"I'm Doing the Best that I Can": Mothers Lived Experience with Food Insecurity, Coping Strategies, and Mental Health Implications.

Background: Food insecurity can have lasting physical and mental health consequences. The experience of food insecurity within a household may disproportionately impact mothers because they tend to manage the household food environment. Objective: This study sought to understand the stresses faced by United States mothers experiencing food insecurity, related coping mechanisms, and the impacts of these stressors on their mental health. Methods: Semistructured interviews were conducted in May and June 2022 with a purposive sample of Virginia mothers who reported experiences of food insecurity. Participants were recruited from a related survey and university and community LISTSERVs. Interviews were transcribed and analyzed by trained coders. A thematic analysis was conducted to describe themes that emerged from the data. Virtual interviews were 20-60 min in duration. Mothers with children living in their household, having experienced food insecurity, and living in Virginia were eligible. Results: The following 3 themes emerged from the interviews with the mothers (n = 15): 1) food insecurity added stress to mothers' lives in multiple ways (e.g. worry about obtaining the "right" foods and internalized or experienced stigma), 2) mothers used positive and negative coping strategies to address the impacts of these stressors (e.g. use of community resources and reduced personal food intake), and 3) the stressors and coping strategies had varying impacts on mothers' mental health (e.g. added to existing mental health challenges or reduced their mental capacity to make changes). Conclusions: Study findings suggest that a multilevel and tailored approach to address diverse stressors is warranted. Future research should explore emotional coping strategies that comprehensively empower mothers to manage stressors, leverage resources, and reduce social stigma associated with food insecurity and accessing nutrition and mental health assistance. This may improve their household food security and mitigate the burden of stressors on their mental health because system-level solutions to food insecurity are pursued.

Telomere length as biomarker of nutritional therapy for prevention of type 2 diabetes mellitus development in patients with coronary heart disease: CORDIOPREV randomised controlled trial.

BACKGROUND: Telomere Length (TL), a marker of cellular aging, holds promise as a biomarker to elucidate the molecular mechanism of diabetes. This study aimed to investigate whether shorter telomeres are associated with a higher risk of type 2 diabetes mellitus (T2DM) incidence in patients with coronary heart disease; and to determine whether the most suitable dietary patterns, particularly a Mediterranean diet or a low-fat diet, can mitigate the development of diabetes in these patients after a follow-up period of five years. METHODS: The CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study) was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive two healthy diets. Clinical investigators were masked to treatment assignment; participants were not. Quantitative-PCR was used to assess TL measurements. FINDINGS: 1002 patients (59.5 ± 8.7 years and 82.5% men) were enrolled into Mediterranean diet (n = 502) or a low-fat diet (n = 500) groups. In this analysis, we included all 462 patients who did not have T2DM at baseline. Among them, 107 patients developed T2DM after a median of 60 months. Cox regression analyses showed that patients at risk of short telomeres (TL < percentile 20th) are more likely to experience T2DM than those at no risk of short telomeres (HR 1.65, p-value 0.023). In terms of diet, patients at high risk of short telomeres had a higher risk of T2DM incidence after consuming a low-fat diet compared to patients at no risk of short telomeres (HR 2.43, 95CI% 1.26 to 4.69, p-value 0.008), while no differences were observed in the Mediterranean diet group. CONCLUSION: Patients with shorter TL presented a higher risk of developing T2DM. This association could be mitigated with a specific dietary pattern, in our case a Mediterranean diet, to prevent T2DM in patients with coronary heart disease. TRIAL REGISTRATION: Clinicaltrials.gov number NCT00924937.

Imaging of chronic thromboembolic pulmonary hypertension before, during and after balloon pulmonary angioplasty.

Balloon pulmonary angioplasty (BPA) has recently been elevated as a class I recommendation for the treatment of inoperable or residual chronic thromboembolic pulmonary hypertension (CTEPH). Proper patient selection, procedural safety, and post-procedural evaluation are crucial in the management of these patients, with imaging work-up playing a pivotal role. Understanding the diagnostic and therapeutic imaging algorithms of CTEPH, the imaging features of patients amenable to BPA, all imaging findings observed during and immediately after the procedure and the changes observed during the follow-up is crucial for all interventional radiologists involved in the care of patients with CTEPH. This article illustrates the imaging work-up of patients with CTEPH amenable to BPA, the imaging findings observed before, during and after BPA, and provides a detailed description of all imaging modalities available for CTEPH evaluation.

Altered CELF4 splicing factor enhances pancreatic neuroendocrine tumors aggressiveness influencing mTOR and everolimus response.

Pancreatic neuroendocrine tumors (PanNETs) comprise a heterogeneous group of tumors with growing incidence. Recent molecular analyses provided a precise picture of their genomic and epigenomic landscape. Splicing dysregulation is increasingly regarded as a novel cancer hallmark influencing key tumor features. We have previously demonstrated that splicing machinery is markedly dysregulated in PanNETs. Here, we aimed to elucidate the molecular and functional implications of CUGBP ELAV-like family member 4 (CELF4), one of the most altered splicing factors in PanNETs. CELF4 expression was determined in 20 PanNETs, comparing tumor and non-tumoral adjacent tissue. An RNA sequencing (RNA-seq) dataset was analyzed to explore CELF4-linked interrelations among clinical features, gene expression, and splicing events. Two PanNET cell lines were employed to assess CELF4 function in vitro and in vivo. PanNETs display markedly upregulated CELF4 expression, which is closely associated with malignancy features, altered expression of key tumor players, and distinct splicing event profiles. Modulation of CELF4 influenced proliferation in vitro and reduced in vivo xenograft tumor growth. Interestingly, functional assays and RNA-seq analysis revealed that CELF4 silencing altered mTOR signaling pathway, enhancing the effect of everolimus. We demonstrate that CELF4 is dysregulated in PanNETs, where it influences tumor development and aggressiveness, likely by modulating the mTOR pathway, suggesting its potential as therapeutic target.

Telomere Maintenance Is Associated with Type 2 Diabetes Remission in Response to a Long-Term Dietary Intervention without Non-Weight Loss in Patients with Coronary Heart Disease: From the CORDIOPREV Randomized Controlled Trial.

In order to evaluate whether telomere maintenance is associated with type 2 diabetes remission, newly diagnosed type 2 diabetes patients without glucose-lowering treatment (183 out of 1002) from the CORDIOPREV study (NCT00924937) were randomized to consume a Mediterranean or low-fat diet. Patients were classified as Responders, those who reverted from type 2 diabetes during the 5 years of dietary intervention (n = 69), and Non-Responders, who did not achieve diabetes remission by the end of the follow-up period (n = 104). We found no differences in diabetes remission between the two diets, and we determined telomere length (TL) by measuring qPCR, telomerase activity using the TRAP assay, and direct redox balance based on the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSH) via colorimetric assay. Responders exhibited higher baseline TL in comparison with Non-Responders (p = 0.040), and a higher TL at baseline significantly predicted a higher probability of type 2 diabetes remission (OR 2.13; 95% CI, 1.03 to 4.41). After the dietary intervention, Non-Responders showed significant telomere shortening (-0.19, 95% CI -0.32 to 0.57; p = 0.005). Telomere shortening was significantly pronounced in type 2 diabetes patients with a worse profile of insulin resistance and/or beta-cell functionality: high hepatic insulin resistance fasting, a high disposition index (-0.35; 95% CI, -0.54 to -0.16; p < 0.001), and a low disposition index (-0.25; 95% CI, -0.47 to -0.01; p = 0.037). In addition, changes in TL were correlated to the GSH/GSSG ratio. Responders also showed increased telomerase activity compared with baseline (p = 0.048), from 0.16 (95% CI, 0.08 to 0.23) to 0.28 (95% CI, 0.15 to 0.40), with a more marked increase after the dietary intervention compared with Non-Responders (+0.07; 95% CI, -0.06-0.20; p = 0.049). To conclude, telomere maintenance may play a key role in the molecular mechanisms underlying type 2 diabetes remission in newly diagnosed patients. However, further larger-scale prospective studies are necessary to corroborate our findings.

Dietary antioxidant intake reduces carotid intima-media thickness in coronary heart disease patients: From the CORDIOPREV study.

BACKGROUND: Atherosclerosis is the leading underlying cause of coronary heart disease (CHD). In patients with CHD, intima-media thickness of common carotid arteries (IMT-CC) is a reliable, validated, and non-invasive marker of the progression of atherosclerosis. Dietary intervention may affect IMT-CC evolution through different pathways. There is a lack of clinical trials evaluating the effect of total dietary antioxidant content of diets on IMT-CC, especially in patients with CHD. OBJECTIVE: We evaluated the correlation between the diet's total antioxidant content and the changes in IMT-CC produced after 5 years of dietary intervention following two healthy diet models (Mediterranean diet and low-fat diet). We also evaluated whether the diet's total antioxidant content was related to the total redox capacity of the participants. METHODS: From the total participants of the CORDIOPREV study (clinical trial register NCT00924937), 805 participants completed the IMT-CC measurement and the dietary antioxidant evaluation at baseline and after 5 years of dietary intervention. IMT-CC was carried out by ultrasound and the dietary antioxidant evaluation was performed by the Dietary Antioxidant Index (DAI). Additionally, direct redox balance was evaluated in a subset of population by the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSH) by colorimetric assay. RESULTS: We observed an inverse correlation between evolution of DAI and IMT-CC after 5-years of dietary intervention. The mean of the DAI index augmented in the Mediterranean Diet group, whereas it decreased in the Low-fat group. DAI was correlated to the GSH/GSSG ratio, supporting DAI as an adequate estimator of diet's antioxidant content. When looking for individual components of the DAI that were associated to the changes in IMT-CC, an inverse correlation was found for carotenoids, vitamin E, vitamin C, and zinc and the IMT-CC. CONCLUSIONS: Our study indicates that, after five years of dietary intervention, changes in DAI inversely correlate with changes in IMT-CC in patients with CHD. Overall effect of Mediterranean diet resulted in an increase of DAI, conversely to low-fat. Specific elements included in the DAI index were inversely correlated with IMT-CC.

Contextual Factors Influencing the Adoption of Physical Activity Direct Education and Policy, Systems, and Environmental Change Initiatives by Virginia EFNEP and SNAP-Ed Staff.

OBJECTIVE: To explore factors influencing the adoption of direct education programs and policy, systems, and environmental (PSE) change initiatives focused on physical activity for Supplemental Nutrition Assistance Program-eligible audiences by Virginia Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff. METHODS: Online survey with Expanded Food and Nutrition Education Program and SNAP-Ed peer (paraprofessional) educators (n = 28) and SNAP-Ed agents (master of science level) (n = 9) in Virginia. Descriptive statistics were computed for sociodemographic characteristics and responses to questions on the basis of Likert-type scales. Exploratory factor analyses were run to identify the underlying structures of the different variables. RESULTS: The main factors for peer educators were related to substituting nutrition programs or content for physical activity programs. Other factors included staff qualifications and expectations about leading vs teaching physical activities. For PSEs, the top factors were the capacity to reach many community members, attract new partners and stakeholders, and personal interest in the PSE. CONCLUSIONS AND IMPLICATIONS: The results provide insight into potential barriers and motivators for adopting physical activity education and PSEs within community-based initiatives and can be used to inform program planning and staff training. Additional research is warranted to examine other factors influencing the adoption and implementation of physical activity programs and PSEs.

Reduction of circulating methylglyoxal levels by a Mediterranean diet is associated with preserved kidney function in patients with type 2 diabetes and coronary heart disease: From the CORDIOPREV randomized controlled trial.

AIM: Advanced glycation end products (AGEs) play a role in kidney disease in type 2 diabetes mellitus (T2DM). However, there have been no prior controlled clinical trials examining the effects of specific diets on AGE metabolism and their impact on kidney function. Our aim was to assess whether modulating AGE metabolism resulting in reduced AGEs levels, after consumption of two healthy diets, could delay kidney function decline in patients with T2DM and coronary heart disease (CHD). METHODS: T2DM patients (540 out of 1002 patients from the CORDIOPREV study), with estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73 m2, were classified based on their baseline kidney function: normal eGFR (≥ 90 ml/min/1.73 m2), mildly decreased eGFR (60- < 90 ml/min/1.73 m2) and moderately decreased eGFR (<60 ml/min/1.73 m2). Serum AGE levels, methylglyoxal (MG) and N-carboximethyllysine (CML), and gene expression related to AGE metabolism (AGER1, RAGE, and GloxI mRNA) were measured before and after 5-years of dietary intervention (a Mediterranean diet or a low-fat diet). RESULTS: Mediterranean diet produced a lower declined of eGFR compared to the low-fat diet only in patients with mildly decreased eGFR (P = 0.035). Moreover, Mediterranean diet was able to decrease MG levels and increase GloxI expression in normal and mildly decreased eGFR patients (all P < 0.05). One standard deviation increment of MG levels after dietary intervention resulted in a 6.8-fold (95 % CI 0.039;0.554) higher probability of eGFR decline. CONCLUSION: Our study showed that lowering circulating AGE levels, specifically MG, after following a Mediterranean diet, might be linked to the preservation of kidney function, evidenced by a decreased decline of eGFR in T2DM patients with CHD. Patients with mildly decreased eGFR could potentially benefit more from AGE reduction in maintaining kidney function.

Quinoa panicles contribute to carbon assimilation and are more tolerant to salt stress than leaves.

Contribution of inflorescences to seed filling have attracted great attention given the resilience of this photosynthetic organ to stressful conditions. However, studies have been almost exclusively focused to small grain cereals. In this study, we aimed to explore these responses in quinoa, as a climate resilient seed crop of elevated economic and nutritious potential. We compared the physiological and metabolic performance of panicles and leaves of two quinoa cultivars growing under contrasting salinity levels. Plant growth, photosynthetic and transpiratory gas exchange and chlorophyll fluorescence were monitored in inflorescences and leaves throughout the experiment. At flowering stage, young and mature leaves and panicles were sampled for key metabolic markers related to carbon, nitrogen and secondary metabolisms. When subjected to salt stress, panicles showed attenuated declines on photosynthesis, water use, pigments, amino acids, and protein levels as compared to leaves. In fact, the assimilation rates, together with a high hexose content evidenced an active photosynthetic role of the panicle under optimal and salt stress conditions. Moreover, we also found significant genotypic variability for physiological and metabolic traits of panicles and leaves, which emphasizes the study of genotype-dependent stress responses at the whole plant level. We conclude that quinoa panicles are less affected by salt stress than leaves, which encourages further research and exploitation of this organ for crop improvement and stress resilience considering the high natural diversity.

US Adults' Perceptions, Beliefs, and Behaviors towards Plant-Rich Dietary Patterns and Practices: International Food Information Council Food and Health Survey Insights, 2012-2022.

Expert groups recommend that populations adopt dietary patterns higher in whole, plant-based foods and lower in red and processed meat as a high-impact climate action. Yet, there is limited understanding of populations' willingness to adopt plant-rich dietary patterns. This study examined United States (US) adults' perceptions, beliefs, and behaviors towards plant-rich dietary patterns and practices over a decade. Fifteen questions from the International Food Information Council's Food and Health Surveys (2012-2022) were analyzed across four sustainability domains (i.e., human health, environmental, social, and economic domains). Most respondents had favorable perceptions of environmentally sustainable food and beverages, but sustainability influenced less than half of consumers' purchase decisions. Plant-rich dietary pattern adherence increased across survey years (12.1% [2019] to 25.8% [2022], p < 0.001). One-quarter (28.1%) of Americans reported reducing their red meat intake over 12 months (2020-2022). Yet, another 15.5% reported greater red meat intake, and 18.8% reported greater plant-based meat alternative (PBMA) intake over 12 months. The percentage of respondents who reported greater red meat and PBMA consumption in the previous 12 months significantly increased across the years surveyed (2020-2022, p < 0.05). IFIC Survey findings highlight growing US consumer awareness of health, environmental, and social sustainability but low adoption of plant-rich dietary patterns and practices. Government leadership and coordinated actions by health professionals, civil society, and businesses are needed to educate and incentivize Americans to adopt plant-rich dietary behaviors, and greater industry transparency is needed to show how food and beverage products support human and planetary health.

Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting.

BACKGROUND: Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. METHODS: In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients' post-operative functionality was assessed with the MSTS score. RESULTS: Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients' mean post-operative MSTS score was 29.6. CONCLUSIONS: Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis.

Association between telomere length and intima-media thickness of both common carotid arteries in patients with coronary heart disease: From the CORDIOPREV randomized controlled trial.

BACKGROUND AND AIMS: A critical telomere length (TL) is associated with cardiovascular mortality. Dietary habits have been demonstrated to affect cardiovascular risk. However, it remains unclear how exactly TL determines the response to specific dietary approaches in the reduction of arterial injury. We aimed to evaluate whether TL was associated with the progression of arterial injury (assessed by intima-media thickness of both common carotid arteries: IMT-CC), after long-term consumption of two healthy dietary models in patients with coronary heart disease (CHD). METHODS: From the 1002 CHD patients of the CORDIOPREV study, 903 completed IMT-CC and TL evaluation at baseline and were randomized to follow a Mediterranean diet or a low-fat diet for 5 years. RESULTS: Patients at risk of short TL (TL < 20th percentile) presented an elevated IMT-CC, (0.79 ± 0.17 vs patients at non-risk 0.74 ± 0.17 p < 0.001). TL and IMT-CC showed an inverse association (ß = -0.035, p = 0.002). Patients who consumed a Mediterranean diet, regardless of the risk of short TL, showed a significant decrease in IMT-CC, with a higher reduction in those patients with risk of short TL (-0.03 ± 0.11, p = 0.036). TL (ß = 0.019, p = 0.024), age (ß = -0.001, p = 0.031), energy intake (ß = -0.000, p = 0.036), use of statins (ß = -0.027, p = 0.028) and allocation into the Mediterranean diet (vs low-fat diet) (ß = -0.024, p = 0.003) were significant contributors to changes in IMT-CC. CONCLUSIONS: Patients who had a reduced TL exhibited a greater decrease in IMT-CC after consuming a Mediterranean diet.

COVID-19-related financial scarcity is associated with greater delay discounting but not probability discounting.

Prior studies suggest that scarcity increases delay discounting (devaluation of delayed outcomes) and disturbs other decision-making processes. Evidence on the effect of COVID-19 on delay discounting is mixed. Also, no study has examined the effect of COVID-19-related scarcity on probability discounting (devaluation of probabilistic outcomes). The goal of the study was to examine cross-sectional associations between financial impact during the COVID-19 pandemic, delay discounting, and probability discounting. During April 2020, 1012 participants with low income were recruited on Amazon Mechanical Turk and completed measures of delay and probability discounting, perceived COVID-19-related financial impacts, and food security. Regression analyses indicate that compared to those with no COVID-19-related financial impacts, those with severe COVID-19-related financial impacts had greater delay discounting of money and greater delay discounting of a grocery gift card. Also, greater food insecurity in the past month was associated with greater delay discounting of a grocery gift card but not delay discounting of money. Perceived COVID-19 related financial impact was not associated with probability discounting. Combined with laboratory experiments, this study provides additional support for the idea that feelings of scarcity may increase delay discounting. However, as this study was observational, no assumptions of causality should be made about the specific effect of COVID-19 on delay discounting.

Application of Compositional Data Analysis to Study the Relationship between Bacterial Diversity in Human Faeces and Sex, Age, and Weight.

This work uses Compositional Data Analysis (CoDA) to examine the typical human faecal bacterial diversity in 39 healthy volunteers from the Andalusian region (Spain). Stool samples were subjected to high-throughput sequencing of the V3 and V4 regions of the 16S ribosomal RNA gene using Illumina MiSeq. The numbers of sequences per sample and their genus-level assignment were carried out using the Phyloseq R package. The alpha diversity indices of the faecal bacterial population were not influenced by the volunteer's sex (male or female), age (19-46 years), and weight (48.6-99.0 kg). To study the relationship between these variables and the faecal bacterial population, the ALDEx2 and coda4microbiome CoDA packages were used. Applying ALDEx2, a trend suggesting a connection between sex and the genera Senegalimassilia and Negatibacillus (slightly more abundant in females) and Desulfovibrio (more abundant in males) was found. Moreover, age was tentatively associated with Streptococcus, Tizzerella, and Ruminococaceae_UCG-003, while weight was linked to Senegalimassilia. The exploratory tool of the coda4microbiome package revealed numerous bacterial log-ratios strongly related to sex and, to a lesser extent, age and weight. Moreover, the cross-sectional analysis identified bacterial signature balances able to assign sex to samples regardless of controlling for volunteers' age or weight. Desulfovibrio, Faecalitalea, and Romboutsia were relevant in the numerator, while Coprococcus, Streptococcus, and Negatibacillus were prominent in the denominator; the greater presence of these could characterise the female sex. Predictions for age included Caproiciproducens, Coprobacter, and Ruminoclostridium in the numerator and Odoribacter, Ezakiella, and Tyzzerella in the denominator. The predictions depend on the relationship between both groups, but the abundance of the first group and scarcity of the second could be related to older individuals. However, the association of the faecal bacterial population with weight did not yield a satisfactory model, indicating scarce influence. These results demonstrate the usefulness of the CoDA methodology for studying metagenomics data and, specifically, human microbiota.

Dietary modulation of advanced glycation end products metabolism on carotid intima-media thickness in type 2 diabetes patients: From the CORDIOPREV study / Modulación a través de la dieta del metabolismo de los productos finales de glicación avanzada sobre el grosor de la íntima-media carotídea en pacientes con diabetes tipo 2: estudio CORDIOPREV

Background: Advanced glycation end products (AGEs) are pro-oxidant and cytotoxic compounds involved in the progression of chronic diseases as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The total body burden of AGEs also depend of those consume through the diet. Our aim was to analyze whether the reduction of AGE levels, after the consumption of two-healthy diets were associated with a greater decrease of intima-media thickness of both common carotid arteries (IMT-CC) in patients with T2DM and coronary heart disease (CHD). Methods: 540 CHD patients with T2DM, at baseline, from the CORDIOPREV study, were divided into two groups: (1) Responders, patients whose IMT-CC was reduced or not changed after dietary intervention and (2) Non-responders, patients whose IMT-CC was increased after dietary intervention. A total of 423 completed baseline and the 5-year follow-up carotid ultrasounds were analyzed in this study.Results: Our data showed that Responders, despite had a higher baseline IMT-CC and serum methylglyoxal (MG) levels than Non-responders, showed a reduction of serum levels of this glycotoxin after dietary intervention. Conversely, in patients whose IMT-CC was increased after dietary intervention (Non-responders), serum MG levels were increased. Moreover, an increase of circulating level of AGEs (and in particular, MG), after dietary intervention, could be considered a risk factor for the progression of atherosclerosis in patients with T2DM and CHD. Conclusion: These results support the importance of identifying underlying mechanisms in the context of secondary prevention of CVD that would provide therapeutic targets to reduce the high risk of cardiovascular events of these patients.(AU)

Antecedentes: Los productos finales de glicación avanzada (AGE) son compuestos prooxidantes y citotóxicos involucrados en la progresión de enfermedades crónicas, como las enfermedades cardiovasculares (ECV) y la diabetes mellitus tipo 2 (DMT2). La carga corporal total de AGE también depende de aquellos que se consumen a través de la dieta. Nuestro objetivo fue analizar si la reducción de los niveles de AGE, tras el consumo de dos dietas cardiosaludables, se asociaba con una mayor disminución del grosor íntima-media de ambas arterias carótidas comunes (GIM-CC) en pacientes con DMT2 y enfermedad coronaria establecida (EC). Métodos: Un total de 540 pacientes con EC y DMT2, al inicio del estudio CORDIOPREV, se dividieron en dos grupos: 1) respondedores, pacientes cuyo GIM-CC disminuyó o no se modificó tras la intervención dietética, y 2) no respondedores, pacientes cuyo GIM-CC aumentó tras la intervención dietética. En este estudio se incluyeron, finalmente, un total de 423 pacientes, aquellos que completaron el estudio de ecografía carotídea tanto en el basal como a los 5 años de intervención dietética. Resultados: Nuestros resultados mostraron que los respondedores, a pesar de tener un GIM-CC y niveles séricos de metilglioxal (MG) más elevados que los no respondedores, mostraron una reducción de los niveles séricos de esta glicotoxina tras la intervención dietética. Por el contrario, en los pacientes cuyo IMT-CC aumentó tras la intervención dietética (no respondedores), los niveles séricos de MG aumentaron. Un aumento de los niveles circulantes de AGE (y en particular de MG) tras la intervención dietética podría considerarse un factor de riesgo para la progresión de la aterosclerosis en pacientes con DMT2 y CE. Conclusión: Estos resultados apoyan la importancia de identificar los mecanismos subyacentes en el contexto de la prevención secundaria de la ECV que proporcionarían dianas y estrategias terapéuticas para reducir el alto riesgo de eventos...(AU)

Oral intake of Lactiplantibacillus pentosus LPG1 Produces a Beneficial Regulation of Gut Microbiota in Healthy Persons: A Randomised, Placebo-Controlled, Single-Blind Trial.

The search for vegetable-origin probiotic microorganisms is a recent area of interest. This study conducted a phase I clinical trial to assess the effects of oral administration of Lactiplantibacillus pentosus LPG1, a natural strain with probiotic potential isolated from table olive fermentations, on the gut microbiota. The trial was a randomised, placebo-controlled, single-blind study involving 39 healthy volunteers. Group A (n = 20) ingested one capsule/day of L. pentosus LPG1 containing 1 × 1010 UFC/capsule, while Group B (n = 19) received one capsule/day containing only dextrose (placebo). The capsules were taken during breakfast for 30 consecutive days. Human stool samples were collected from all volunteers at the beginning (baseline) and at the end of the study (post-intervention) and were subjected to 16S rRNA metataxonomic analysis using Illumina MiSeq. Sequencing data at the genus level were statistically analysed using traditional methods and compositional data analysis (CoDA). After treatment, the alpha diversity in Group B (placebo) decreased according to an increase in the Berger and Parker dominance index (p-value < 0.05); moreover, dominance D increased and Simpson 1-D index decreased (p-value < 0.10). The Lactobacillus genus in the faeces was included in the CoDA signature balances (selbal and coda4microbiome) and played a notable role in distinguishing samples from baseline and post-intervention in Group A (LPG1). Additionally, ingesting L. pentosus LPG1 modified the gut microbiota post-intervention, increasing the presence of Parabacteroides and Agathobacter, but reducing Prevotella. These findings suggest that L. pentosus LPG1 is a potentially beneficial gut microbiota modulator in healthy persons.

Changes in quantity plant-based protein intake on type 2 diabetes remission in coronary heart disease patients: from the CORDIOPREV study.

PURPOSE: Diabetes remission is a phenomenon described in the context of drastic weight loss due to bariatric surgery or low-calorie diets. Evidence suggests that increasing the intake of plant protein could reduce the risk of type 2 diabetes. We sought for association between changes in plant protein intake in the context of 2 healthy diets without weight loss nor glucose-lowering medication, and diabetes remission in coronary heart disease patients from the CORDIOPREV study. METHODS: Newly diagnosed type 2 diabetes participants without glucose-lowering treatment were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was assessed with a median follow-up of 60 months according to the ADA recommendation. Information on patient's dietary intake was collected using food-frequency questionnaires. At first year of intervention, 177 patients were classified according to changes in plant protein consumption into those who increased or decreased its intake, in order to perform an observational analysis on the association between protein intake and diabetes remission. RESULTS: Cox regression showed that patients increasing plant protein intake were more likely to remit from diabetes than those who decreased its intake (HR = 1.71(1.05-2.77)). The remission occurred mainly at first and second year of follow-up with diminished number of patients achieving remission in the third year onwards. The increase in plant protein was associated with lower intake of animal protein, cholesterol, saturated fatty acids, and fat, and with higher intake of whole grains, fibre, carbohydrates, legumes, and tree nuts. CONCLUSION: These results support the need to increase protein intake of vegetal origin as dietary therapy to reverse type 2 diabetes in the context of healthy diets without weight loss.

Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index.

PURPOSE: To evaluate percutaneous transhepatic biliary drainage (PTBD) safety and efficacy in patients with perihilar cholangiocarcinoma (PCCA). METHODS: This retrospective observational study included patients with PCCA and obstructive cholestasis referred for a PTBD in our institution between 2010 and 2020. Technical and clinical success rates and major complication and mortality rates one month after PTBD were used as main variables. Patients were divided and analyzed into two groups: > 30 and < 30 Comprehensive Complication Index (CCI). We also evaluated post-surgical outcomes in patients undergoing surgery. RESULTS: Out of 223 patients, 57 were included. Technical success rate was 87.7%. Clinical success at 1 week was 83.6%, before surgery 68.2%, 80.0% at 2 weeks and 86.7% at 4 weeks. Mean total bilirubin (TBIL) values were 15.1 mg/dL (baseline), 8.1 mg/dL one week after PTBD), 6.1 mg/dL (2 weeks) and 2.1 mg/dL (4 weeks). Major complication rate was 21.1%. Three patients died (5.3%). Risk factors for major complications after the statistical analysis were: Bismuth classification (p = 0.01), tumor resectability (p = 0.04), PTBD clinical success (p = 0.04), TBIL 2 weeks after PTBD (p = 0.04), a second PTBD (p = 0.01), total PTBDs (p = 0.01) and duration of drainage (p = 0.03). Major postoperative complication rate in patients who underwent surgery was 59.3%, with a median CCI of 26.2. CONCLUSION: PTBD is safe and effective in the management of biliary obstruction caused by PCCA. Bismuth classification, locally advanced tumors, and failure to achieve clinical success in the first PTBD are factors related to major complications. Our sample reported a high major postoperative complication rate, although with an acceptable median CCI.

Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework to Advance the Science and Practice of Healthy Food Retail.

Although healthy food retail strategies are widely used, there appears to be a limited understanding of the processes and determinants for successful adoption, implementation, and sustainment. To fill this gap, we recommend the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to be used to advance the science and practice of healthy food retail. In this perspective, we: (1) introduce EPIS and describe why it was chosen as a recommended implementation science framework for healthy food retail, (2) highlight healthy food retail evidence supporting EPIS, and (3) discuss research and practice needs moving forward.

A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States.

OBJECTIVE: To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE: Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA: English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION: Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS: Data were analyzed by the lead investigator and described narratively. RESULTS: Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS: The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.