Does Magnesium Provide a Protective Effect in Crohn's Disease Remission? A Systematic Review of the Literature.

This systematic review evaluates the hypothesis that optimal serum magnesium levels may enhance remission rates in Crohn's disease (CD) and considers whether magnesium supplementation could be beneficial in CD management. This review aims to synthesize available evidence concerning the impact of serum magnesium on disease remission in CD, and to analyze the effectiveness and mechanistic roles of magnesium supplementation. Adhering to the PRISMA guidelines, we searched PubMed, Web of Science, and Scopus up to January 2024 using MeSH terms and free-text queries related to CD and magnesium. The inclusion criteria were studies that investigated serum magnesium levels, effects of supplementation, and the inflammatory mechanisms in CD remission. From the 525 records identified, eight studies met the inclusion criteria after the removal of duplicates and irrelevant records. These studies, conducted between 1998 and 2023, involved a cumulative sample of 453 patients and 292 controls. Key findings include significantly lower serum magnesium levels in CD patients (0.79 ± 0.09 mmol/L) compared to controls (0.82 ± 0.06 mmol/L), with up to 50% prevalence of hypomagnesemia in CD patients observed in one study. Notably, CD patients, particularly men, exhibited lower magnesium intake (men: 276.4 mg/day; women: 198.2 mg/day). Additionally, low magnesium levels correlated with increased sleep latency (95% CI -0.65 to -0.102; p = 0.011) and decreased sleep duration (95% CI -0.613 to -0.041; p = 0.028). Another key finding was the significant association between low serum magnesium levels and elevated CRP levels as an indicator of CD disease activity. The findings support the hypothesis that serum magnesium levels are significantly lower in CD patients compared to healthy controls and suggest that magnesium supplementation could improve CD management by enhancing remission rates and sleep quality. However, more rigorous, evidence-based research is necessary to define specific supplementation protocols and to fully elucidate the role of magnesium in CD pathophysiology.

Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients.

BACKGROUND: Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function. OBJECTIVE: The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA. METHODS: 72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention. RESULTS: In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p= 0.001, p= 0.002, p= 0.001, p= 0.001, p= 0.001, respectively) after 12 weeks of treatment. CONCLUSION: The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise.

Effects of Four Weeks of In-Season Pre-Workout Supplementation on Performance, Body Composition, Muscle Damage, and Health-Related Markers in Basketball Players: A Randomized Controlled Study.

This randomized, double-blinded, experimental study investigated the effects of a four-week daily pre-workout supplementation (200 mg caffeine, 3.3 g creatine monohydrate, 3.2 g ß-alanine, 6 g citrulline malate, and 5 g BCAA) vs. placebo (isocaloric maltodextrin) on anaerobic (jumping, sprinting, agility, and the running-based anaerobic sprint test: RAST) and aerobic (Yo-Yo intermittent recovery test level 1) performance, as well as on body composition and selective muscle damage/health-related blood markers in well-trained basketball players during the in-season period. Eighteen basketball players (age: 24.4 ± 6.3 years, height: 185.7 ± 8.0 cm, weight: 85.7 ± 12.8 kg, body fat: 16.5 ± 4.2%) were randomly assigned into two groups: pre-workout supplement (PWS, n = 10) or placebo (PL, n = 8). PWS consumption increased aerobic performance (PWS: 8 ± 6%; PL: -2 ± 6%; p = 0.004) compared to PL. A significant decrease was observed in peak (F = 7.0; p = 0.017), average (F = 10.7; p = 0.005), and minimum power (F = 5.1; p = 0.039) following 4 weeks of supplementation in both groups. No other significant changes were observed between groups (p > 0.05). In conclusion, the consumption of the current PWS over a four-week period appears to positively influence the aerobic performance of well-trained basketball players during the in-season period. However, it does not appear to mitigate the observed decline in anaerobic power, nor does it affect performance in jumping, sprinting, and agility, or alter body composition or selective muscle damage/health-related blood markers.

Influencia de la intervención nutricional pre-cirugía de cáncerdigestivo en la estancia hospitalaria / Influence of pre-surgery nutritional intervention on the hospital stay in patients with digestive cancer

Introducción: La desnutrición hospitalaria en el paciente oncológico digestivo subsidiario de cirugía tiene una elevada prevalencia y supone un aumento de las complicaciones postquirúrgicas, de la estancia hospitalaria y de los costes asociados a esta.Objetivos: El objetivo principal es analizar si la intervención nutricional pre-cirugía en pacientes con cáncer digestivo tiene impacto en la estancia hospitalaria. Los objetivos secundarios son analizar el estado nutricional antes de la cirugía, ver si existe correlación entre los marcadores analíticos nutricionales y la duración de la estancia hospitalaria y entre recibir intervención nutricional preoperatoria y la evolución de los parámetros antropométricos.Material y Métodos: Estudio prospectivo de 1 año de duración en el que se incluyeron 88 pacientes con cáncer digestivo subsidiarios de cirugía. Se comparó la estancia hospitalaria entre un grupo de estos pacientes que recibió intervención nutricional pre-cirugía y otro grupo que no la recibió.Resultados: Se incluyeron 47 pacientes en el grupo de intervención y 41 en el grupo control. Entre los pacientes valorados (grupo intervención) la desnutrición fue del 29,5% previa a la cirugía y del 64% tras esta. La suplementación nutricional oral alcanzó al 80% de los pacientes desnutridos o en riesgo, iniciándose en el 51% de ellos antes de la intervención quirúrgica. Se observaron diferencias significativas de menos de 5 días de hospitalización en los pacientes del grupo de intervención.Discusión: La diferencia en los días de hospitalización en el grupo de intervención podría deberse a la intervención y suplementación nutricional previa a la cirugía ya que ambos recibieron tratamiento nutricional durante el ingreso en la misma proporción...(AU)

Introduction: Hospital malnutrition in digestive cancerpatients requiring surgery has a high prevalence and repre-sents an increase in post-surgical complications, hospital stayand its associated costs.Objectives: The main objective is to analyze whether pre-surgery nutritional intervention in patients with digestive can-cer has an impact on hospital stay. The secondary objectivesare to analyze the nutritional status before surgery, to see ifthere is correlation between nutritional analytical markers andthe length of hospital stay and between receiving preopera-tive nutritional intervention and the evolution of anthropo-metric parameters. Material and Methods: Prospective 1-year study in which88 patients with digestive cancer requiring surgery were in-cluded. The hospital stay was compared between a group ofthese patients who received nutritional intervention pre-surgery and another group that did not receive it.Results: 47 patients were included in the interventiongroup and 41 in the control group. Among the patients eval-uated (intervention group), malnutrition was 29,5% beforesurgery and 64% after surgery. Oral nutritional supplementa-tion reached 80% of malnourished or at-risk patients, startingin 51% of them before surgery. Significant differences of lessthan 5 days of hospitalization were observed in patients in theintervention group.Discussion: The difference in the days of hospitalization inthe intervention group could be due to the intervention andnutritional supplementation prior to surgery since both re-ceived nutritional treatment during hospitalization in the sameproportion.Conclusions: The nutritional assessment of these patientsprior to surgery allows us to detect patients at risk of malnu-trition or already established malnutrition and significantly re-duce hospital stay by up to 5 days.(AU)

Nutrition interventions for body composition, physical function, cognition in hospitalized older adults: A systematic review of individuals 75 years and older.

BACKGROUND: Globally, the oldest old population is expected to triple by 2050. Hospitalization and malnutrition can result in progressive functional decline in older adults. Minimizing the impact of hospitalization on functional status in older adults has the potential to maintain independence, reduce health and social care costs, and maximize years in a healthy state. This study aimed to systematically review the literature to identify nutritional interventions that target physical function, body composition, and cognition in the older population (≥ 75 years). METHODS: A systematic review was conducted to evaluate the efficacy of nutritional interventions on physical function, body composition, and cognition in adults aged ≥ 75 years or mean age ≥80 years. Searches of PubMed (National Institutes of Health, National Library of Medicine), Scopus (Elsevier), EMBASE (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCOhost), and PsycInfo (EBSCOhost) were conducted. Screening, data extraction, and quality assessment were performed in duplicate and independently (CRD42022355984; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=355984). RESULTS: Of 8311 citations identified, 2939 duplicates were excluded. From 5372 citations, 189 articles underwent full-text review leaving a total of 12 studies for inclusion. Interventions were food-based, protein-based, carbohydrate-based, personalized, or used parenteral nutrition. Ten studies monitored anthropometric or body composition changes with three showing maintenance or improvements in lean mass, body mass index, triceps skinfold, and mid-upper arm circumference compared with the control group. Six studies monitored physical function but only the largest study found a beneficial effect on activities of daily living. Two of three studies showed the beneficial effects of nutritional intervention on cognition. CONCLUSION: There are few, high-quality, nutrition-based interventions in older adults ≥75 years. Despite heterogeneity, our findings suggest that large, longer-term (>2 weeks) nutritional interventions have the potential to maintain body composition, physical function, and cognition in adults aged 75 years and older during hospitalization.

Prehabilitation programs in liver resection: a narrative review.

BACKGROUND AND OBJECTIVE: Liver resection (LR) is a commonly performed surgical procedure for the management of hepatocellular carcinoma and other liver conditions. Despite its benefits in providing patients a potential cure, it is also associated with significant postoperative complications and prolonged recovery periods. In recent years, pre-operative rehabilitation (prehabilitation) has emerged as an up-and-coming strategy to optimize patients' physical, psychological and functional status before LR, leading to improved surgical and patient postoperative outcomes. Hence, our review aims to explore and synthesize the existing literature on prehabilitation in LR to provide an overview of the current evidence to help guide physicians in managing their patients. METHODS: A comprehensive literature search was conducted in multiple electronic databases from inception to July 2023. The search strategy was tailored to capture studies investigating the role of prehabilitation in LR, and the factors that contribute to beneficial outcomes in the postoperative period. KEY CONTENT AND FINDINGS: Prehabilitation programs encompass a multifaceted approach to enhance surgical outcomes and patient well-being. This considers the specific needs of the varying patient populations, such as the elderly, or the cancer ridden. Improving physical fitness, nutritional supplementation and psychological support are the common tenets of prehabilitation. In physical prehabilitation, patients are engaged in intensive physical exercise often by means of a cycle ergometer. Addressing nutritional deficiencies through supplements and dietary interventions is also vital. Psychosocial assessments, advance care planning, music therapy, and progressive relaxation exercises are shown to enhance patient resilience and well-being. In addition, innovative approaches such as optimizing fluid balance, avoiding epidural analgesia, perioperative steroid administration, phosphate correction and branched-chain amino acid supplementation are being explored. CONCLUSIONS: Prehabilitation is important in optimizing patients before LR and is key in improving postoperative outcomes. Several prehabilitation strategies exist, but no formal consensus exists on patient selection and an ideal program.

The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials.

Purpose: The prevalence of hypertension (HTN) increases with age and there is a need for effective, evidence-based treatments for HTN among older adults. The objective of this study was to perform a network meta-analysis to evaluate the effectiveness of different forms of nutritional supplementation on reducing blood pressure in older adults. Methods: A systematic review using PubMed and Clinical Key was performed to identify randomized controlled trials (RCTs) evaluating the effects of dietary supplements on blood pressure in adults older than 65 years of age. Network meta-analysis (NMA) was used to compare and rank the effects of different supplements on systolic (sBP), diastolic (dBP), and mean (mBP) blood pressure. Supplements were ranked according to P score. Meta-regressions were conducted to examine whether treatment effects were moderated by baseline BP and supplementation duration. Findings: We identified 144 relevant studies in the literature, twelve of which met criteria for inclusion in NMA. The included studies were published between 2003 and 2022. In reducing sBP, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), inorganic nitrates, tart cherry juice, and vitamin D supplementation were more effective than placebo, and the effect of tart cherry juice outranked that of vitamin D, vitamin E, and vitamin K2. In reducing dBP, inorganic nitrates, DHA and EPA, protein, resveratrol, and vitamin D supplementation were more effective than placebo, and the effect of resveratrol outranked that of tart cherry juice, vitamin D, vitamin E, and vitamin K2. However, the effects of tart cherry juice on sBP and resveratrol on dPB were smaller than the pooled effect of placebo, and none of the pairwise differences between the effects of examined supplements were statistically significant. Caution is needed when interpreting these results given concerns about the risk of bias assessed in seven of the twelve studies included in this analysis.

Acute effects of caffeine or quercetin ingestion on motor unit firing pattern before and after resistance exercise.

The aim of the present study was to investigate the acute effect of caffeine or quercetin ingestion on motor unit firing patterns and muscle contractile properties before and after resistance exercise. High-density surface electromyography (HDs-EMG) during submaximal contractions and electrically elicited torque in knee extensor muscles were measured before (PRE) and 60 min after (POST1) ingestion of caffeine, quercetin glycosides, or placebo, and after resistance exercise (POST2) in ten young males. The Convolution Kernel Compensation technique was used to identify individual motor units of the vastus lateralis muscle for the recorded HDs-EMG. Ingestion of caffeine or quercetin induced significantly greater decreases in recruitment thresholds (RTs) from PRE to POST1 compared with placebo (placebo: 94.8 ± 9.7%, caffeine: 84.5 ± 16.2%, quercetin: 91.9 ± 36.7%), and there were significant negative correlations between the change in RTs (POST1-PRE) and RT at PRE for caffeine (rs = - 0.448, p < 0.001) and quercetin (rs = - 0.415, p = 0.003), but not placebo (rs = - 0.109, p = 0.440). Significant positive correlations between the change in firing rates (POST2-POST1) and RT at PRE were noted with placebo (rs = 0.380, p = 0.005) and quercetin (rs = 0.382, p = 0.007), but not caffeine (rs = 0.069, p = 0.606). No significant differences were observed in electrically elicited torque among the three conditions. These results suggest that caffeine or quercetin ingestion alters motor unit firing patterns after resistance exercise in different threshold-dependent manners in males.

Impact of preconception and antenatal supplementation with myo-inositol, probiotics, and micronutrients on offspring BMI and weight gain over the first 2 years.

BACKGROUND: Nutritional intervention preconception and throughout pregnancy has been proposed as an approach to promoting healthy postnatal weight gain in the offspring but few randomised trials have examined this. METHODS: Measurements of weight and length were obtained at multiple time points from birth to 2 years among 576 offspring of women randomised to receive preconception and antenatally either a supplement containing myo-inositol, probiotics, and additional micronutrients (intervention) or a standard micronutrient supplement (control). We examined the influence on age- and sex-standardised BMI at 2 years (WHO standards, adjusting for study site, sex, maternal parity, smoking and pre-pregnancy BMI, and gestational age), together with the change in weight, length, BMI from birth, and weight gain trajectories using latent class growth analysis. RESULTS: At 2 years, there was a trend towards lower mean BMI among intervention offspring (adjusted mean difference [aMD] - 0.14 SD [95% CI 0.30, 0.02], p = 0.09), and fewer had a BMI > 95th percentile (i.e. > 1.65 SD, 9.2% vs 18.0%, adjusted risk ratio [aRR] 0.51 [95% CI 0.31, 0.82], p = 0.006). Longitudinal data revealed that intervention offspring had a 24% reduced risk of experiencing rapid weight gain > 0.67 SD in the first year of life (21.9% vs 31.1%, aRR 0.76 [95% CI 0.58, 1.00], p = 0.047). The risk was likewise decreased for sustained weight gain > 1.34 SD in the first 2 years of life (7.7% vs 17.1%, aRR 0.55 [95% CI 0.34, 0.88], p = 0.014). From five weight gain trajectories identified, there were more intervention offspring in the "normal" weight gain trajectory characterised by stable weight SDS around 0 SD from birth to 2 years (38.8% vs 30.1%, RR 1.29 [95% CI 1.03, 1.62], p = 0.029). CONCLUSIONS: Supplementation with myo-inositol, probiotics, and additional micronutrients preconception and in pregnancy reduced the incidence of rapid weight gain and obesity at 2 years among offspring. Previous reports suggest these effects will likely translate to health benefits, but longer-term follow-up is needed to evaluate this. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02509988 (Universal Trial Number U1111-1171-8056). Registered on 16 July 2015.

Alcalase-Assisted Mytilus edulis Hydrolysate: A Nutritional Approach for Recovery from Muscle Atrophy.

Muscle atrophy is a complex physiological condition caused by a variety of reasons, including muscle disuse, aging, malnutrition, chronic diseases, immobilization, and hormonal imbalance. Beyond its effect on physical appearance, this condition significantly reduces the quality of human life, thus warranting the development of preventive strategies. Although exercising is effective in managing this condition, it is applicable only for individuals who can engage in physical activities and are not bedridden. A combination of exercise and nutritional supplementation has emerged as a more advantageous approach. Here, we evaluated the effects of enzyme-assisted hydrolysates of Mytilus edulis prepared using Protamex (PMH), Alcalase (AMH), or Flavourzyme (FMH) in protecting against muscle atrophy in a dexamethasone (Dex)-induced muscular atrophy model in vitro and in vitro. Alcalase-assisted M. edulis hydrolysate (AMH) was the most efficient among the tested treatments and resulted in higher protein recovery (57.06 ± 0.42%) and abundant amino acid composition (43,158 mg/100 g; 43.16%). AMH treatment also escalated the proliferation of C2C12 cells while increasing the total number of nuclei, myotube coverage, and myotube diameter. These results were corroborated by a successful reduction in the levels of proteins responsible for muscle atrophy, including E3 ubiquitin ligases, and an increase in the expression of proteins associated with muscle hypertrophy, including myogenin and MyHC. These results were further solidified by the successful enhancement of locomotor ability and body weight in zebrafish following AMH treatment. Thus, these findings highlight the potential of AMH in recovery from muscle atrophy.

Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study.

Introduction: Protein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS). Methods: A total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients. Results: After 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5-92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS. Conclusion: In a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation.

The impact of an oral nutritional supplement on body weight gain in older adults with malnutrition: an open-label randomized controlled trial.

BACKGROUND: The global aging population is expanding rapidly and many individuals have a particularly higher risk of malnutrition. Malnutrition can lead to impaired body function, morbidity, and mortality. Meeting nutritional requirements is a key strategy to minimize multiple debilitating adverse outcomes associated with malnutrition in the elderly. Oral nutritional supplements (ONS) have been widely used as a dietary intervention for malnutrition in older adults. These supplements provide additional nutrients and calories to support nutritional requirements and have been shown to improve nutritional status, physical function, and quality of life in malnourished older adults. METHODS: This is an open-label, randomized controlled, parallel-group study including 50 institutionalized older adults (aged > 60 years) with malnutrition or at risk of malnutrition, living in a selected elderly care institution in Colombo, Sri Lanka. The aim is to assess improvement in healthy body weight gain and body composition in older adults with malnutrition at risk of malnutrition by using an ONS. Older adults will be screened for malnutrition using the Mini Nutrition Assessment (MNA) tool and eligible participants randomized using the simple random sampling technique to intervention and control groups (1:1 allocation ratio). The intervention group will consume 200 mL of ONS before bed continuously for 12 weeks. The primary outcome is the percentage who achieved at least 5% weight gain in the intervention group compared to the control group. Nutritional status (anthropometric, biochemical, clinical, and dietary), body composition (dual-energy X-ray absorptiometry), frailty, functional capacity (hand grip strength, knee extension, and Barthel index) cognitive status (Montreal Cognitive Assessment), and physical activity will be assessed as secondary outcomes at baseline and at the end of the 12-week intervention. Some measurements (anthropometry, dietary, and functional assessments) will also be performed at the end of the 4th week. Data will be analyzed using SPSS V-23. DISCUSSION: This study will determine whether the use of an ONS is effective in promoting healthy weight gain in older adults with malnutrition or at risk of malnutrition. In addition, investigating the impact of an ONS on multiple outcomes via clinical, nutritional, functional, and cognitive function will provide a more comprehensive understanding of the potential benefits of these supplements. TRIAL REGISTRATION: Sri Lanka Clinical Trail Registry SLCTR/2022/021. Oct. 6, 2022.

The dose-response relationship of quercetin on the motor unit firing patterns and contractile properties of muscle in men and women.

Quercetin is one type of ergogenic aid and its effects on the neuromuscular system have recently attracted interest, but its dose-effect is not yet fully understood. The aim of this study was to examine the effect of different doses of quercetin ingestion on motor unit firing patterns and muscle contractile properties in humans. Thirteen young males and females conducted neuromuscular performance tests before (PRE) and 60 min after (POST) ingestions of 500 or 200 mg of quercetin glycosides (Qg500/Qg200, respectively) or placebo (PLA) on three different days. At PRE and POST, motor unit firing rates were calculated from high-density surface electromyography of the vastus lateralis muscle during 120-s isometric contraction of knee extension at 10% of maximal voluntary contraction. Electrically elicited forces in knee extensor muscles were also measured. After 60 s of voluntary contraction, motor unit firing rates, normalized by the exerted muscle force at POST, were significantly lower at POST than PRE with Qg500 and Qg200 (p < 0.05), but not with PLA (p > 0.05). Changes in motor unit firing rates normalized by the exerted force from PRE to POST were significantly greater with Qg500 than Qg200 at the end of contraction (p < 0.05). Under all three conditions, the electrically elicited force did not significantly change from PRE to POST (p > 0.05). These results suggest that both 500 and 200-mg quercetin ingestions alter motor unit firing patterns, and that quercetin's effect is at least partially dose-dependent.

Mid-to-long-term outcomes with image-guided placement of de novo low-profile gastrojejunostomy tubes in pediatric patients.

OBJECTIVE: De novo low-profile gastrojejunostomy (GJ) tubes are advantageous in children that require prolonged supplemental nutrition. However, few institutions place these devices at the time of initial feeding tube placement. We aim to build upon our previously published initial experience with this procedure to study mid-to-long-term outcomes of pediatric patients who have had de novo, image-guided, percutaneous low-profile GJ tube placement. METHODS: All de novo, image-guided, percutaneous, low-profile GJ tube placements at a single children's hospital were retrospectively reviewed between May 2014 and March 2021. Technical parameters, including fluoroscopy time, tube size, technical success, and complications were recorded. Clinical data, including age, indication, weight gain and transition to gastric/oral feeds were analyzed. RESULTS: 64 de novo low-profile GJ tubes were successfully placed in 65 patients (mean age: 4.6 years, median: 1, range: 0.2-19; mean pre-procedural weight: 16.8 kg, median: 8.2, range: 4.4-66.7). Average clinical follow-up 23.4 months (range: 0.1-75, median 10.4). Average weight gain was 6.1 kg. Average increase in weight percentile was 7.3%. 19 (19/64; 29.7%) patients had conversion from GJ to G tube. 11 (11/64; 17.2%) patients had their enteric tube removed completely. There were 7 minor complications (7/65; 10.7%), most common being excessive skin irritation (6/7) and 9 major complications (9/65; 13.8%), most common being tube dislodgment within the first 30 days (6/9). CONCLUSIONS: These results further support that de novo, image-guided, percutaneous, low-profile GJ tube placement is technically feasible and efficacious in children requiring post-pyloric nutritional supplementation with a favorable safety profile.

The effects of N-acetylcysteine supplement on metabolic parameters in women with polycystic ovary syndrome: a systematic review and meta-analysis.

Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disease, often accompanied by metabolic disorders. Metformin, as an insulin sensitizer, is widely used to improve the metabolic function of PCOS, but may have gastrointestinal side effects. Emerging evidence suggests that N-acetylcysteine (NAC) improves metabolic parameters in PCOS and may be a potential alternative to metformin. Methods: We searched four online databases, PubMed, Embase, Web of Science, and Cochrane Library, from inception to April 1, 2023. The I2 statistic and Cochrane's Q test were employed to determine heterogeneity between studies, with an I2 value >50% or p < 0.1 considered significant. The data were expressed as standardized mean differences and corresponding 95% confidence intervals. Results: A total of 11 randomized controlled trials were included in the final analysis, including 869 women with PCOS. The results showed that NAC caused more changes in body mass index (SMD: -0.16, 95% CI: -0.40 to 0.08), body weight (SMD: -0.25, 95% CI: -0.50 to 0.00), fasting insulin (SMD: -0.24, 95% CI: -0.53 to 0.06), ratio of fasting blood glucose to fasting insulin (SMD: 0.38, 95% CI: -0.33 to 1.08), total cholesterol (SMD: -0.11, 95% CI: -0.39 to 0.17), triglycerides (SMD: -0.18, 95% CI: -0.63 to 0.28), and low-density lipoprotein (SMD: -0.09, 95% CI: -0.51 to 0.33) compared with metformin. Compared with metformin or placebo, NAC significantly reduced fasting blood-glucose levels (SMD: -0.23, 95% CI: -0.43 to -0.04; SMD: -0.54, 95% CI: -1.03 to -0.05, respectively). In addition, NAC significantly reduced total cholesterol (SMD: -0.74, 95% CI: -1.37 to -0.12), and this effect was observed when NAC was compared with placebo. However, NAC reduced HDL levels in women with PCOS compared with metformin (SMD: -0.14, 95% CI: -0.42 to 0.14). Conclusion: This study suggests that NAC is effective in improving metabolic parameters in PCOS and may be a promising nutritional supplement for the treatment of PCOS.Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=415172, identifier CRD42022339171.

Metabolic Disorders and Psoriasis: Exploring the Role of Nutritional Interventions.

(1) Background: Psoriasis is a chronic autoimmune disease with a close relationship with metabolic diseases such as obesity, diabetes, and dyslipidemia. The aim of this review was to identify the relationship between psoriasis, metabolic diseases, and dietetic therapies. According to recent findings, there is a strong association between psoriasis and obesity as well as vitamin D and micronutrient deficiencies. (2) Methods: This review was conducted via PubMed, aiming to search for studies involving psoriasis linked with metabolic disorders or with nutritional treatments. (3) Results: Our review shows that a healthy lifestyle can positively influence the course of the disease. The maintaining of a proper body weight together with physical activity and good nutritional choices are associated with an improvement in psoriasis severity. A Mediterranean diet rich in fiber, vitamins, and polyphenols may indeed be a strategy for controlling psoriasis symptoms. The effectiveness of this diet lies not only in its anti-inflammatory power, but also in its ability to favorably influence the intestinal microbiota and counteract dysbiosis, which is a risk factor for many autoimmune diseases. (4) Conclusions: In synergy with standard therapy, the adoption of an appropriate diet can be recommended to improve the clinical expression of psoriasis and reduce the incidence of comorbidities.

Effects of Acute Caffeine Ingestion on Cognitive Performance before and after Repeated Small-Sided Games in Professional Soccer Players: A Placebo-Controlled, Randomized Crossover Trial.

Soccer is a team sport that requires players to process a significant amount of information quickly and respond with both speed and accuracy to the ever-changing demands of the game. As such, success in soccer depends not only on physical attributes but also on cognitive abilities such as perception and decision-making. The aim of the current study was to investigate the acute effects of caffeine ingestion on Stroop test performance before and after repeated small-sided games (SSG) in professional soccer players. Twelve professional male soccer players (29 ± 4.1 years; 78.1 ± 7.7 kg body mass) participated in this study. A randomized crossover double-blind placebo-controlled trial was used. Caffeine (5 mg.kg-1) or a placebo was ingested 45 min before a protocol consisting of five 5 min SSG with 1 min rest intervals. A computerized version of the colour Stroop test was completed immediately before and after the exercise protocol. During the Stroop test, words appeared on the computer screen in three different ways: (i) neutral words (neutral condition); (ii) correspondent colour (i.e., "red" painted in red; congruent condition), or; (iii) different colour (i.e., "red" painted in green; incongruent condition). The incongruent condition aimed to cause the interference effect, as the colour and the word did not match. Ratings of perceived exertion (RPE) were assessed after each SSG. RPE increased during the five sets of the SSG protocol (p < 0.001), without differences between the caffeine and placebo trials. The soccer-specific exercise protocol promoted a faster response during the Stroop test (two-way ANOVA main effect for SSG protocol: p < 0.05), with no differences in accuracy (p > 0.05). Caffeine ingestion resulted in slower reaction time during the Stroop test during the congruent and neutral trials but not during the incongruent trial (two-way ANOVA main effect for supplementation: p = 0.009, p = 0.045, and p = 0.071, respectively). Accuracy was lower in the caffeine trial in congruent and incongruent trials (p < 0.05 caffeine vs. placebo both on the pre- and post-SSG protocol). In conclusion, a soccer-specific exercise protocol improved the Stroop test performance in professional soccer players, but acute caffeine ingestion (5 mg.kg-1) was detrimental.

A study on the effect of nutrition education based on the goal attainment theory on oral nutritional supplementation after colorectal cancer surgery.

OBJECTIVE: To investigate their compliance with postoperative oral nutritional supplementation and nutritional outcomes. METHODS: A total of 84 patients with colorectal cancer surgery with NRS-2002 risk score ≥ 3 who were treated with oral nutritional supplementation were selected and divided into control and observation groups according to the random number table method, with 42 cases in each group. The control group received conventional oral nutritional supplementation and dietary nutrition education; the observation group established a nutrition intervention group based on the Goal Attainment Theory and carried out individualized nutrition education based on the Goal Attainment Theory. The nutritional indicators at 1 day postoperative, 7 days postoperative, oral nutritional supplementation adherence scores at 7 and 14 days postoperative, and the attainment rate of trans-oral nutritional intake at 21 days postoperative were compared between the 2 groups of patients. RESULTS: There was no statistically significant difference between the nutritional status indexes of the 2 groups of patients before the intervention, p > 0.05; when comparing the prealbumin of the 2 groups of patients at 7 days postoperatively, the prealbumin level of the patients in the observation group at 7 days postoperatively (200.25 ± 53.25) was better than that of the control group (165.73 ± 43.00), with a p value of 0.002, and the difference was statistically significant (p < 0.05). Comparison of oral nutritional supplementation adherence scores at 7 and 14 days postoperatively showed that ONS treatment adherence scores were better than those of the control group, with statistically significant differences (p < 0.05). When comparing the attainment rate of oral nutritional intake at 21 days after surgery, the difference was statistically significant (p < 0.05). CONCLUSION: Nutritional education based on the Goal Attainment Theory can effectively improve the adherence to oral nutritional supplementation therapy and protein intake attainment rate of colorectal cancer patients after surgery and effectively improve the nutritional status of patients.

Zinc and vitamin D deficiency and supplementation in hypophosphatasia patients - A retrospective study.

Hypophosphatasia (HPP) is characterized by severe skeletal symptoms including mineralization defects, insufficiency fractures, and delayed facture healing or non-unions. HPP is caused by mutations of the tissue non-specific alkaline phosphatase (TNSALP). Zinc is a cofactor of TNSALP and vitamin D an important regulator of bone matrix mineralization. Data from this retrospective study indicates that deficiencies in zinc or vitamin D occur in HPP patients with a similar frequency as in the general population. While guidelines for repletion of these micronutrients have been established for the general population, the transferability of the efficacy and safety of these regiments to HPP patients still needed to be determined. We filtered for variant classification (ACMG 3-5, non-benign) and data completeness from a total cohort of 263 HPP patients. 73.5 % of this sub-cohort were vitamin D deficient while 27.2 % were zinc deficient. We retrospectively evaluated the effect of supplementation according to general guidelines in 10 patients with zinc-deficiency and 38 patients with vitamin d-deficiency. The treatments significantly raised serum zinc or vitamin D levels respectively. All other assessed disease markers (alkaline phosphatase, pyrodoxal-5-phosphate) or bone turnover markers (phosphate, calcium, parathyroid hormone, bone specific alkaline phosphatase, creatinine, desoxypyridinoline) remained unchanged. These results highlight that general guidelines for zinc and vitamin D repletion can be successfully applied to HPP patients in order to prevent deficiency symptoms without exacerbating the disease burden or causing adverse effects due to changes in bone and calcium homeostasis.