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1.
Nat Commun ; 12(1): 2598, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972511

RESUMO

The intestinal immune system is an important modulator of glucose homeostasis and obesity-associated insulin resistance. Dietary factors, the intestinal microbiota and their metabolites shape intestinal immunity during obesity. The intestinal immune system in turn affects processes such as intestinal permeability, immune cell trafficking, and intestinal hormone availability, impacting systemic insulin resistance. Understanding these pathways might identify mechanisms underlying treatments for insulin resistance, such as metformin and bariatric surgery, or aid in developing new therapies and vaccination approaches. Here, we highlight evolving concepts centered on intestinal immunity, diet, and the microbiota to provide a working model of obesity-related metabolic disease.


Assuntos
Microbioma Gastrointestinal/imunologia , Doenças Metabólicas/imunologia , Doenças Metabólicas/metabolismo , Obesidade/metabolismo , Animais , Linfócitos B/imunologia , Citocinas/metabolismo , Dietoterapia , Humanos , Sistema Imunitário/citologia , Sistema Imunitário/metabolismo , Inflamação/imunologia , Inflamação/metabolismo , Resistência à Insulina/imunologia , Doenças Metabólicas/microbiologia , Doenças Metabólicas/terapia , Obesidade/dietoterapia , Obesidade/imunologia , Obesidade/terapia , Linfócitos T/imunologia
3.
Medicine (Baltimore) ; 100(17): e25710, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907154

RESUMO

BACKGROUND: Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. As apelin is an adipocytokine closely associated with diabetes, this study explored the clinical significance of serum apelin levels in patients with type 2 DPN before and after treatment. METHODS: In total, 44 patients with T2DM without DPN (non-DPN group), 41 patients with DPN who received antihyperglycemic treatment (DPN-A group), 44 patients with DPN who received antihyperglycemic treatment combined with nutritional neurotherapy (DPN-B group), and 40 healthy control individuals (NC group) were selected continuously enrolled in the present study. Enzyme-linked immunosorbent assays (ELISA) were performed to determine serum levels of apelin and tumor necrosis factor-α (TNF-α). Related apelin, fasting blood glucose (FBG), glycosylated hemoglobin A1c, TNF-α, body mass index, fasting C peptide, and nerve conduction velocity (NCV) were recorded in each group before and after treatment. RESULTS: Serum levels of apelin and TNF-α were higher in patients with diabetes than those in the NC group, as well as in the DPN group as compared to the non-DPN group; furthermore, some NCV values were significantly reduced in the DPN group. After treatment, the serum levels of apelin, TNF-α, and FBG reduced in patients with diabetes; moreover, apelin levels were found significantly lower in the DPN-B group as compared to the DPN-A group, while some NCV values significantly increased in the DPN-B group. Apelin was negatively correlated with part of NCV values and positively correlated with TNF-α and FBG (P < .01). CONCLUSION: Our results show that the increase in serum apelin levels is an important clinical reference index for DPN, while a decrease indicates that the DPN treatment is effective.


Assuntos
Apelina/sangue , Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Monitoramento de Medicamentos , Insulina , Condução Nervosa/efeitos dos fármacos , Glicemia/análise , Índice de Massa Corporal , China/epidemiologia , Correlação de Dados , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/etiologia , Neuropatias Diabéticas/terapia , Dietoterapia/métodos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Eletromiografia/métodos , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/farmacocinética , Insulina/administração & dosagem , Insulina/farmacocinética , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/sangue
4.
Nutrients ; 13(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33918259

RESUMO

BACKGROUND: The Dietary Approach to Stop Hypertension (DASH) and potassium supplementation have been shown to reduce the risk of death with a functioning graft (DWFG) and renal graft failure in renal transplant recipients (RTR). Unfortunately, a key problem for patients is the adherence to these diets. The aim of this study is to evaluate the cost-effectiveness and budget impact of higher adherence to either the DASH or potassium supplementation. METHODS: A Markov model was used to simulate the life course of 1000 RTR in the Netherlands. A societal perspective with a lifetime time horizon was used. The potential effect of improvement of dietary adherence was modelled in different scenarios. The primary outcomes are the incremental cost-effectiveness ratio (ICER) and the budget impact. RESULTS: In the base case, improved adherence to the DASH diet saved 27,934,786 and gained 1880 quality-adjusted life years (QALYs). Improved adherence to potassium supplementation saved €1,217,803 and gained 2901 QALYs. Both resulted in dominant ICERs. The budget impact over a five-year period for the entire Dutch RTR population was €8,144,693. CONCLUSION: Improving dietary adherence in RTR is likely to be cost-saving and highly likely to be cost-effective compared to the current standard of care in the Netherlands.


Assuntos
Dietoterapia/economia , Abordagens Dietéticas para Conter a Hipertensão/economia , Suplementos Nutricionais/economia , Transplante de Rim/reabilitação , Potássio na Dieta/administração & dosagem , Análise Custo-Benefício , Dietoterapia/métodos , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Países Baixos , Cooperação do Paciente/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida
5.
Med Sci Monit ; 27: e929218, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33888673

RESUMO

BACKGROUND In this study, we explored the effect of an improved dietary pattern on 25-hydroxyvitamin D3 [25(OH)VitD3] level in hypertensive patients in a rural setting and investigated the possible mechanism for lowering blood pressure. MATERIAL AND METHODS Thirty-three participants with overweight or obesity were randomly divided into 2 groups. A 24-h dietary review method was used for dietary assessment. Participants in both groups were provided the same balanced diet except for the breakfast staple food for 4 weeks. General characteristics, body composition analysis, blood pressure, serum lipid profile, inflammatory indices, and serum 25(OH)VitD3 level were assessed at baseline and at the completion of the 4-week dietary intervention. Nutrient intake was analyzed by dietary analysis software, and SPSS software was used for correlation and regression analyses. RESULTS Thirty-one participants completed the study. The prevalence of vitamin D deficiency was 100% at baseline. After the dietary intervention, the prevalence of vitamin D deficiency decreased to 45%. Levels of dietary intake of vitamin D, cholesterol, protein, fat, and calcium showed a significantly positive correlation with the serum 25(OH)VitD3 level. Body fat, visceral fat, waist-to-hip ratio, serum triglyceride, and Toll-2 expression were negatively correlated with the serum 25(OH)VitD3 level. Blood pressure had a significant negative correlation with 25(OH)VitD3 level. Participants in both groups experienced a significant decrease in blood pressure. CONCLUSIONS Intake of a balanced diet rich in vitamin D, with appropriate amounts of cholesterol, protein, calcium, and fat, helped improve body composition, ameliorated lipid metabolism disorder, reduced inflammation, and improved serum 25(OH)VitD3 level, thus lowering blood pressure.


Assuntos
Grupo com Ancestrais do Continente Asiático , Calcifediol/sangue , Dieta/métodos , Hipertensão/metabolismo , População Rural , Deficiência de Vitamina D/epidemiologia , Idoso , China/epidemiologia , Dietoterapia , Feminino , Humanos , Hipertensão/dietoterapia , Hipertensão/epidemiologia , Metabolismo dos Lipídeos , Masculino , Pessoa de Meia-Idade , Prevalência
6.
Int J Mol Sci ; 22(8)2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33918736

RESUMO

Fibromyalgia is a syndrome characterized by chronic and widespread musculoskeletal pain, often accompanied by other symptoms, such as fatigue, intestinal disorders and alterations in sleep and mood. It is estimated that two to eight percent of the world population is affected by fibromyalgia. From a medical point of view, this pathology still presents inexplicable aspects. It is known that fibromyalgia is caused by a central sensitization phenomenon characterized by the dysfunction of neuro-circuits, which involves the perception, transmission and processing of afferent nociceptive stimuli, with the prevalent manifestation of pain at the level of the locomotor system. In recent years, the pathogenesis of fibromyalgia has also been linked to other factors, such as inflammatory, immune, endocrine, genetic and psychosocial factors. A rheumatologist typically makes a diagnosis of fibromyalgia when the patient describes a history of pain spreading in all quadrants of the body for at least three months and when pain is caused by digital pressure in at least 11 out of 18 allogenic points, called tender points. Fibromyalgia does not involve organic damage, and several diagnostic approaches have been developed in recent years, including the analysis of genetic, epigenetic and serological biomarkers. Symptoms often begin after physical or emotional trauma, but in many cases, there appears to be no obvious trigger. Women are more prone to developing the disease than men. Unfortunately, the conventional medical therapies that target this pathology produce limited benefits. They remain largely pharmacological in nature and tend to treat the symptomatic aspects of various disorders reported by the patient. The statistics, however, highlight the fact that 90% of people with fibromyalgia also turn to complementary medicine to manage their symptoms.


Assuntos
Fibromialgia/diagnóstico , Fibromialgia/etiologia , Fibromialgia/terapia , Animais , Antioxidantes/metabolismo , Biomarcadores , Dietoterapia , Gerenciamento Clínico , Suscetibilidade a Doenças , Epigênese Genética , Regulação da Expressão Gênica , Predisposição Genética para Doença , Humanos , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Prognóstico , Testes Sorológicos
7.
Nutrients ; 13(3)2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33807102

RESUMO

Weight loss is key to controlling the increasing prevalence of metabolic syndrome (MS) and its components, i.e., central obesity, hypertension, prediabetes and dyslipidaemia. The goals of our study were two-fold. First, we characterised the relationships between eating duration, unprocessed and processed food consumption and metabolic health. During 4 weeks of observation, 213 adults used a smartphone application to record food and drink consumption, which was annotated for food processing levels following the NOVA classification. Low consumption of unprocessed food and low physical activity showed significant associations with multiple MS components. Second, in a pragmatic randomised controlled trial, we compared the metabolic benefits of 12 h time-restricted eating (TRE) to standard dietary advice (SDA) in 54 adults with an eating duration > 14 h and at least one MS component. After 6 months, those randomised to TRE lost 1.6% of initial body weight (SD 2.9, p = 0.01), compared to the absence of weight loss with SDA (-1.1%, SD 3.5, p = 0.19). There was no significant difference in weight loss between TRE and SDA (between-group difference -0.88%, 95% confidence interval -3.1 to 1.3, p = 0.43). Our results show the potential of smartphone records to predict metabolic health and highlight that further research is needed to improve individual responses to TRE such as a shorter eating window or its actual clock time.


Assuntos
Peso Corporal , Dieta , Ingestão de Alimentos , Adolescente , Adulto , Idoso , Composição Corporal , Dietoterapia/métodos , Exercício Físico , Fast Foods , Feminino , Humanos , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Terapia Nutricional , Obesidade/dietoterapia , Smartphone , Fatores de Tempo , Perda de Peso , Adulto Jovem
8.
Nutrients ; 13(3)2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33802429

RESUMO

The food we eat is thought to play a role in both the increasing incidence as well as the course of Crohn's disease. What to eat and what to avoid is an increasingly important question for both patients and physicians. Restrictive diets are widely adopted by patients and carry the risk of inducing or worsening malnutrition, without any guarantees on anti-inflammatory potential. Nevertheless, exploration of novel therapies to improve long-term management of the disease is desperately needed and the widespread use of exclusive enteral nutrition in the induction of paediatric Crohn's disease makes us wonder if a similar approach would be beneficial in adult patients. This narrative review discusses the current clinical evidence on whole food diets in achieving symptomatic and inflammatory control in Crohn's disease and identifies knowledge gaps with areas for future research.


Assuntos
Doença de Crohn/terapia , Dietoterapia/métodos , Adulto , Criança , Nutrição Enteral/métodos , Feminino , Humanos , Masculino , Indução de Remissão/métodos
9.
Nutrients ; 13(4)2021 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-33800668

RESUMO

Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of 'trigger' foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.


Assuntos
Dietoterapia/métodos , Dieta/efeitos adversos , Dispepsia/dietoterapia , Dispepsia/etiologia , Alimentos/efeitos adversos , Humanos
10.
Int J Mol Sci ; 22(5)2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33652942

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is to date the most common chronic liver disease in clinical practice and, consequently, a major health problem worldwide. It affects approximately 30% of adults in the general population and up to 70% of patients with type 2 diabetes (T2DM). Despite the current knowledge of the epidemiology, pathogenesis, and natural history of NAFLD, no specific pharmacological therapies are until now approved for this disease and, consequently, general strategies have been proposed to manage it. They include: (a) lifestyle change in order to promote weight loss by diet and physical activity, (b) control of the main cardiometabolic risk factors, (c) correction of all modifiable risk factors leading the development and progression of advanced forms of NAFLD, and (d) prevention of hepatic and extra-hepatic complications. In the last decade, several potential agents have been widely investigated for the treatment of NAFLD and its advanced forms-shedding some light but casting a few shadows. They include some glucose-lowering drugs (such as pioglitazone, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose co-transporter-2 (SGLT-2) inhibitors), antioxidants (such as vitamin E), statins or other lipid lowering agents, bile and non-bile acid farnesoid X activated receptor (FXR) agonists, and others. This narrative review discusses in detail the different available approaches with the potential to prevent and treat NAFLD and its advanced forms.


Assuntos
Hepatopatia Gordurosa não Alcoólica/terapia , Animais , Antioxidantes/uso terapêutico , Dietoterapia , Gerenciamento Clínico , Exercício Físico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipoglicemiantes/uso terapêutico , Estilo de Vida
11.
Int J Mol Sci ; 22(4)2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33670590

RESUMO

Weight control based on dietary restriction (DR) alone can cause lipid metabolic failure and progression to fatty liver. This study aimed to investigate the effect of exercise on preventing DR-induced hepatic fat accumulation in Zucker fatty (ZF) rats by focusing on the relationship between adipose tissue lipolysis and hepatic fat uptake. Six-week-old male ZF rats were randomly assigned to obese, DR, or DR with exercise (DR + Ex) groups. The DR and DR + Ex groups were fed a restricted diet, with the latter also undergoing voluntary exercise. After 6 weeks, hepatic fat accumulation was observed in the DR group, whereas intrahepatic fat was markedly reduced in the DR + Ex group. Compared with the obese (Ob) group, the DR group exhibited 2.09-fold expression of hepatic fatty acid translocase (FAT)/CD36 proteins (p < 0.01) and 0.14-fold expression of hepatic fatty acid-binding protein (FABP)1 (p < 0.01). There were no significant differences between the DR + Ex group and the Ob group. FAT/CD36 and hepatic triglyceride (TG) expression levels were strongly positively correlated (r = 0.81, p < 0.001), whereas there was a strong negative correlation between FABP1 and hepatic TG expression levels (r = -0.65, p < 0.001). Our results suggest that hepatic fat accumulation induced by DR in ZF rats might be prevented through exercise-induced modifications in FAT/CD36 and FABP1 expression.


Assuntos
Tecido Adiposo/metabolismo , Dietoterapia/métodos , Fígado Gorduroso/metabolismo , Fígado/metabolismo , Condicionamento Físico Animal/fisiologia , Animais , Antígenos CD36/metabolismo , Proteínas de Ligação a Ácido Graxo/metabolismo , Fígado Gorduroso/fisiopatologia , Fígado Gorduroso/prevenção & controle , Obesidade/metabolismo , Fatores de Proteção , Ratos Zucker , Triglicerídeos/metabolismo
12.
JAMA ; 325(9): 865-877, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33651094

RESUMO

Importance: The prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments. Observations: Validation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective. Conclusions and Relevance: Advances in the identification of specific dysfunctions as causes of individual symptoms in the "IBS spectrum" leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.


Assuntos
Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/terapia , Dor Abdominal/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Antidiarreicos/uso terapêutico , Diagnóstico Diferencial , Dietoterapia , Fibras na Dieta/uso terapêutico , Suplementos Nutricionais , Humanos , Laxantes/uso terapêutico , Psicoterapia
13.
Aten Primaria ; 53(4): 101983, 2021 04.
Artigo em Espanhol | MEDLINE | ID: mdl-33743202

RESUMO

The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.


Assuntos
Algoritmos , Lista de Checagem , Diabetes Mellitus Tipo 2/terapia , Consulta Remota/métodos , Terapia Combinada , Diabetes Mellitus Tipo 2/diagnóstico , Dietoterapia/métodos , Terapia por Exercício , Humanos , Hipoglicemiantes/uso terapêutico , Adesão à Medicação , Consulta Remota/normas
14.
Int J Mol Sci ; 22(4)2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33671915

RESUMO

Food restriction is a robust nongenic, nonsurgical and nonpharmacologic intervention known to improve health and extend lifespan in various species. Food is considered the most essential and frequently consumed natural reward, and current observations have demonstrated homeostatic responses and neuroadaptations to sustained intermittent or chronic deprivation. Results obtained to date indicate that food deprivation affects glutamatergic synapses, favoring the insertion of GluA2-lacking α-Ammino-3-idrossi-5-Metil-4-idrossazol-Propionic Acid receptors (AMPARs) in postsynaptic membranes. Despite an increasing number of studies pointing towards specific changes in response to dietary restrictions in brain regions, such as the nucleus accumbens and hippocampus, none have investigated the long-term effects of such practice in the dorsal striatum. This basal ganglia nucleus is involved in habit formation and in eating behavior, especially that based on dopaminergic control of motivation for food in both humans and animals. Here, we explored whether we could retrieve long-term signs of changes in AMPARs subunit composition in dorsal striatal neurons of mice acutely deprived for 12 hours/day for two consecutive days by analyzing glutamatergic neurotransmission and the principal forms of dopamine and glutamate-dependent synaptic plasticity. Overall, our data show that a moderate food deprivation in experimental animals is a salient event mirrored by a series of neuroadaptations and suggest that dietary restriction may be determinant in shaping striatal synaptic plasticity in the physiological state.


Assuntos
Corpo Estriado/metabolismo , Jejum/fisiologia , Privação de Alimentos/fisiologia , Plasticidade Neuronal/fisiologia , Neurônios/metabolismo , Sinapses/metabolismo , Animais , Dietoterapia , Dopamina/metabolismo , Ácido Glutâmico/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Receptores de AMPA/metabolismo , Transmissão Sináptica/fisiologia
15.
Value Health ; 24(3): 325-335, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641765

RESUMO

OBJECTIVES: Important links between dietary patterns and diseases have been widely applied to establish nutrition interventions. However, knowledge about between-person heterogeneity regarding the benefits of nutrition intervention can be used to personalize the intervention and thereby improve health outcomes and efficiency. We performed a systematic review of cost-effectiveness analyses (CEAs) of interventions with a personalized nutrition (PN) component to assess their methodology and findings. METHODS: A systematic search (March 2019) was performed in 5 databases: EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. CEAs involving interventions in adults with a PN component were included; CEAs focusing on clinical nutrition or undernutrition were excluded. The CHEERS checklist was used to assess the quality of CEAs. RESULTS: We identified 49 eligible studies among 1792 unique records. Substantial variation in methodology was found. Most studies (91%) focused only on psychological concepts of PN such as behavior and preferences. Thirty-four CEAs were trial-based, 13 were modeling studies, and 4 studies were both trial- and model-based. Thirty-two studies used quality-adjusted life year as an outcome measure. Different time horizons, comparators, and modeling assumptions were applied, leading to differences in costs/quality-adjusted life years. Twenty-eight CEAs (49%) concluded that the intervention was cost-effective, and 75% of the incremental cost-utility ratios were cost-effective given a willingness-to-pay threshold of $50 000 per quality-adjusted life year. CONCLUSIONS: Interventions with PN components are often evaluated using various types of models. However, most PN interventions have been considered cost-effective. More studies should examine the cost-effectiveness of PN interventions that combine psychological and biological concepts of personalization.


Assuntos
Dietoterapia/economia , Dietoterapia/métodos , Análise Custo-Benefício , Dietoterapia/psicologia , Dieta Saudável , Humanos , Estilo de Vida , Anos de Vida Ajustados por Qualidade de Vida , Projetos de Pesquisa
16.
Nutrients ; 13(2)2021 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-33669988

RESUMO

The gut microbiota (GM) represents a diverse and dynamic population of microorganisms and about 100 trillion symbiotic microbial cells that dwell in the gastrointestinal tract. Studies suggest that the GM can influence the health of the host, and several factors can modify the GM composition, such as diet, drug intake, lifestyle, and geographical locations. Gut dysbiosis can affect brain immune homeostasis through the microbiota-gut-brain axis and can play a key role in the pathogenesis of neurodegenerative diseases, including dementia and Alzheimer's disease (AD). The relationship between gut dysbiosis and AD is still elusive, but emerging evidence suggests that it can enhance the secretion of lipopolysaccharides and amyloids that may disturb intestinal permeability and the blood-brain barrier. In addition, it can promote the hallmarks of AD, such as oxidative stress, neuroinflammation, amyloid-beta formation, insulin resistance, and ultimately the causation of neural death. Poor dietary habits and aging, along with inflammatory responses due to dysbiosis, may contribute to the pathogenesis of AD. Thus, GM modulation through diet, probiotics, or fecal microbiota transplantation could represent potential therapeutics in AD. In this review, we discuss the role of GM dysbiosis in AD and potential therapeutic strategies to modulate GM in AD.


Assuntos
Doença de Alzheimer/microbiologia , Encéfalo/microbiologia , Disbiose/terapia , Microbioma Gastrointestinal/fisiologia , Mucosa Intestinal/metabolismo , Animais , Barreira Hematoencefálica/microbiologia , Dietoterapia , Disbiose/metabolismo , Disbiose/psicologia , Transplante de Microbiota Fecal , Humanos , Permeabilidade , Probióticos/uso terapêutico
17.
Nutrients ; 13(2)2021 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-33668596

RESUMO

BACKGROUND: An increasing number of dietary interventions for cancer survivors have been based on the behaviour change theory framework. The purpose of this study is to review the use and implementation of behaviour change theories in dietary interventions for people after cancer and assess their effects on the reported outcomes. METHODS: The search strategy from a Cochrane review on dietary interventions for cancer survivors was expanded to incorporate an additional criterion on the use of behaviour change theory and updated to September 2020. Randomised controlled trials (RCT) testing a dietary intervention compared to the control were included. Standard Cochrane methodological procedures were used. RESULTS: Nineteen RCTs, with 6261 participants (age range 44.6 to 73.1 years), were included in the review. The Social Cognitive Theory was the most frequently used theory (15 studies, 79%). Studies included between 4 to 17 behaviour change techniques. Due to limited information on the mediators of intervention and large heterogeneity between studies, no meta-analyses was conducted to assess which theoretical components of the interventions are effective. CONCLUSIONS: Whilst researchers have incorporated behaviour change theories into dietary interventions for cancer survivors, due to inconsistencies in design, evaluation and reporting, the effect of theories on survivors' outcomes remains unclear.


Assuntos
Terapia Comportamental , Sobreviventes de Câncer/psicologia , Dietoterapia/psicologia , Teoria Psicológica , Adulto , Idoso , Dieta Saudável/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/dietoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
BMJ ; 372: n72, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762260

RESUMO

Left sided colonic diverticulitis is a common and costly gastrointestinal disease in Western countries, characterized by acute onset of often severe abdominal pain. Imaging is necessary to make an initial diagnosis and determine disease severity. Colonoscopy should be done six to eight weeks after diagnosis to rule out a missed colon malignancy. Antibiotic treatment is used selectively in immunocompetent patients with mild acute uncomplicated diverticulitis. The clinical course of diverticulitis commonly includes unpredictable recurrences and chronic gastrointestinal symptoms, which are a detriment to quality of life. A better understanding of prognosis has prompted a shift toward non-operative approaches. The decision to undergo prophylactic colon resection should be individualized to consider the severity of diverticulitis, the patient's health and immune status, and the patient's preferences and values, as well as benefits and risks. Because only a section of colon is removed, recurrent diverticulitis remains a risk. Acute diverticulitis with an abscess is treated with antibiotics that cover Gram negative and anaerobic bacteria, with or without percutaneous drainage. Acute diverticulitis with purulent or feculent contamination of the peritoneal cavity is managed with surgery; primary resection and anastomosis is the procedure of choice in stable patients.


Assuntos
Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/terapia , Doença Aguda , Antibacterianos/uso terapêutico , Anti-Inflamatórios , Colectomia , Colonoscopia , Dietoterapia , Humanos , Prognóstico , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
19.
JAMA Netw Open ; 4(2): e2030921, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33566105

RESUMO

Importance: Many factors are associated with food choice. Personalized interventions could help improve dietary intake by using individual purchasing preferences to promote healthier grocery purchases. Objective: To test whether a healthy food incentive intervention using an algorithm incorporating customer preferences, purchase history, and baseline diet quality improves grocery purchase dietary quality and spending on healthy foods. Design, Setting, and Participants: This was a 9-month randomized clinical crossover trial (AB-BA) with a 2- to 4-week washout period between 3-month intervention periods. Participants included 224 loyalty program members at an independent Rhode Island supermarket who completed baseline questionnaires and were randomized from July to September 2018 to group 1 (AB) or group 2 (BA). Data analysis was performed from September 2019 to May 2020. Intervention: Participants received personalized weekly coupons with nutrition education during the intervention period (A) and occasional generic coupons with nutrition education during the control period (B). An automated study algorithm used customer data to allocate personalized healthy food incentives to participant loyalty cards. All participants received a 5% grocery discount. Main Outcomes and Measures: Grocery Purchase Quality Index-2016 (GPQI-16) scores (range, 0-75, with higher scores denoting healthier purchases) and percentage spending on targeted foods were calculated from cumulative purchasing data. Participants in the top and bottom 1% of spending were excluded. Paired t tests examined between-group differences. Results: The analytical sample included 209 participants (104 in group 1 and 105 in group 2), with a mean (SD) age of 55.4 (14.0) years. They were predominantly non-Hispanic White (193 of 206 participants [94.1%]) and female (187 of 207 participants [90.3%]). Of 161 participants with income data, 81 (50.3%) had annual household incomes greater than or equal to $100 000. Paired t tests showed that the intervention increased GPQI-16 scores (between-group difference, 1.06; 95% CI, 0.27-1.86; P = .01) and percentage spending on targeted foods (between-group difference, 1.38%; 95% CI, 0.08%-2.69%; P = .04). During the initial intervention period, group 1 (AB) and group 2 (BA) had similar mean (SD) GPQI-16 scores (41.2 [6.6] vs 41.0 [7.5]) and mean (SD) percentage spending on targeted healthy foods (32.0% [10.8%] vs 31.0% [10.5%]). During the crossover intervention period, group 2 had a higher mean (SD) GPQI-16 score than group 1 (42.9 [7.7] vs 41.0 [6.8]) and mean (SD) percentage spending on targeted foods (34.0% [12.1%] vs 32.0% [13.1%]). Conclusions and Relevance: This pilot trial demonstrated preliminary evidence for the effectiveness of a novel personalized healthy food incentive algorithm to improve grocery purchase dietary quality. Trial Registration: ClinicalTrials.gov Identifier: NCT03748056.


Assuntos
Comportamento de Escolha , Comportamento do Consumidor , Dieta Saudável , Motivação , Valor Nutritivo , Adulto , Idoso , Estudos Cross-Over , Dietoterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
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