Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention / Práticas de nutricionistas em unidades de diálise no Brasil: avaliação e intervenção nutricionais

ABSTRACT Introduction: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. Objective: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. Methodology: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. Results: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. Conclusion: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Resumo Introdução: A importância da atuação do nutricionista em unidades de diálise é indiscutível e obrigatória no Brasil, porém pouco sabemos sobre as práticas adotadas por esses profissionais. Objetivo: Conhecer práticas adotadas na rotina dos atendimentos nutricionais, com foco nas ferramentas de avaliação nutricional e nas estratégias de tratamento das pessoas com risco ou diagnóstico de desnutrição. Metodologia: Questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens. Incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, utilização e frequência de ferramentas de avaliação nutricional, estratégias de intervenção nutricional em casos de risco ou diagnóstico de desnutrição e prescrição e acesso a suplementos alimentares orais. Resultados: Foram recebidos eletronicamente o equivalente a 24% das unidades de diálise brasileiras (n = 207). As ferramentas de avaliação nutricional mais utilizadas com ou sem frequência pré-estabelecida foram inquéritos dietéticos (96%) e Avaliação Global Subjetiva (83%). As estratégias em casos de risco ou presença de desnutrição utilizadas com mais frequência (quase sempre/sempre) foram a orientação de incremento energético e proteico por meio de alimentos (97%) e o aumento da periodicidade das visitas (88%). A frequência de prescrição de suplemento industrializado de fórmula padrão e especializada foi bastante semelhante. A disponibilização de suplementos alimentares pelo Sistema Único de Saúde aos pacientes variou entre as regiões. Conclusão: A maior parte dos nutricionistas utiliza diversas ferramentas de avaliação nutricional e estratégias de intervenção em casos de risco ou desnutrição, porém a frequência de utilização de tais ferramentas e estratégias foi bastante variada.

Nutritional knowledge, eating habits, factors affecting muscle damage, and antioxidant enzyme levels of Korean wrestlers.

PURPOSE: The aim in this study was to investigate the diet and nutritional knowledge of elite Korean wrestlers and verify the differences in their exercise performance , muscle damage indicators, and antioxidant enzyme levels according to wrestler level. METHODS: A 7-day dietary and nutrition knowledge survey was administered to 30 adult male elite wrestlers (national team: n=11; professional team: n=19). The Wingate test was conducted for 60 seconds to analyze muscle damage indicators and antioxidant levels. Blood and blood lactate concentration analyses were performed four times; the statistical significance level of all data was p<0.05. RESULTS: Significant differences were found in general nutrition knowledge questionnaire (GNKQ) scores (p=0.043), diet (p=0.001), anaerobic performance (p=0.001), muscle damage indicators (p=0.026), antioxidant levels, and blood lactic acid concentrations (30 min after exercise, p=0.007; 90 min after exercise, p=0.038) between the national and the professional groups. CONCLUSION: To the findings confirm the relationship between the differences in diet, nutrition, and motor function for wrestlers of different expertise levels. In a follow-up, a comprehensive study on nutrition knowledge, athlete training , and weight loss is needed that considers a wider scope of subjects and analyzes additional variables.

Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation.

BACKGROUND: Malnutrition is a significant concern reported in adult critically ill patients, yet there is no gold standard to assess nutritional status in this population. This study examines the association between nutritional status and clinical outcomes in intensive care unit (ICU) patients using nutritional risk assessment tools and aims to look for the best tool. METHOD: In a single-center prospective cohort study among 165 patients, the predictive performance of high or low malnutrition risk assessed by Nutritional Risk Screening (NRS), Modified Nutrition Risk in Critically Ill (m-NUTRIC), Mini-Nutritional-Assessment Short-Form (MNA-SF), Controlling Nutritional status (CONUT), and Prognostic Nutritional Index (PNI) were evaluated and compared for mortality, organ failure, length of hospitalization, and mechanical ventilation (MV). RESULTS: Different assessment tools showed various nutritional statuses. m-NUTRIC and NRS-2002 were found to be associated more strongly relative to other tools with mortality (RR = 1.72; 95% CI, 1.42-2.08) and (RR = 1.37; 95% CI, 1.08-1.72), organ failure (RR = 1.69; 95% CI, 1.44-1.96) and (RR = 1.22; 95% CI, 0.99-1.48), MV (RR = 1.46; 95% CI, 1.27-1.65) and (RR = 1.21; 95% CI, 1.04-1.39) respectively. There was no correlation between malnutrition levels assessed by mentioned tools except for NRS-2002 and length of hospitalization. In predicting mortality or illness severity, the cut points were different for some tools like NUTRIC-score and all assessed outcomes (3.5), MNA-SF and mortality (6.5), CONUT with mortality, and MV (6.5). CONCLUSIONS: A considerable proportion of patients admitted to the ICU are at high risk for malnutrition. Compared to other tools, m-NUTRIC and NRS-2002 proved superior in predicting clinical outcomes in critically ill patients. Other tools overestimated the risk of malnutrition in the ICU so couldn't predict clinical outcomes correctly.

OsAAP8 mutation leads to significant improvement in the nutritional quality and appearance of rice grains.

Members of the permease gene family are responsible for important biological functions in the growth and development of rice. Here, we show that OsAAP8 is a constitutive expression gene, and its translated protein is localized on the cell membrane. Mutation of the OsAAP8 can promote the expression of genes related to protein and amylopectin synthesis, and also promote the enlargement of protein bodies in its endosperm, leading to an increase in the protein, amylopectin, and total amino acid content of grains in OsAAP8 mutants. Seeds produced by the OsAAP8 mutant were larger, and the chalkiness traits of the OsAAP8 mutants were significantly reduced, thereby improving the nutritional quality and appearance of rice grains. The OsAAP8 protein is involved in the transport of various amino acids; OsAAP8 mutation significantly enhanced the root absorption of a range of amino acids and might affect the distribution of various amino acids. Therefore, OsAAP8 is an important quality trait gene with multiple biological functions, which provides important clues for the molecular design of breeding strategies for developing new high-quality varieties of rice. Supplementary Information: The online version contains supplementary material available at 10.1007/s11032-024-01473-w.

The effects of pregnancy-related changes in eating attitudes and behaviours on nutritional status.

BACKGROUND: During pregnancy, the requirements of essential nutrients for the mother and foetus increase. The changes in pregnant women's eating behaviours may vary according to their sociodemographic characteristics. It is important to meet these increased requirements and understand the factors influencing eating habits during pregnancy. OBJECTIVES: This study aimed to determine the effects of changes in pregnant women's eating attitudes and behaviours and their sociodemographic characteristics on their meeting status for nutrient recommendations. METHODS: Sociodemographic information, eating behaviours, and attitudes of 656 pregnant women were obtained in face-to-face interviews between February and June 2020. Food consumption records were taken with a 24-hour recall method and evaluated according to the estimated average requirement value. RESULTS: The average age of pregnant women was 29.0 ±â€…5.2 years, 28.0% were high school graduates, and 69.2% were non-working. The frequency of intakes below the estimated mean requirement value were iron, folic acid, vitamin B6, niacin, and calcium. It was demonstrated that there was a significant difference in snack consumption based on the working status and nutrition information obtained (P < .05). Getting nutrition information, age, education level, working status, and pre-pregnancy body mass index significantly increased food consumption (P < .05). CONCLUSION: Inadequate nutrient intake is a common public health problem in pregnant women. It is necessary to identify the sociodemographic characteristics that negatively impact pregnant women's nutritional status and to develop nutrition and health education programs based on these features.

Analysis of risk characteristics for early progression and late progression in locally advanced rectal cancer patients: a large population-based and validated study.

BACKGROUND AND OBJECTIVE: The current study aimed to explore the factors influencing early progression (EP) and late progression (LP) in locally advanced rectal cancer (LARC) patients. METHODS: The patients were classified into EP and LP groups using one year as a cutoff. The random survival forest model was utilized to calculate the probability of time-to-progression. Besides, inverse probability of treatment weighting (IPTW) analysis and the Surveillance, Epidemiology, and End Results (SEER) were conducted to validate our results. RESULTS: Our study revealed that PNI, CEA level, and pathological stage were independent prognostic factors for PFS both in EP group and LP group. For EP group patients, Group 1 had the highest probability of progression at the 9th month of follow-up, while Group 2 exhibited the highest probability at the 6th month. Group 3, on the other hand, showed two peaks of progression at the 4th and 8th months of follow-up. As for LP group patients, Groups 4, 5, and 6 all exhibited peaks of progression between the 18th and 24th months of follow-up. Furthermore, our results suggested that PNI was also an independent prognostic factor affecting OS in both EP group and LP group. Finally, the analysis of IPTW and SEER database further confirmed our findings. CONCLUSIONS: Our results indicated a significant correlation between immune and nutritional status with PFS and OS in both EP and LP groups. These insights can aid healthcare professionals in effectively identifying and evaluating patients' nutritional status, enabling them to develop tailored nutrition plans and interventions.

C-Reactive Protein Is a Potential Prognostic Marker in Patient with Advanced or Metastatic Urothelial Carcinoma Treated with Enfortumab Vedotin: A Multi-Center Retrospective Study.

BACKGROUND: In the EV-301 trial, enfortumab vedotin prolonged survival in patients with locally advanced or metastatic urothelial carcinoma previously treated with platinum-based therapy and programmed cell death 1/programmed death-ligand 1 inhibitor. However, real-world Asian data are limited, and potential prognostic markers are non-existent. We aimed to investigate potential prognostic markers for enfortumab vedotin therapy in Asian patients. METHODS: We retrospectively enrolled 61 Japanese patients treated with enfortumab vedotin therapy at our hospital and affiliated hospitals between January 2019 and September 2023. RESULTS: Enrolled patients (38 men, 23 women; median age 74 [IQR: 68-79] years) had bladder cancer (26 patients) or upper-tract urothelial carcinoma (35 patients). Fifty-four patients reported adverse events (grade >3 in 12). Skin disorders, pruritus, and neuropathy were common adverse effects. The median overall survival was 17.1 months (95% confidence interval: 10.0-not applicable). In multivariate analysis, the C-reactive protein level was an independent marker predicting favorable overall survival with enfortumab vedotin. Patient characteristics did not differ between C-reactive protein-high and -low groups. CONCLUSIONS: Our study provides real-world data showing that enfortumab vedotin prolonged survival in Asian patients similar to the EV-301 trial. Additionally, the C-reactive protein level might be considered a prognostic marker of enfortumab vedotin therapy in such patients.

Vitamin Nutritional Status in Patients with Pancreatic Cancer: A Narrative Review.

Due to the high mortality rate in Western countries, pancreatic cancer is considered one of the big killers, leaving patients and their families with little hope upon diagnosis. Although surgical and drug therapies are critical for cancer patients to improve life expectancy and alleviation of suffering, nutrition plays a key role in improving cancer treatment outcomes. This narrative review, conducted as part of the activities of the Italian Society of Human Nutrition (SINU) working group in oncology, focuses on the prevalence of vitamin malnutrition among pancreatic cancer patients. The results of the literature search show that pancreatic cancer patients are at a heightened risk of water-soluble vitamin deficiencies, particularly of vitamins B1, B3, and B6. Additionally, they also face an increased risk of deficiency of fat-soluble vitamins. Among these vitamins, the potential role of vitamin D in pancreatic cancer has garnered the most attention, with its plasma levels being identified as a significant factor in patient survival. Investigating vitamin nutritional status could provide valuable insights for incorporating nutritional approaches into the prevention and treatment of pancreatic cancer, thereby reducing the exacerbation of symptoms associated with the diagnosis.

Pathways in formulating foods for the elderly.

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.

Navigating Nutritional Strategies: Permissive Underfeeding in Critically Ill Patients.

Nutritional support is a critical component of care for critically ill patients, impacting their recovery and overall prognosis. Traditional approaches to feeding in the intensive care unit (ICU) have focused on meeting estimated energy requirements, often resulting in unintended consequences such as overfeeding and associated complications. Permissive underfeeding, a concept gaining attention recently, offers a more controlled approach by intentionally providing fewer calories than traditionally recommended. This comprehensive review explores the rationale, evidence, and practical considerations surrounding permissive underfeeding in critically ill patients. We discuss the physiological basis of permissive underfeeding, its potential benefits in mitigating the risks of overfeeding, and the challenges associated with implementation in clinical practice. Through an analysis of critical studies and clinical trials, we evaluate the comparative effectiveness of permissive underfeeding versus traditional feeding methods and examine its impact on patient outcomes. Recommendations for patient selection, monitoring, and future research directions are provided to guide clinicians in optimizing nutritional support strategies for critically ill individuals. By considering the role of permissive underfeeding alongside traditional feeding approaches, healthcare professionals can tailor nutritional interventions to individual patient needs, ultimately improving outcomes in the ICU.

Impact of body composition parameters on radiation therapy compliance in locally advanced rectal cancer: A retrospective observational analysis.

Background: The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes. Methods: This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC). Results: The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36-4.01) and lower SMI (0.73, 95 % CI 0.55-0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24-6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93-0.98), and higher SMI (0.97, 95 % CI 0.95-0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93-0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01-1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93-0.99). Conclusions: Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.

A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol.

BACKGROUND: High-energy re-feeding protocols are increasingly utilised for nutritional rehabilitation in adolescents with anorexia nervosa (AN), however, concern persists that adults with AN may be at greater risk of developing complications. In addition, research on psychological outcomes of eating disorder (ED) inpatient treatment programs, and outcomes of high-energy protocols in avoidant restrictive food intake disorder (ARFID) and bulimia nervosa (BN), is limited. This study of an ED inpatient program using a high-energy protocol, compared changes in weight and psychosocial outcomes between adolescents and adults, and identified medical risk factors associated with deviation from the protocol. METHOD: This prospective observational study took place in a voluntary ED treatment program in a private hospital. Weight, height, and psychosocial questionnaires (ED Examination-Questionnaire, Depression Anxiety Stress Score, Clinical Impairment Assessment and AN/BN Stage of Change) were collected from consenting adolescents (16-20 years) and adults (> 20 years) on admission and discharge. Medical tolerance to the high-energy protocol was assessed daily. Independent samples t-tests and paired samples t-tests were applied to normally distributed data, and Mann-Whitney U tests and Wilcoxon signed-rank tests to skewed data. P-values < 0.05 were considered significant statistically. RESULTS: Ninety-seven participants were recruited. The majority (n = 91, 94%) were female and most (n = 80, 83%) had AN. Forty-two (43%) were adolescents and 55 (57%) were adults. In participants with AN, weight change (Δ) was significant [median Δ 8.0 (interquartile range (IQR) 4.3) kg]. There was no difference in rate of weight change between adolescents and adults with AN [mean Δ 1.8 (standard deviation (SD) 0.5) kg/week vs. Δ 1.8 (SD 0.6) kg/week; p = 0.841, respectively]. One (1%) participant with AN did not tolerate the high-energy protocol due to oedema. Participants achieved positive change in psychosocial questionnaire scores (p < 0.001) after the the specialist ED program, with no difference between adolescents and adults (p > 0.05). CONCLUSIONS: This voluntary ED treatment program using a high energy re-feeding protocol was effective in achieving positive weight and psychological change for adolescents and adults with minimal adverse events. This indicates that the specialist ED program has both nutritional and psychological benefits.

Nutritional recovery of adolescent inpatients with anorexia nervosa (AN) can be safely and effectively carried out using high-energy feeding protocols. However, not enough research has been done to support the use of these protocols in adults with AN, or people with avoidant restrictive food intake disorder (ARFID) and bulimia nervosa (BN). The psychological effects of using high-energy protocols for people with eating disorders (EDs) are also rarely reported. We aimed to find out a) if our high-energy re-feeding protocol is effective for adolescents and adults with AN, and for people with other EDs; b) are there any medical side-effects of re-feeding that require the feeding protocol to change; c) do psychosocial measures of health change from admission to discharge; and d) are there differences in weight or psychosocial change between adolescents and adults? We found that for adolescents and adults with AN, weight increases were the same when using the high-energy protocol. The protocol was changed for only one participant with AN, who experienced oedema. Both adolescents and adults had positive improvements across all psychosocial questionnaires. The results of this research will help to guide clinicians and researchers on safe and effective care for people with EDs in voluntary treatment settings.

Swedish translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©)-A validated tool for screening and assessing malnutrition in clinical practice and research.

INTRODUCTION: The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. AIM: To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. METHODS: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. RESULTS: The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). CONCLUSION: The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research.

Database construction and comparative genomics analysis of genes involved in nutritional metabolic diseases in fish.

Nutritional metabolic diseases in fish frequently arise in the setting of intensive aquaculture. The etiology and pathogenesis of these conditions involve energy metabolic disorders influenced by both internal genetic factors and external environmental conditions. The exploration of genes associated with nutritional and metabolic disorder has sparked considerable interest within both the aquaculture scientific community and the industry. High-throughput sequencing technology offers researchers extensive genetic information. Effectively mining, analyzing, and securely storing this data is crucial, especially for advancing disease prevention and treatment strategies. Presently, the exploration and application of gene databases concerning nutritional and metabolic disorders in fish are at a nascent stag. Therefore, this study focused on the model organism zebrafish and five primary economic fish species as the subjects of investigation. Using information from KEGG, OMIM, and existing literature, a novel gene database associated with nutritional metabolic diseases in fish was meticulously constructed. This database encompassed 4583 genes for Danio rerio, 6287 for Cyprinus carpio, 3289 for Takifugu rubripes, 3548 for Larimichthys crocea, 3816 for Oreochromis niloticus, and 5708 for Oncorhynchus mykiss. Through a comparative systems biology approach, we discerned a relatively high conservation of genes linked to nutritional metabolic diseases across these fish species, with over 54.9 % of genes being conserved throughout all six species. Additionally, the analysis pinpointed the existence of 13 species-specific genes within the genomes of large yellow croaker, tilapia, and rainbow trout. These genes exhibit the potential to serve as novel candidate targets for addressing nutritional metabolic diseases.

Ramadan Fasting and Its Impact on Patients With Chronic Kidney Disease: Insights and Guidelines.

Fasting during the month of Ramadan is a religious practice observed by millions of Muslims worldwide, including those with chronic kidney disease (CKD). This comprehensive review aims to reflect upon the impacts of Ramadan fasting on CKD patients, excluding those on renal replacement therapy, through an analysis of clinical trials, observational studies, and expert reviews from diverse geographic and methodological backgrounds. It addresses renal function stability, broader health considerations, hydration and electrolyte balance, individual variability in fasting responses, clinical and biochemical effects, nutritional considerations, and metabolic effects. This review reveals that, with appropriate monitoring, dietary management, and individualized care plans, many CKD patients can safely participate in Ramadan fasting without adversely affecting their renal function or overall health. It emphasizes the need for a multidisciplinary approach to patient education, pre-Ramadan assessment, and post-Ramadan follow-up. Furthermore, it highlights the importance of considering individual variability and comorbidities in fasting guidance and underscores the necessity of future research to develop robust, patient-centered fasting guidelines. This review aims to provide healthcare professionals with evidence-based recommendations to support CKD patients wishing to observe Ramadan fasting, ensuring patient safety and optimizing care outcomes.

Zinc supplementation for dysgeusia in patients with unresectable pancreatic cancer.

BACKGROUND: Although patients with advanced pancreatic cancer (PC) often experience dysgeusia with zinc deficiency during chemotherapy, data on zinc supplementation for dysgeusia and its effects on nutritional status are scarce. We aimed to examine the efficacy of zinc supplementation in patients with advanced PC. METHODS: Thirty-three patients with unresectable PC who presented with dysgeusia and zinc deficiency during chemotherapy and received zinc acetate hydrate between January 2018 and December 2022 were included. We evaluated the changes in serum zinc levels and the improvement in dysgeusia. Among the 26 patients who received zinc supplementation for 12 weeks, we also compared patient characteristics and changes in serum zinc and albumin levels between patients who showed improvement in dysgeusia (effective group) and those who did not (non-effective group). RESULTS: The serum zinc level increased significantly after zinc supplementation (median: 60 µg/dL at baseline, 99.5 µg/dL at 4 weeks, 101 µg/dL at 8 weeks and 101 µg/dL at 12 weeks). The rate of improvement in dysgeusia increased over time (18.2% at 4 weeks, 33.3% at 8 weeks, and 42.4% at 12 weeks). Comparing the effective group and non-effective group revealed that while the median serum albumin level of the effective group did not change, the non-effective group showed a significant decrease from baseline to 12 weeks (3.2 g/dL to 3.0 g/dL, p = 0.03). CONCLUSION: Zinc supplementation significantly increased serum zinc levels, improving dysgeusia. Zinc supplementation might also contribute to maintaining nutritional status in patients with unresectable PC.

Unveiling the molecular mechanisms: dietary phytosterols as guardians against cardiovascular diseases.

Until recently, the main pharmaceuticals used to control cholesterol and prevent cardiovascular disease (CVD) were statin-related drugs, known for their historical side effects. Therefore, there is growing interest in exploring alternatives, such as nutritional and dietary components, that could play a central role in CVD prevention. This review aims to provide a comprehensive understanding of how natural phytosterols found in various diets combat CVDs. We begin with a description of the overall approach, then we explore in detail the different direct and indirect mechanisms that contribute to reducing cardiovascular incidents. Phytosterols, including stigmasterol, ß-sitosterol, ergosterol, and fucosterol, emerge as promising molecules within nutritional systems for protection against CVDs due to their beneficial effects at different levels through direct or indirect cellular, subcellular, and molecular mechanisms. Specifically, the mentioned phytosterols exhibit the ability to diminish the generation of various radicals, including hydroperoxides and hydrogen peroxide. They also promote the activation of antioxidant enzymes such as superoxide dismutase, catalase, and glutathione, while inhibiting lipid peroxidation through the activation of Nrf2 and Nrf2/heme oxygenase-1 (HO-1) signaling pathways. Additionally, they demonstrate a significant inhibitory capacity in the generation of pro-inflammatory cytokines, thus playing a crucial role in regulating the inflammatory/immune response by inhibiting the expression of proteins involved in cellular signaling pathways such as JAK3/STAT3 and NF-κB. Moreover, phytosterols play a key role in reducing cholesterol absorption and improving the lipid profile. These compounds can be used as dietary supplements or included in specific diets to aid control cholesterol levels, particularly in individuals suffering from hypercholesterolemia.

Association of child marriage and nutritional status of mothers and their under-five children in Bangladesh: a cross-sectional study with a nationally representative sample.

BACKGROUND: Child marriage remains an important problem around the world with young mothers and their under-five children often experiencing under-nutrition. The problem is rarely studied in the Bangladeshi population. This paper was designed to identify the association between child marriage and nutritional status of mothers and their under-five children in Bangladesh. METHODS: Nationally representative secondary data was used for this study, data was extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The sample consisted of 7235 mothers aged 18-49 years and their under-five children. The mothers were classified into two classes according to their age at first marriage: (i) child marriage (marriage at < 18 years) and (ii) not child marriage (marriage at ≥ 18 years). The nutritional status of mothers was measured by body mass index (BMI), and under-five children's nutritional status was measured by (i) height-for-age (z-score) (stunting), (ii) weight-for-age (z-score) (underweight), and (iii) weight-for-height (z-score) (wasting). The chi-square test and two-level logistic regression model were used for data analysis using SPSS software (IBM version 20). RESULTS: The prevalence of child marriage among Bangladeshi women was 69.0%, with the mean and median of age at the first marriage being 16.57 ± 2.83 years and 16 years, respectively. Of the mothers, 15.2% suffered from chronic energy deficiency (underweight), and 72.8% were married at < 18 years. The prevalence of stunting, underweight, and wasting among under-five children in Bangladesh was 31.0%, 22.0%, and 8.5%, respectively. Compared to women married at the age of ≥ 18 years, there was a significantly higher likelihood of chronic energy deficiency among women who married at < 18 years [Adjusted OR = 1.27, CI: 1.05-1.82; p < 0.05]. Under-five children of mothers married before the age of 18 were more likely to have stunting [Adjusted OR = 1.201, CI: 1.11-1.72; p < 0.05], wasting [Adjusted OR = 1.519, CI: 1.15-2.00; p < 0.01], and underweight [Adjusted OR = 1.150, CI: 1.09-1.82; p < 0.05] compared to children of mothers who married at age ≥ 18. CONCLUSION: The rate of child marriage among Bangladeshi women is high, and it is significantly associated with malnutrition among mothers and their under-five children. The Bangladesh government can use the findings of this study to prevent and reduce child marriage and malnutrition among mothers and their under-five children to achieve sustainable development goals by 2030.

Exploring the Nutritional Potential and Functionality of Hemp and Rapeseed Proteins: A Review on Unveiling Anti-Nutritional Factors, Bioactive Compounds, and Functional Attributes.

Plant-based proteins, like those derived from hemp and rapeseed can contribute significantly to a balanced diet and meet human daily nutritional requirements by providing essential nutrients such as protein, fiber, vitamins, minerals, and antioxidants. According to numerous recent research papers, the consumption of plant-based proteins has been associated with numerous health benefits, including a reduced risk of chronic diseases such as heart disease, diabetes, and certain cancers. Plant-based diets are often lower in saturated fat and cholesterol and higher in fiber and phytonutrients, which can support overall health and well-being. Present research investigates the nutritional attributes, functional properties, and potential food applications of hemp and rapeseed protein for a potential use in new food-product development, with a certain focus on identifying anti-nutritional factors and bioactive compounds. Through comprehensive analysis, anti-nutritional factors and bioactive compounds were elucidated, shedding light on their impact on protein quality and digestibility. The study also delves into the functional properties of hemp and rapeseed protein, unveiling their versatility in various food applications. Insights from this research contribute to a deeper understanding of the nutritional value and functional potential of hemp and rapeseed protein, paving the way for their further utilization in innovative food products with enhanced nutritional value and notable health benefits.

Paradise by the far-red light: Far-red and red:blue ratios independently affect yield, pigments, and carbohydrate production in lettuce, Lactuca sativa.

In controlled environment agriculture, customized light treatments using light-emitting diodes are crucial to improving crop yield and quality. Red (R; 600-700 nm) and blue light (B; 400-500 nm) are two major parts of photosynthetically active radiation (PAR), often preferred in crop production. Far-red radiation (FR; 700-800 nm), although not part of PAR, can also affect photosynthesis and can have profound effects on a range of morphological and physiological processes. However, interactions between different red and blue light ratios (R:B) and FR on promoting yield and nutritionally relevant compounds in crops remain unknown. Here, lettuce was grown at 200 µmol m-2 s-1 PAR under three different R:B ratios: R:B87.5:12.5 (12.5% blue), R:B75:25 (25% blue), and R:B60:40 (40% blue) without FR. Each treatment was also performed with supplementary FR (50 µmol m-2 s-1; R:B87.5:12.5+FR, R:B75:25+FR, and R:B60:40+FR). White light with and without FR (W and W+FR) were used as control treatments comprising of 72.5% red, 19% green, and 8.5% blue light. Increasing the R:B ratio from R:B87.5:12.5 to R:B60:40, there was a decrease in fresh weight (20%) and carbohydrate concentration (48% reduction in both sugars and starch), whereas pigment concentrations (anthocyanins, chlorophyll, and carotenoids), phenolic compounds, and various minerals all increased. These results contrasted the effects of FR supplementation in the growth spectra; when supplementing FR to different R:B backgrounds, we found a significant increase in plant fresh weight, dry weight, total soluble sugars, and starch. Additionally, FR decreased concentrations of anthocyanins, phenolic compounds, and various minerals. Although blue light and FR effects appear to directly contrast, blue and FR light did not have interactive effects together when considering plant growth, morphology, and nutritional content. Therefore, the individual benefits of increased blue light fraction and supplementary FR radiation can be combined and used cooperatively to produce crops of desired quality: adding FR increases growth and carbohydrate concentration while increasing the blue fraction increases nutritional value.