Adherence to the Mediterranean diet is linked to reduced psychopathology in female celiac disease patients.

Celiac disease (CD) is a chronic enteropathy, affecting approximately 1% of the population worldwide with a higher prevalence in women. Recent studies demonstrate that CD is associated with an increased prevalence of psychopathology. The present study was undertaken to investigate the relationship between adherence to the Mediterranean Diet (MD) and psychopathological symptoms among CD patients, since the MD is a physical and mental health protective dietary regimen, which can easily be rendered gluten-free. A total of 134 CD patients (28 males and 106 females) were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R), and MD adherence was calculated using the Mediterranean Dietary Serving Score (MDSS). As regards psychopathological symptoms, female patients presented with statistically significant higher depression and anxiety than males. The majority of patients (64.9%) had low adherence to the MD (MDSS <14) with a mean score of 9.44 ± 3.26 and 9.14 ± 3.07 for men and women, respectively, out of a total of 24 points. High MD adherence was observed in 35.7% of the male and 34.9% of the female patients, with a mean score of 16.40 ± 2.63 and 16.35 ± 2.12, respectively. Interestingly, MD adherence was inversely associated with the intensity of several psychopathological symptoms in female patients, which represented the majority of the sample. The results of the study underline the need to encourage CD patients to adapt to a Mediterranean-style GFD.

Nutritional Assessment of Greek Liver Cirrhosis Patients: Mini Nutritional Assessment Predicts Mortality.

Malnutrition is highly prevalent in liver cirrhosis (LC). It increases as the severity of the disease progresses and it is related to poor survival. The objectives of the study were the nutritional assessment of Greek LC patients, using various nutritional assessment and screening tools, and the comparison of their predictive value for mortality. In total, 137 (77 male) consecutive LC patients (median age: 67 years) were assessed with subjective global assessment (SGA) and mini nutritional assessment (MNA) questionnaires, anthropometrics, handgrip strength (HGS) tests, and bioelectric impedance analysis (BIA), in comparison to a control group of 148 healthy people. Disease severity was assessed using the model for end-stage liver disease (MELD) scores. Patients were followed up for a median of 19 months. Survival curves were calculated using the Kaplan-Meier method. In total, 60% and 43% of patients were of adequate nutritional status by SGA and MNA, respectively, which was confirmed by most anthropometric measurements. MNA and SGA scores correlated significantly with anthropometrics and BIA-derived parameters. Besides the MELD score, mid-arm circumference (MAC), triceps skinfold (TSF), BIA's phase angle (Pha), and MNA predicted mortality in cirrhotic patients. The nutritional assessment demonstrated an unexpectedly high prevalence of well-nourished LC patients. MNA was a strong predictor of mortality.

The Association Between Handgrip Strength and Predialysis Serum Sodium Level in Patients With Chronic Kidney Disease Stage 5D.

Purpose: Handgrip strength (HGS) is a useful tool for the systematic assessment of muscle function related to nutritional status. Reduced HGS has been associated with adverse clinical outcomes in chronic kidney disease (CKD) stage 5D patients. In the same patients, predialysis low serum sodium (sNa) has been associated with malnutrition and mortality. Here, we investigated the role of predialysis sNa on muscle function in CKD-5D patients. Methods: We evaluated 45 patients on hemodialysis (HD) and 28 patients on peritoneal dialysis (PD) with HGS measurement, bioimpedance analysis, anthropometric measures, and malnutrition inflammation score (MIS). According to established diagnostic criteria, reduced HGS was defined as strength below 30 and 20 Kg in men and women, respectively. Predialysis sNa values were defined as the mean of all predialysis measurements during the preceding 6 months. Data analysis was performed separately for each of the HD and PD groups. Results: The proportions of reduced HGS did not differ between the HD (66%) and PD (54%) groups, respectively. Patients in the HD group as compared to those in the PD group had higher serum albumin and potassium and mid-arm muscle circumference and lower residual renal function (RRF) and residual urine volume. Multivariate logistic analysis, after controlling for muscle mass, nutritional biomarkers, MIS, fluid overload and RRF, showed that for every 1 mmol/l increase of sNa the odds of reduced HGS was decreased by 60% (OR = 0.40, 95% CI: 0.16-0.99) and 42% (OR = 0.58, 95% CI: 0.36-0.93) in HD and PD patients, respectively. However, stratified analysis indicated that lower sNa levels predicted reduced HGS in individuals with a background of malnutrition, inflammation, overhydration and less preserved RRF, representing unfavorable conditions strongly related to muscle wasting in the dialysis setting. Conclusions: Predialysis sNa is a strong and independent determinant of HGS, a reliable nutritional marker in CKD-5D stage patients. However, according to our findings, lower sNa levels appear to be a marker of underlying unfavorable conditions that are heavily associated with reduced HGS, rather than a causal determinant of reduced HGS. Whether optimizing sNa levels improves patient muscle performance requires further investigations.

Nutritional status in hemodialysis patients is inversely related to depression and introversion.

Although hemodialysis (HD) is a life-sustaining treatment for the majority of patients with end-stage renal disease, it may adversely affect their psychological status. Depression is highly prevalent among these patients, and it is associated with malnutrition, morbidity and mortality. Recent studies have demonstrated that depression is positively associated with neuroticism and introversion in HD patients. The aim of the present study was to explore the relationship between depression, personality traits (extraversion-introversion, neuroticism, psychoticism) and nutritional status among HD patients. Fifty-two HD patients were assessed via questionnaires for depression (CES-D) and personality traits (EYSENCK, EPQ). Nutritional assessment was conducted through bioelectrical impedance analysis (BIA) and anthropometry measurements (height, post-dialysis weight). The study revealed novel significant correlations. Both post-dialysis weight and phase angle were negatively related to introversion (r = -0.314, p < 0.05 and r = -0.542, p < 0.01, respectively) and depression (r = -0.456, p < 0.01 and r = -0.467, p < 0.01, respectively). This study demonstrates that both depression and introversion are inversely related to adequate nourishment in HD patients and suggests that personality plays an important role in the nutritional status of these patients.

Adiponectin and end-stage renal disease.

Adiponectin (ADPN) is an adipokine with significant anti-inflammatory, insulin-sensitizing and anti-atherogenic properties, which is generally associated with a beneficial cardiometabolic profile. Paradoxically, end-stage renal disease (ESRD) is characterized by markedly increased plasma ADPN levels and increased cardiovascular risk. In spite of the cardioprotective properties attributed to adiponectin, cardiovascular complications remain the main cause of mortality in the ESRD population. Furthermore, these patients have enhanced chronic inflammation, increased insulin resistance and persistent protein-energy wasting. Studies of the impact of ADPN on clinical outcomes among ESRD patients have so far yielded contradictory results. This review article summarizes the current knowledge on ADPN functions and explores the role of ADPN in ESRD patients, with specific focus on inflammation, insulin resistance, cardiovascular disease and wasting.

Associations of several anthropometric indices with insulin resistance in children: The Children Study.

AIM: To compare the associations of several anthropometric indices (i.e. waist circumference [WC], waist-to-height ratio, body mass index (BMI) and waist-to-hip ratio) with the insulin resistance (IR) proxy measures in Greek schoolchildren. METHODS: A random sample of 248 children was used. Fasting plasma glucose and serum insulin levels were measured. IR was estimated through homeostasis model assessment (HOMA), glucose-to-insulin ratio and quantitative insulin sensitivity check index. RESULTS: Insulin levels and IR indices were significantly related to BMI, WC and waist-to-height ratio. Glucose-to-insulin ratio and quantitative insulin sensitivity check index were inversely correlated with all anthropometric indices, while insulin levels and HOMA were positively associated with these indices. Generally, all significant correlations were weak to moderate (0.217

Structural and biochemical characterization of a new Mg(2+) binding site near Tyr94 in the restriction endonuclease PvuII.

We have determined the crystal structure of the PvuII endonuclease in the presence of Mg(2+). According to the structural data, divalent metal ion binding in the PvuII subunits is highly asymmetric. The PvuII-Mg(2+) complex has two distinct metal ion binding sites, one in each monomer. One site is formed by the catalytic residues Asp58 and Glu68, and has extensive similarities to a catalytically important site found in all structurally examined restriction endonucleases. The other binding site is located in the other monomer, in the immediate vicinity of the hydroxyl group of Tyr94; it has no analogy to metal ion binding sites found so far in restriction endonucleases. To assign the number of metal ions involved and to better understand the role of Mg(2+) binding to Tyr94 for the function of PvuII, we have exchanged Tyr94 by Phe and characterized the metal ion dependence of DNA cleavage of wild-type PvuII and the Y94F variant. Wild-type PvuII cleaves both strands of the DNA in a concerted reaction. Mg(2+) binding, as measured by the Mg(2+) dependence of DNA cleavage, occurs with a Hill coefficient of 4, meaning that at least two metal ions are bound to each subunit in a cooperative fashion upon formation of the active complex. Quenched-flow experiments show that DNA cleavage occurs about tenfold faster if Mg(2+) is pre-incubated with enzyme or DNA than if preformed enzyme-DNA complexes are mixed with Mg(2+). These results show that Mg(2+) cannot easily enter the active center of the preformed enzyme-DNA complex, but that for fast cleavage the metal ions must already be bound to the apoenzyme and carried with the enzyme into the enzyme-DNA complex. The Y94F variant, in contrast to wild-type PvuII, does not cleave DNA in a concerted manner and metal ion binding occurs with a Hill coefficient of 1. These results indicate that removal of the Mg(2+) binding site at Tyr94 completely disrupts the cooperativity in DNA cleavage. Moreover, in quenched-flow experiments Y94F cleaves DNA about ten times more slowly than wild-type PvuII, regardless of the order of mixing. From these results we conclude that wild-type PvuII cleaves DNA in a fast and concerted reaction, because the Mg(2+) required for catalysis are already bound at the enzyme, one of them at Tyr94. We suggest that this Mg(2+) is shifted to the active center during binding of a specific DNA substrate. These results, for the first time, shed light on the pathway by which metal ions as essential cofactors enter the catalytic center of restriction endonucleases.