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Food components and ocular pathophysiology: a critical appraisal of the role of oxidative mechanisms

Background and Objectives: Three of the major ocular diseases, namely cataracts, age-related macular degeneration and glaucoma are associated with oxidative damage. Disease risk and progression may be reduced through consumption of dietary components. To critically examine the literature on dietary and supplemental intakes of fruit and vegetables, meat, antioxidants (vitamins C, E and A), calcium, folate, iron, and their association with ocular disease. Methods and Study Design: Google Scholar and key references from texts and publications were searched using search terms (eye disease, antioxidants), (vision, nutrition), no date restriction, only articles in English were included. Results: We found probable evidence that dietary intake of fruits and vegetables, and vitamin C lowered incidence of cataracts and age-related macular degeneration. In high supplemental doses, vitamin C increases macular degeneration risk. Vitamin A from food was protective for cataracts and glaucoma, but not in supplemental form. Vitamin A was associated with lower incidence of macular degeneration. We also found probable evidence that higher intakes of meat increased the risk of cataracts and macular degeneration. Dietary calcium and iron appeared protective against glaucoma, but not in supplemental form. Conclusions: While a nutrient rich diet high in fruit and vegetables, and associated antioxidants appeared to be protective, we would caution intake of supplementary antioxidants for those with ocular disease.

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Enteral nutritional support in non-ICU hospitalized patients: current practice in Mexico

Background and Objectives: Patients receiving ≥80% of their energy requirements by enteral nutrition (EN) have better clinical outcomes; unfortunately, there are discrepancies between the amount prescribed and amount received. The aim of this study was to explore the nutritional clinical practice, determine the adequacy and identify reasons for underfeeding. Methods and Study Design: A retrospective study was conducted in hospitalized, non-intensive care unit, adult patients receiving EN for ≥72 h. The following data were recorded: the prescribed target of energy and protein per day, daily energy intake, and the percentage of adequacy of the energy and protein requirement up to hospital day seven. Complications during administration or reasons for interruption and the proportion of patients who received ≥80% of the energy goals on days four and seven were also recorded. Results: In total, 52 patients were included (61.5% women), with a median age of 57.5 years; 20.4% and 6.1% of the patients received ≥80% of their energy and protein goals, respectively, on day four, which improved to 28% (p＜0.005) and 19% (p＜0.001), respectively, on day seven. During the first seven days, a statistically significant (p＜0.001) difference was observed between the amount of prescribed and administered energy over 24 h. The patients who received ＜80% of their total energy requirement remained hospitalized for 29 days (IQR 16.5-45.5), while those who received ≥80% were hospitalized for 18 days (IQR 13.3-28.8) (p＜0.05). Conclusions: Significant energy and protein deficits were documented. Furthermore, it is necessary to use strategies such as the implementation of an algorithm to optimize EN.

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Prevalence and risk factors for complications in adult patients with short bowel syndrome receiving long-term home parenteral nutrition

Background and Objectives: Short bowel syndrome (SBS) is a complicated and challenging disease where home parenteral nutrition (HPN) is widely used. The complications of long-term HPN-dependent in adult patients with SBS are poorly documented. This study was mainly aimed to assess the prevalence and risk factors of HPN-associated complications in adult patients with SBS, especially the catheter-related sepsis and HPN-associated liver/biliary disorders. Methods and Study Design: 47 non-malignant adult patients with SBS who received HPN for more than 2 years in our clinical nutrition center were included. Patients were divided into two groups according to whether HPN-associated complications were present or not. Student's t-test and χ^2 test were applied to compare the differences between the two groups. Results: The mean frequency of catheter-related sepsis was 0.31±0.05 per catheter year of HPN. An higher incidence of catheter-related infections (p＜0.001) and shorter delay between HPN onset and first infection (p＜0.001) were identified as risk factors for catheter-related sepsis. A total of 25 patients (53.2%) developed HPN-associated liver/biliary diseases. The identified risk factors for HPNassociated liver/biliary disorders were higher rate of catheter-related infections (p=0.009), shorter delay between HPN onset and first infection (p=0.017), higher energy content of HPN (p=0.014), higher glucose rate of HPN (p=0.009), and lower lipid rate of HPN (p=0.022). Conclusion: Our study revealed that adult patients with SBS receiving long-term HPN treatment developed a low prevalence of catheter-related sepsis but a rather high prevalence of HPN-associated liver/biliary disorders. We also identified several risk factors for HPN-associated complications which should be taken notice of in clinical practice.

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Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD

Background and Objectives: Evidence suggests that dietary fiber benefits patients with chronic kidney disease (CKD); however, this conclusion requires further validation. In this study, we examined the effects of dietary fiber on kidney function, inflammation, indoxyl sulfate, nutritional status, and cardiovascular risk in patients with advanced CKD. Methods and Study Design: We performed linear regressions to assess the association between dietary fiber intake and CKD parameters. The aforementioned parameters were compared over an 18-month follow- up period. Kaplan–Meier analysis was used to investigate the association between fiber intake and Cardiac vascular disease (CVD). Results: In total, 157 patients were included in this study. Dietary fiber and inflammatory indices were associated (interleukin [IL]-6: β=−0.024, p=0.035). The differential estimated glomerular filtration rate (ΔeGFR) as well as levels of C-reactive protein, IL-6, indoxyl sulfate, and serum cholesterol in the higher fiber intake (≥25 g/day) group were lower than those in the lower fiber intake (＜25 g/day) group (p＜0.05). Differences in IL-6 and indoxyl sulfate levels were more significant in patients in the higher protein intake group (p＜0.05). Dietary fiber intake may be a protective factor associated with CVD (hazard ratio=0.537 and 0.305– 0.947). The protein nutritional status was not different between the two groups (p＞0.05). Conclusions: Our results suggest that increasing fiber intake can retard the decrease in the eGFR; can reduce the levels of proinflammatory factors, indoxyl sulfate, and serum cholesterol; and is negatively associated with cardiovascular risk, but does not disrupt the nutritional status of patients with CKD.

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The effect of an Annona muricata leaf extract on nutritional status and cytotoxicity in colorectal cancer: a randomized controlled trial

Background and Objectives: Annona muricata leaf infusion has traditionally been consumed to maintain health, but is now considered for use in treating cancer patients. The objective of this study was to elucidate the effects of A. muricata leaf extract in humans and human cell lines. Methods and Study Design: Thirty outpatients with colorectal cancer who had undergone primary tumor resection were enrolled in a randomized double-blind placebo- controlled pre–post-trial. They were divided into two groups: those who ingested A. muricata leaf extract (n=14) and those who ingested a placebo (n=14) daily for 8 weeks. Twenty-eight subjects completed the trial; they were equally distributed between the two groups. Serum from patients of both groups was compared for cytotoxicity against colorectal cancer cell lines. The nutritional status of patients was monitored throughout the study. Results: Ex vivo and clinical studies showed higher cytotoxicity in the supplemented group compared with the placebo group. Further research is required to investigate the long-term effect of A. muricata leaf extract, particularly on parameters directly related to cytotoxic activity toward colorectal cancer cells and nutrition status.

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Dietary galacto-oligosaccharides improve skin health: a randomized double blind clinical trial

Background and Objectives: To study the effects of galacto-oligosaccharides (GOS) on the skin, we investigated skin-related parameters in healthy adults who received GOS for 12 weeks. Methods and Study Design: This double-blind, randomized, placebo-controlled study included subjects divided into two groups (control and GOS) by stratified block randomization. The GOS group received 1.0 g of GOS twice a day, whereas the control group received only vehicle. Results: The results showed that the increase in corneometer values from baseline to week 12 was significantly greater in the GOS group than in the control group (6.91 vs 2.88 arbitrary units, p＜0.05). The transepidermal water loss (TEWL) in the GOS group was reduced significantly after 12 weeks of GOS treatment (20.1 g/h/m^2 at baseline vs 17.5 g/h/m^2 at week 12, p＜0.05). The differences in total and percentage of wrinkle areas between the two groups were statistically significant after 12 weeks of GOS treatment (p＜0.05). Conclusion: Our findings support that oral treatment with GOS is beneficial to the skin and present the possibility of new nutritional strategies for skin care.

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Lactobacillus intake for 60 days favors antioxidant status of human breast milk: an RCT

Background and Objectives: This study aimed to evaluate the effects of lactobacillus supplementation on trends of breast milk antioxidant parameters. Methods and Study Design: In an interventional study, 50 lactating women were randomly allocated to receive a daily supplement of lactobacillus (n=25) or a placebo (n=25) for 60 days. Daily dietary intake, anthropometric measures and breast milk antioxidant parameters were determined at the onset, and days 30 and 60 of the study. Repeated-measures ANOVA were performed to assess the change over time in the anthropometric and biochemical parameters between the two groups. The main effect of treatment was compared by using Bonferroni's procedure for CI adjustment. The significance level was set at p＜0.05. Results: There was a significant increase in breast milk total antioxidant capacity (TAC) between onset of study and day 30 (p=0.01) and day 60 (p=0.001) after lactobacillus supplementation; however, breast milk TAC level did not change significantly between days 30 and 60 (p=0.7). In the placebo group, breast milk TAC levels decreased significantly after 60 days (p=0.001). Breast milk malondialdehyde (MDA) levels decreased progressively during the study in the lactobacillus group (p=0.001); however, there was a significant increase in MDA with time in breast milk samples in the placebo group (p=0.015). Conclusions: Based on the findings, lactobacillus supplementation for 60 days could significantly increase breast milk TAC and decrease breast milk MDA levels, compared with baseline; however, further studies are needed to confirm these results.

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Snack bar compositions and their acute glycaemic and satiety effects

Background and Objectives: Maintaining blood glucose within homeostatic limits and eating foods that suppress hunger and promote satiety have beneficial impacts for health. This study investigated the glycaemic response and satiety effects of a serving size of a healthier snack bar, branded Nothing Else, that met the required nutrient profiling score criteria for a health claim, in comparison to two top-selling commercial snack bars. Methods and Study Design: In an experimental study, 24 participants aged ≥50 years were recruited. On three different days blood glucose concentration was measured twice at baseline and 15, 30, 45, 60, 90 and 120 minutes after consumption of a serving size of each bar. Satiety effects were self-reported hunger, fullness, desire to eat, and amount could eat ratings on visual analogue scales. Results: The incremental area under the blood glucose response curve (iAUC) over two hours for the Nothing Else bar was 30% lower than commercial Bar 2 (p＜0.001). At 45 minutes after eating, the Nothing Else bar induced the highest fullness rating and lowest hunger rating among the three snack bars. At two hours, fullness induced by the Nothing Else bar was twice that of Bar 2 (p=0.019), but not different to Bar 1 (p=0.212). Conclusions: The Nothing Else snack bar developed using the nutrient profiling scheme as a guideline, with its high protein and dietary fibre contents, had a lower glycaemic impact and induced a higher subjective satiety than the two commercial snack bars of equal weight.

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Symptomatic efficacy of buckwheat products in Non-Celiac Gluten Sensitivity (NCGS)

Background and Objectives: Buckwheat (Fagopyrum esculentum) is a gluten-free grain with acclaimed beneficial effects on human health. Our aim was to assess the effect of buckwheat products on intestinal/extra-intestinal symptoms and biochemical parameters in patients with Non-Celiac Gluten Sensitivity (NCGS). Methods and Study Design: A randomized, crossover trial with two intervention phases was conducted on 19 NCGS patients over a 12 week-period. The participants were assigned to consume products made from buckwheat or to maintain their normal gluten-free diet for 6 weeks in a random order. Symptoms due to NCGS were evaluated using two questionnaires. Results: During the intervention period with buckwheat products, patients experienced a significant decrease in the severity of abdominal pain and bloating (p=0.03). In contrast, the control group showed a significant worsening trend for the majority of NCGS symptoms such as nausea, headache, joint/muscle pain, and attention disorders. The replacement diet with buckwheat products also resulted in a significant increase of serum magnesium (+4.7%) and a significant reduction in the circulating levels of some pro-inflammatory cytokines such as interferon gamma (-33.3%) and monocyte chemotactic protein-1 (-46.5%). Conclusion: The study supports the positive effects of buckwheat for NCGS patients, showing that this alternative cereal can contribute to the reduction of both negative gastro-intestinal and related symptoms, and nutritional deficiencies, and lead to an improvement in inflammatory profile.

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Body mass index above 24 is beneficial for the 6-month survival rate in hepatocellular carcinoma patients with extrahepatic metastases

Background and Objectives: To investigate the effect of overweight status on the 6-month survival rate in patients with extrahepatic hepatocellular carcinoma (HCC). Methods and Study Design: We retrospectively analyzed the records of 51 patients with hepatocellular carcinoma and extrahepatic metastases between 2007 and 2010 before treatment. The associations among overweight status (body mass index [BMI] ＞24 kg/m2), demographic variables, and survival outcome were analyzed by univariate and multivariate analysis. Results: BMI＞24 kg/m2 was significantly associated with the 6-month survival rate (p=0.042). Gender (p=0.149), Child Pugh classification (p=0.149), Okuda staging (p=0.093), and albumin concentration ＞3.5 mg/dL (p=0.082) showed marginal survival benefits in univariate analysis. Multivariate analysis confirmed that BMI ＞24 kg/m2 was an independent prognostic factor for the 6-month survival rate (p=0.03). Conclusions: BMI ＞24 kg/m2 was associated with an improved 6-month survival rate in patients with extrahepatic metastatic hepatocellular carcinoma.