correlation with the newborn's bone health was found.

Treatment of antibody-mediated rejection of kidney grafts with bortezomib and/or rituximab compared to standard regimen: experience of Slovene National Center.

BACKGROUND: The aim of our study was to determine outcomes of standard treatment of antibody-mediated rejection (ABMR) of kidney grafts as compared to the addition of bortezomib or rituximab. METHODS: The cohort of this retrospective study included patients treated for ABMR of kidney grafts at our national center in the period of 2005 - 2017, divided into two groups: standard (ST) group treated standardly with plasmapheresis or immunoadsorption, intravenous immunoglobulins, and corticosteroids, and BR group treated with the addition of bortezomib and/or rituximab. Patient and graft survival at 2 years was analyzed by Kaplan-Meier method, and predictors of graft survival were analyzed by Cox regression. RESULTS: There were 78 patients with ABMR (48 in the ST group, 30 in the BR group), 41 (53%) were men, mean age 49.5 ± 13.8 years. In ST and BR, respectively, mean serum creatinine was 267 ± 164 and 208 ± 112 µmol/L (p = 0.088), donor-specific antibodies (DSA) were positive in 75% and 97% (p = 0.022), and ABMR was acute in 50% and 33% (p = 0.149). Patient survival at 2 years was 89% in the ST and 100% in the BR group (p = 0.125). Cumulative proportion of kidney graft survival at 1 and 2 years was 67% and 53% in the ST group and 73% and 48% in the BR group, respectively, (p = 0.641). Chronic ABMR (HR 5.22, p = 0.004) was significant, while dialysis dependency at biopsy (HR 3.28, p = 0.072), serum creatinine at kidney biopsy (HR 1.003, p = 0.082), and presence of DQ-DSA (HR 3.37, p = 0.062) were borderline significant predictors of worse graft outcome. Infections were relatively common in both groups, with a trend towards more rehospitalizations due to infections in the first 6 months after treatment in the BR group (p = 0.066). In 5 patients (17%), treatment with bortezomib was discontinued prematurely due to cytopenia. CONCLUSIONS: Bortezomib or rituximab, added to standard treatment, did not significantly improve kidney graft survival and was also not associated with significant side effects, except cytopenia in some cases. Treatment of acute ABMR resulted in better graft survival than chronic ABMR.
.

Prevalence and risk factors for nonvertebral bone fractures in kidney transplant recipients - a single-center retrospective analysis.

BACKGROUND: Complex and longstanding bone disease superimposed by harmful influences of immunosuppression is the reason for increased risk of bone fracture in kidney transplant recipients. The aim of our study was to analyze the incidence and prevalence of nonvertebral bone fractures and early (in the first post-transplant year) clinical and laboratory risk factors for suffering bone fracture in the long-term post-transplant period. METHODS: Clinical and laboratory data as well as bone mineral density (BMD) measurements of 507 first kidney transplant recipients who were transplanted in the period from 1976 to 2011 were analyzed. RESULTS: The mean age of included patients was 54.3 ± 12.0 years, there were 45% females, and mean time on renal replacement treatment prior to transplantation was 63.4 ± 43.6 months. The average observation time post-transplant was 9.7 years (1.4 - 36.3 years). Post-transplant, 64 (12.6%) patients suffered 89 nonvertebral fractures (44 patients suffered 1 fracture, 15 patients 2 fractures, and 5 patients 3 fractures). Patients with fractures had significantly lower late BMD of femoral neck in the period of 1 - 10 years post-transplant, had osteopenia and osteoporosis more frequently in the same time period, and higher serum alkaline phosphatase in the first year post-transplant. 13 patients (13/64, 20.3%) had major fractures. Patients with major fractures were significantly older than patients with no major fractures and had lower serum albumin. Frequency of treatment with bisphosphonate, calcium, or phosphate did not differ between the groups. Vitamin D supplement (active form in 98% of cases) was prescribed more frequently in the group without fractures, but this was not statistically significant. CONCLUSION: Fracture rate in our transplant patient population was comparable to that reported in the literature. Except for a higher level of serum total alkaline phosphatase in the fracture group, we found no other early laboratory risk factors for bone fractures. BMD at the femoral region 1 - 10 years after kidney transplantation but not BMD at the time of transplantation was a risk factor for nonvertebral fractures. Osteopenia and osteoporosis in the post-transplant period were found to be a fracture risk factor.
.