Co-fermentation improves the functional properties and nutritional quality of infant complementary food products.

Food-to-food fortification and fermentation are effective strategies to enhance the product functionality and nutrient density of infant complementary foods. However, their effectiveness hinges on a deep understanding of ingredient combinations. Our research focused on the physicochemical and techno-functional aspects of sorghum-baobab blends, comparing two processes: 'co-ferment-cook' and 'ferment-cook-fortify'. The results show that both techniques improved the water absorption capacity by 17-20% and the water solubility index increased by over 100% while maintaining a comparable nutritional composition and energy density. The calculated energy density (2048.8-2345 kJ day-1) was sufficient for both blends for infants 6-11 months old with an average breast milk intake. Viscosity, another crucial factor for complementary feeding, improved significantly (P < 0.05) after co-ferment-cook compared to ferment-cook-fortify reaching a value suitable for children older than 18 months. Starch digestibility increased with co-ferment-cook, while protein digestion increased with fortified non-fermented foods. In conclusion, our findings emphasize that combining fermentation and fortification processing steps is optimal for balancing the nutritional and techno-functional properties of sorghum porridges for infant complementary foods. Processing parameters must be optimized to reach the viscosity suitable for complementary feeding at the assigned soluble solid contents for the age group 6-24 months.

Designing sustainable weaning foods for developing countries: not only a matter of nutrients.

Blended complementary foods from cereals and high-protein sources are used worldwide to cope with infants' malnutrition. However, the usefulness of the food matrix during traditional processes reaches suboptimal effectiveness due to cereal gelatinization and viscosity, which reduce consumption. The interplay between nutritional and physical qualities needed for weaning children presents further significant constraints. A combination of processing methods can improve and optimize the overall product quality. This paper investigated the nutritional, functional, and anti-nutritional factors of a complementary infant porridge made by combining fermented sorghum flour with germinated bottle gourd seed flour. Overall, the combination improved the functional and physical properties of the porridge suitable for children of 10 months and over. A serving of 100 g would contribute 115-145% and 23-31% of the recommended nutritional intake of protein and energy, respectively, for low breast milk energy between 6-24 months. The results demonstrate that a combination of strategies and technologies are needed to balance nutritional and physical quality.

[Therapeutic apheresis in idiopathic nephrotic syndrome]. / Aferesi terapeutica nella sindrome nefrosica idiopatica.

Idiopathic nephrotic syndrome (INS) is characterized by diffuse foot process effacement on electron microscopy and minimal changes (called minimal change nephropathy [MCN]), focal segmental glomerular sclerosis (FSGS), or the mesangial variant with proliferation on light microscopy. No evidence of immune deposits is seen. MCN is the most common form of INS in children and is sensitive to corticosteroid therapy in 90% of cases. FSGS accounts for 20-30% of biopsy-proven glomerulopathies in adult patients. Fifty percent of drug-resistant patients develop terminal renal failure in 6-8 years. Moreover, FSGS reappears in 15-50% of cases after the first transplant and in a higher percentage after the second graft. Genetic forms of INS, with mutation of the NPHS1 and NPHS2 genes encoding nephrin and podocin, are mostly steroid resistant and very rarely recur in the transplant. On the basis of any clinical pattern they are indistinguishable from idiopathic forms. Sera from patients with FSGS may contain some proteinuric or permeability factors (PFs), which have been partially identified and are predictive of recurrence in kidney grafts. Removal of PFs by means of plasmapheresis or plasma immunoadsorption by protein A or LDL apheresis has been associated with proteinuria reduction in cases of FSGS both of native and transplanted kidneys, in small series or cohort studies described by many authors. In this review of the main studies we will analyze the results of the apheretic treatments and the role of some clinical, serological and histological parameters in determining the outcome of patients.

A vitamin E-coated polysulfone membrane reduces serum levels of inflammatory markers and resistance to erythropoietin-stimulating agents in hemodialysis patients: results of a randomized cross-over multicenter trial.

BACKGROUND: Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of cardiovascular disease and anemia. Vitamin E is a fat-soluble antioxidant that plays a central role in reducing lipid peroxidation and inhibiting the generation of reactive oxygen species. The aim of this cross-over randomized study was to compare the effects of a vitamin E-coated polysulfone (Vit E PS) membrane and a non-vitamin E-coated polysulfone (PS) membrane on inflammatory markers and resistance to erythropoietin-stimulating agents (ESAs). METHODS: After a 1-month run-in period of standard bicarbonate dialysis with a synthetic membrane, 62 patients of both genders, and older than 18 years, dialysis vintage 48 ± 27 months, BMI 22 ± 3 (from 13 different dialysis units) were randomized (A-B or B-A) in a cross-over design to Vit E PS (treatment A) and to PS (treatment B) both for 6 months. C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were determined by a sandwich enzyme immunoassay at baseline and every 2 months; red blood cell count, ESA dose and ESA resistance index (ERI) were assessed monthly. RESULTS: Hemoglobin (Hb) levels significantly increased in the Vit E PS group from 11.1 ± 0.6 g/dl at baseline to 11.5 ± 0.7 at 6 months (p < 0.001) and remained unchanged in the PS group. Although ESA dosage remained stable during the observation periods in both groups, ERI was significantly reduced in the Vit E PS group from 10.3 ± 2.2 IU-dl/kg/g Hb week at baseline to 9.2 ± 1.7 at 6 months (p < 0.001). No significant variation of ERI was observed in the PS group. A significant reduction in plasma CRP and IL-6 levels was observed in the Vit E PS group: CRP from 6.7 ± 4.8 to 4.8 ± 2.2 mg/l (p < 0.001) and IL-6 from 12.1 ± 1.4 to 7.5 ± 0.4 pg/ml (p < 0.05). In the PS group, CRP varied from 6.2 ± 4.0 to 6.4 ± 3.7, and IL-6 from 10.6 ± 2.1 to 9.6 ± 3.5 (p = n.s.). CONCLUSIONS: Treatment with Vit E PS membranes seems to lead to a reduction in ESA dosage in HD patients; in addition, a low chronic inflammatory response may contribute to a sparing effect on exogenous ESA requirements.

The Pisa experience of renal biopsies, 1977-2005.

INTRODUCTION: Although several registries collecting data of patients with kidney diseases exist, only a few specifically collect data relating to renal biopsy. Kidney biopsy has been performed routinely in Pisa since 1977; the aim of this study was to report the relative frequency of nephropathies according to gender, age at time of biopsy, clinical presentation and renal function, based on histological diagnoses during the years 1977 through 2005. During this time, 3,810 kidney biopsies were performed, of which 89.3% were from native (n=3,446) and 10.7% from transplant kidneys. Throughout this period, 5% of renal biopsies were not diagnostic, so in this paper we report data regarding 3,269 native kidney nephropathies. METHODS: During the years 1977 through 2005, data for renal biopsies were collected on specific registers filled out by clinicians. Information collected in the database included a variety of indicators, such as clinical anamnesis, creatinine clearance, daily proteinuria, hemoglobin levels, blood pressure, height and weight, clinical presentation, and current medications. Clinical presentation was defined as urinary abnormalities (UA), nephrotic syndrome (NS) and acute nephritic syndrome (ANS). Renal diseases were divided into 4 major categories: primary glomerulonephritis (GN), secondary GN, tubulointerstitial nephropathies (TIN) and vascular nephropathies (VN). RESULTS: From 1977 up to 1987, a mean of 95 +/- 18 renal biopsies/year were performed; this number significantly increased to 185 +/- 22 renal biopsies/year (range 138-200) (p<0.001) in the following period (1988-2005). Renal biopsy was more frequently performed in males (59%) compared with females (41%). Of all diseases of the native kidney, primary GN was the most frequent (66%), followed by secondary GN (25.6%), TIN (4.2%) and VN (4.2%). The type of primary GN with the highest frequency was mesangial GN (both IgA and non-IgA) (45.7%), followed by membranous GN (23%), focal segmental glomerulosclerosis (19.8%), minimal change disease (5.3%), crescentic GN (4.2%) and postinfectious GN (2%). In terms of age, renal biopsy was more frequently performed in patients aged 20 to 60 years, and nearly 60% of patients presented a glomerular filtration rate (GFR) >60 ml/min at the time of biopsy. The main clinical reason for performing renal biopsy was UA, in all the types of nephropathies. CONCLUSIONS: We confirm data that renal diseases are more frequent in men, with the exception of secondary GN. The mean age at diagnosis was 42 years resulting from the tendency not to perform renal biopsies in children and in elderly patients. Renal biopsy was mainly performed in patients with GFR >60 ml/min and asymptomatic urinary abnormalities suggesting concern on the part of clinicians regarding glomerular diseases. The tendency to perform renal biopsies has been significantly increasing throughout our follow-up period.

Multicenter study on hepatitis C virus-related cryoglobulinemic glomerulonephritis.

BACKGROUND: Mixed cryoglobulinemia is a multisystem disorder associated strongly with hepatitis C virus (HCV) infection. The kidney frequently is involved, and glomerulonephritis represents the key factor affecting prognosis. METHODS: Clinical, serological, immunogenetic, and morphological data were collected retrospectively from medical records of 146 patients with cryoglobulinemic glomerulonephritis who underwent biopsies in 25 Italian centers and 34 cryoglobulinemic controls without renal involvement. RESULTS: Eighty-seven percent of patients were infected with HCV; genotype 1b was more frequent than genotype 2 (55% versus 43%). Diffuse membranoproliferative glomerulonephritis was the most prevalent histological pattern (83%). Type II cryoglobulin (immunoglobulin Mkappa [IgMkappa]/IgG) was detected in 74.4% of cases. The remainder had type III (polyclonal IgM/IgG) cryoglobulins. A multivariate Cox proportional hazard model showed that age, serum creatinine level, and proteinuria at the onset of renal disease were associated independently with risk for developing severe renal failure at follow-up. Overall survival at 10 years was about 80%. Kaplan-Meier survival curves were worsened by a basal creatinine value greater than 1.5 mg/dL (>133 mumol/L), but were unaffected by sex and HCV infection. Cardiovascular disease was the cause of death in more than 60% of patients. CONCLUSION: Data confirm the close association between mixed cryoglobulinemia and HCV infection and between glomerulonephritis and type II cryoglobulin. Survival profiles are better than previously reported in the literature, probably because of improvement in therapeutic regimens. Causes of death reflect this improvement in survival, with an increased prevalence of cardiovascular events compared with infectious complications and hepatic failure, which were predominant in the past.