Nutrition in Acute Renal Failure

High-fiber-diet-related metabolites improve neurodegenerative symptoms in patients with obesity with diabetes mellitus by modulating the hippocampal-hypothalamic endocrine axis

Objective

Through transcriptomic and metabolomic analyses, this study examined the role of high-fiber diet in obesity complicated by diabetes and neurodegenerative symptoms.

Method

The expression matrix of high-fiber-diet-related metabolites, blood methylation profile associated with pre-symptomatic dementia in elderly patients with type 2 diabetes mellitus (T2DM), and high-throughput single-cell sequencing data of hippocampal samples from patients with Alzheimer's disease (AD) were retrieved from the Gene Expression Omnibus (GEO) database and through a literature search. Data were analyzed using principal component analysis (PCA) after quality control and data filtering to identify different cell clusters and candidate markers. A protein-protein interaction network was mapped using the STRING database. To further investigate the interaction among high-fiber-diet-related metabolites, methylation-related DEGs related to T2DM, and single-cell marker genes related to AD, AutoDock was used for semi-flexible molecular docking.

Result

Based on GEO database data and previous studies, 24 marker genes associated with high-fiber diet, T2DM, and AD were identified. Top 10 core genes include SYNE1, ANK2, SPEG, PDZD2, KALRN, PTPRM, PTPRK, BIN1, DOCK9, and NPNT, and their functions are primarily related to autophagy. According to molecular docking analysis, acetamidobenzoic acid, the most substantially altered metabolic marker associated with a high-fiber diet, had the strongest binding affinity for SPEG.

Conclusion

By targeting the SPEG protein in the hippocampus, acetamidobenzoic acid, a metabolite associated with high-fiber diet, may improve diabetic and neurodegenerative diseases in obese people.

Amino acid losses during hemodialysis: effects of high-solute flux and parenteral nutrition in acute renal failure

BACKGROUND

During standard hemodialysis, amino acid losses are substantial, amounting to 6 to 9 g per treatment. When these nutritional supplements are infused during dialysis, losses are increased, but a net positive balance can be achieved if the infusion rate is high enough. High-flux dialyzers, used with increasing frequency in modern dialysis centers because of their more permeable synthetic membranes, should cause further amino acid losses; however, the increase has not been measured, and the effect on plasma levels has not been examined. Assessment of net balance requires measurement of blood concentrations as well as of clearance.

METHODS

To quantitate the effect of high-flux dialysis on amino acid balance, we measured clearances, plasma levels, and losses of individual amino acids during hemodialysis in patients with acute renal failure who required daily parenteral nutrition.

RESULTS

Nearly all predialysis amino acid levels in plasma were within the normal range, probably because of control of uremia with prior dialyses and from continuous infusion. In paired studies, clearances were higher (150 +/- 15 mL/min vs 107 +/- 11 mL/min, p < .01), and levels fell more at mid-dialysis with high-flux membranes (28% +/- 5%) than with conventional cellulosic membranes (4 +/- 5%, p < .05). Mean losses of amino acid were 5.2 +/- 0.6 g per conventional dialysis, representing 60% of the total infused, and 7.3 +/- 1.8 g per high-flux dialysis, or 80% of the simultaneous infusion. Fractional losses decreased at higher infusion rates, but losses of individual amino acids varied from one fourth to more than 10 times the amount infused. Compared with other small solutes, plasma levels were relatively well maintained even during high-flux dialysis, a factor that enhanced removal by the dialyzer. Total balance depended more on the infusion rate than on the dialysis membrane.

CONCLUSIONS

These studies show that positive balance can be achieved with concurrent infusion during dialysis, especially at higher amino acid delivery rates. High-flux dialysis causes a greater disturbance of amino acid equilibrium than conventional dialysis does, but 24-hour gains far exceeded losses in the dialysate for most of the amino acids.

Nutritional support in the critical care setting (Part 1)

Over the past two decades nutritional support has rapidly become an integral part of the medical care of critically ill patients. As scientific evidence accumulates supporting the important role of underlying nutritional status in determining the eventual outcome of many illnesses, aggressive nutritional intervention has become commonplace in our medical and surgical ICUs. However, nutritional support, particularly parenteral alimentation, is expensive and associated with important morbidity and even mortality. Furthermore, definite evidence of its clinical efficacy under certain specific conditions is often lacking and in need of properly done prospective studies. This review summarizes the basic principles of nutrition as applied to the critically ill patient in the clinical setting. Special emphasis is on practical considerations regarding cost, efficacy (or lack thereof), and potential advantages, disadvantages, and risk of complications of each proposed approach.