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Alebel A, Demant D, Petrucka P, Sibbritt D. Effects of undernutrition on opportunistic infections among adults living with HIV on ART in Northwest Ethiopia: Using inverse-probability weighting. PLoS One 2022; 17:e0264843. [PMID: 35255109 PMCID: PMC8901070 DOI: 10.1371/journal.pone.0264843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Opportunistic infections (OIs) are the leading causes of hospitalization, morbidity, and mortality (accounting for 94.1% of all deaths) in people living with human immunodeficiency virus (PLHIV). Despite evidence suggested that undernutrition significantly increases the risk of OIs in PLHIV, to our knowledge, no study has examined the actual effects of undernutrition on OIs in this population, particularly in low-income countries. Thus, this study examined the effects of undernutrition on OIs in adults living with HIV receiving antiretroviral therapy (ART). METHODS We conducted a retrospective cohort study among 841adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. Study participants were selected using a simple random sampling technique. Data from participants' medical records were extracted using a project-specific data extraction checklist. The Kaplan Meier survival curve estimated the OIs free survival time. The effects of undernutrition on time to develop OIs was estimated using inverse-probability weighting. Finally, regression coefficients with 95% confidence intervals (95% CIs) were reported, with a statistical significance of p < 0.05. RESULTS Of 841 study participants, 262 (31.2%) developed OIs, and the overall incidence rate was 16.7 (95% CI: 14.8, 18.8) per 100 person-years. The incWidence of OIs in undernourished participants (21/100 person-years, 95% CI: 17.8, 27.4) was higher than well-nourished participants (15.0/100 person-years, 95% CI: 12.9, 17.4). When everyone in the population of interest is well-nourished, average time to develop OIs is estimated as 26.5 (coefficient: 26.5, 95% CI: 20.6, 32.4, p < 0.001) months. When everyone in the population of interest is undernourished, average time to develop OIs is estimated as 17.7 (95% CI: 12.8, 22.6) months. However, when everyone is undernourished, average time to develop OIs decreases by 8.8 (coefficient: -8.8, 95% CI: -16.6, -1.0, p = 0.026) months. Lastly, exposure to undernourishment (intervention) (ratio of average treatment effects to well-nourished potential outcome means in this study was a 32.5% reduction in OIs among adults living with HIV on ART. CONCLUSION We found that undernutrition significantly shortened time to develop OIs in adults living with HIV. This implies that the occurrence of OIs in this vulnerable population can be improved through different cost-effective nutritional interventions, such as routine nutritional assessments and education.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Ramalho R, Rao M, Zhang C, Agrati C, Ippolito G, Wang FS, Zumla A, Maeurer M. Immunometabolism: new insights and lessons from antigen-directed cellular immune responses. Semin Immunopathol 2020; 42:279-313. [PMID: 32519148 PMCID: PMC7282544 DOI: 10.1007/s00281-020-00798-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
Modulation of immune responses by nutrients is an important area of study in cellular biology and clinical sciences in the context of cancer therapies and anti-pathogen-directed immune responses in health and disease. We review metabolic pathways that influence immune cell function and cellular persistence in chronic infections. We also highlight the role of nutrients in altering the tissue microenvironment with lessons from the tumor microenvironment that shapes the quality and quantity of cellular immune responses. Multiple layers of biological networks, including the nature of nutritional supplements, the genetic background, previous exposures, and gut microbiota status have impact on cellular performance and immune competence against molecularly defined targets. We discuss how immune metabolism determines the differentiation pathway of antigen-specific immune cells and how these insights can be explored to devise better strategies to strengthen anti-pathogen-directed immune responses, while curbing unwanted, non-productive inflammation.
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Affiliation(s)
- Renata Ramalho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group G.E.N.A.-IUEM), Instituto Universitário Egas Moniz, Egas Moniz Higher Education School, Monte de Caparica, Portugal
| | - Martin Rao
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Chao Zhang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | | | | | - Fu-Sheng Wang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Markus Maeurer
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal.
- I Medizinische Klinik, Johannes Gutenberg University Mainz, Mainz, Germany.
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3
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Bertoni G, Trevisi E, Lombardelli R. Some new aspects of nutrition, health conditions and fertility of intensively reared dairy cows. ITALIAN JOURNAL OF ANIMAL SCIENCE 2016. [DOI: 10.4081/ijas.2009.491] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Jackson SJT, Singletary KW, Murphy LL, Venema RC, Young AJ. Phytonutrients Differentially Stimulate NAD(P)H:Quinone Oxidoreductase, Inhibit Proliferation, and Trigger Mitotic Catastrophe in Hepa1c1c7 Cells. J Med Food 2015; 19:47-53. [PMID: 26623679 DOI: 10.1089/jmf.2015.0079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Phytonutrients have rapidly emerged as natural food chemicals possessing multifaceted biological actions that may support beneficial health outcomes. Among the vast array of phytonutrients currently being studied, sulforaphane, curcumin, quercetin, and resveratrol have been frequently reported to stimulate the expression of endogenous detoxification enzymes and may thereby facilitate the neutralization of otherwise harmful environmental agents. Some of these same phytonutrients, however, have also been implicated in disrupting normal cell proliferation and hence may possess toxic properties in and of themselves. In this study, we characterize the respective minimum threshold concentrations of the aforementioned phytonutrients in Hepa1c1c7 cells that stimulate NAD(P)H quinone oxidoreductase (NQO1), a key enzyme in the hepatic neutralization of menadione, other biological oxidants, and some environmental carcinogens. Moreover, our findings demonstrate that relatively low concentrations of either sulforaphane or curcumin significantly (P < .05) increase NQO1 protein expression and activity without triggering G2/M cell cycle arrest or mitotic catastrophe. The minimal quercetin concentration inducing NQO1, however, was 100-fold higher than that which disrupted mitosis. Also, while resveratrol modestly stimulated NQO1, the minimally effective resveratrol concentration concomitantly induced evidence of cellular apoptosis. Taken together, these findings indicate that only particular phytonutrients are likely efficacious in upregulating NQO1 activity without also leading to hepatic cytotoxicity.
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Affiliation(s)
- Steven J T Jackson
- 1 U.S. Army Aeromedical Research Laboratory, Aircrew Health and Performance Division , Fort Rucker, Alabama, USA
| | - Keith W Singletary
- 2 Department of Food Science and Human Nutrition, University of Illinois , Urbana, Illinois, USA
| | - Laura L Murphy
- 3 Department of Physiology, Southern Illinois University , Carbondale, Illinois, USA
| | - Richard C Venema
- 4 Medical College of Georgia, Vascular Biology Center, Georgia Regents University , Augusta, Georgia , USA
| | - Andrew J Young
- 5 Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine , Natick, Massachusetts, USA
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Supplemental trace minerals (zinc, copper, and manganese) as sulfates, organic amino acid complexes, or hydroxy trace-mineral sources for shipping-stressed calves. THE PROFESSIONAL ANIMAL SCIENTIST 2015; 31:333-341. [PMID: 32288477 PMCID: PMC7147669 DOI: 10.15232/pas.2014-01383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Crossbred calves (n = 350; average BW 240 ± 1 kg) were obtained from regional livestock auctions. Within each set (block, n = 4), calves were stratified by BW and arrival sex into 1 of 8, 0.42-ha pens (10 to 12 calves per pen). Pens were assigned randomly to 1 of 3 treatments consisting of supplemental Zn (360 mg/d), Mn (200 mg/d), and Cu (125 mg/d) from inorganic (zinc sulfate, manganese sulfate, and copper sulfate; n = 2 pens per block), organic (zinc amino acid complex, manganese amino acid complex, and copper amino acid complex; Availa-4, Zinpro Corp., Eden Prairie, MN; n = 3 pens per block), and hydroxy (IntelliBond Z, IntelliBond C, and IntelliBond M; Micronutrients, Indianapolis, IN; n = 3 pens per block) sources. During the 42- to 45-d backgrounding period calves had ad libitum access to bermudagrass hay and were fed corn and dried distillers grain–based supplements that served as carrier for the treatments. After removal of data for chronic (n = 6) and deceased (n = 1) calves, trace-mineral source had no effect on final or intermediate BW (P = 0.86) or ADG (P ≥ 0.24). With all data included in the analysis, dietary treatments had no effect on the number treated once (P = 0.93), twice (P = 0.71), or 3 times (P = 0.53) for bovine respiratory disease or on the number of calves classified as chronic (P = 0.55). Based on these results, trace-mineral source had no effect on total BW gain, ADG, or morbidity during the receiving phase in shipping-stressed cattle.
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Qi KK, Wu J, Xu ZW. Effects of PEGylated porcine glucagon-like peptide-2 therapy in weaning piglets challenged with lipopolysaccharide. Peptides 2014; 58:7-13. [PMID: 24874708 DOI: 10.1016/j.peptides.2014.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/21/2022]
Abstract
This study aims to evaluate the therapeutic effect of polyethylene glycosylated porcine glucagon-like peptide-2 (pGLP-2), a long-acting form of pGLP-2, in lipopolysaccharide (LPS)-challenged piglets. Eighteen 21-day-old weaning piglets were randomly assigned into three groups: control (saline solution), LPS (100 μg/kg LPS), and PEG-pGLP-2 (10 nmol/kg PEG-pGLP-2+100 μg/kg LPS). All treatments were administered intraperitoneally. Compared with the control treatment, LPS treatment significantly decreased (P<0.05) the villus heights of the duodenum and jejunum, as well as the villus height/crypt depth ratio of the jejunum. However, PEG-pGLP-2 therapy reduced these effects (P>0.05). Specifically, PEG-pGLP-2 infusion significantly increased the villus height/crypt depth ratio of the duodenum (P<0.05) compared with LPS treatment. Compared with the control treatment, LPS treatment significantly increased (P<0.05) the mRNA expression levels of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) in the jejunum. However, PEG-pGLP-2 therapy reduced these effects (P<0.05). Specifically, PEG-pGLP-2 infusion significantly decreased (P<0.05) the mRNA expression levels of interleukin (IL)-8 and TNF-α in the duodenum and jejunum, IL-10 in the duodenum, and IFN-γ in the jejunum compared with the LPS treatment. LPS treatment increased the caspase-3 activity of the ileum mucosal (P<0.05), and this effect was significantly reduced by PEG-pGLP-2 treatment. These results indicate that PEG-pGLP-2 infusion alleviates the severity of intestinal injury in weaning piglets by reducing the secretion of inflammatory cytokines and the caspase-3 activity, and increasing the villus height/crypt depth ratio.
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Affiliation(s)
- Ke-ke Qi
- Institute of Animal Science, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, People's Republic of China
| | - Jie Wu
- Institute of Animal Science, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, People's Republic of China
| | - Zi-wei Xu
- Institute of Animal Science, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, People's Republic of China.
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Conjugated linoleic acid suppresses IRF3 activation via modulation of CD14. J Nutr Biochem 2013; 24:920-8. [DOI: 10.1016/j.jnutbio.2012.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 05/31/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022]
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8
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Gujja S, Terrill T, Mosjidis J, Miller J, Mechineni A, Kommuru D, Shaik S, Lambert B, Cherry N, Burke J. Effect of supplemental sericea lespedeza leaf meal pellets on gastrointestinal nematode infection in grazing goats. Vet Parasitol 2013; 191:51-8. [DOI: 10.1016/j.vetpar.2012.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 06/27/2012] [Accepted: 08/17/2012] [Indexed: 10/28/2022]
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9
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Supplemental trace minerals (zinc, copper, manganese, and cobalt) as Availa-4 or inorganic sources for shipping-stressed beef cattle 1. ACTA ACUST UNITED AC 2012. [DOI: 10.15232/s1080-7446(15)30361-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Early undernutrition is associated with attenuated inflammatory response and alteration in pharmacological efficacy of indomethacin in rats. Eur J Pharm Sci 2012; 46:56-63. [DOI: 10.1016/j.ejps.2012.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 01/05/2012] [Accepted: 02/10/2012] [Indexed: 01/08/2023]
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11
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Ferreira RS, Almeida RAMB, Barraviera SRCS, Barraviera B. Historical perspective and human consequences of Africanized bee stings in the Americas. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2012; 15:97-108. [PMID: 22401177 DOI: 10.1080/10937404.2012.645141] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In 1956, Africanized bees began to spread in the American continent from southern Brazil, where original African bees mated with European bees. A few years later, in 1990, these Africanized bees reached the United States and were found in Texas. Currently, these hybrid bees are found in several North American states and will probably reach the Canadian border in the future. Although the presence of Africanized bees had produced positive effects on Brazilian economy, including improvement in crop pollination and in honey production, turning Brazil into a major exporter, the negative impacts-such as swarming, aggressive behavior, and the ability to mass attack-resulted in serious and fatal envenomation with humans and animals. Victims of bee attacks usually develop a severe envenomation syndrome characterized by the release of a large amount of cytokines [interleukins (IL) IL-1, IL-6, IL-8], and tumor necrosis factor (TNF). Subsequently, such cytokines produce an acute inflammatory response that triggers adverse effects on skeletal muscles; bone marrow; hepatic and renal functions; and cardiovascular, central nervous, and immune systems. Finally, the aim of the present review is to study historical characteristics and current status of Africanized bees' spread, the composition of their venom, the impact of the bees on the Brazilian economy and ecology, and clinical aspects of their stings including immune response, and to suggest a protocol for bee sting management since there is no safe and effective antivenom available.
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Affiliation(s)
- R S Ferreira
- Department of Tropical Diseases and Image Diagnosis, São Paulo State University (UNESP–Univ Estadual Paulista), São Paulo, Brazil.
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12
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Lai M, Zhou R, Huang H, Hu S. Prevalence and risk factors associated with intestinal parasites in pigs in Chongqing, China. Res Vet Sci 2011; 91:e121-4. [DOI: 10.1016/j.rvsc.2011.01.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 01/17/2011] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
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13
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Impact of early malnourishment on the chronic inflammatory response and its implications for the effect of indomethacin on Wistar rats. Br J Nutr 2011; 106:845-51. [PMID: 21736850 DOI: 10.1017/s0007114511001127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of the present study was to investigate whether early undernutrition changes the chronic inflammatory response, so as to study its influence on pharmacological response to indomethacin. Rat offspring of dams fed from the first day of gestation to term or throughout the lactation period received a balanced diet (NN) or a basic regional diet (BRD) from northeast Brazil. According to their dams, the offspring were divided into three groups: NN; basic regional diet during gestation (BRD-g, undernourished during gestation); basic regional diet during gestation and lactation (BRD-gl, undernourished during gestation and lactation). At 2 months of age, Freund's adjuvant (0·2 ml) was inoculated into the plantar surface of the hind paw (day 0) of animals. All animals orally received saline (0·9 %) for 28 d. Another group of adult offspring was subjected to the same procedure as described above, but orally received indomethacin (2 mg/kg) instead of saline, and divided into three subgroups: NN treated with indomethacin (NNI); BRD-g treated with indomethacin (BRDI-g); BRD-gl treated with indomethacin (BRDI-gl). The hind paw volume was calculated on days 0 (initial paw volume), 7, 14 and 28. Hind paw swelling, blood albumin and C-reactive protein (CRP) levels and leucocyte counts were evaluated as markers of inflammation. Reduced hind paw swelling and the blood levels of serum albumin and CRP were found in the BRD-g and BRD-gl offspring. However, no difference was found in the leucocyte count. Compared with their respective saline-treated groups (NN, BRD-g and BRD-gl), the anti-inflammatory effect of indomethacin was lower in the BRDI-g and BRDI-gl groups than in the NNI group. We conclude that early undernutrition attenuated the chronic inflammatory response and the anti-inflammatory effect of indomethacin.
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14
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Immunorestorative Effect of Triiodothyronine Supplementation on the Primary Antibody Response to Sheep Red Blood Cells Following the Development of Immunodepression in Protein-Energy Malnourished Weanling Mice. ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j053v03n02_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Wistuba TJ, Kegley EB, Apple JK, Davis ME. Influence of fish oil supplementation on growth and immune system characteristics of cattle. J Anim Sci 2007; 83:1097-101. [PMID: 15827255 DOI: 10.2527/2005.8351097x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A study was conducted to determine the effects of supplemental fish oil on growth performance and immune system characteristics of beef calves. The grazing phase (78 d) used 48 yearling crossbred steers (231 +/- 22 kg initial BW) grazing 0.45-ha mixed-grass pastures (four per treatment) supplemented with 1.82 kg/d (as-fed basis) of the diets. Diets consisted of 1) corn-based supplement; 2) corn-based supplement with 1.5% (as-fed basis) fish oil; 3) wheat midd-based supplement; and 4) wheat midd-based supplement with 1.5% fish oil. On d 78, all calves were bled by jugular venipuncture, and blastogenic response of peripheral blood lymphocytes to phytohemagglutinin, concanavalin A, and pokeweed mitogen was measured. Fish oil supplementation negatively affected ADG with the corn-based supplement, but it had no effect when added to the wheat midd-based supplement (base-supplement x fish oil interaction; P < 0.03). Isolated lymphocytes from calves fed the corn-based supplement with fish oil had a greater response to stimulation with concanavalin A than did lymphocytes from calves fed the corn-based supplement alone, but there was no effect of fish oil addition to the wheat midd-based supplement (base-supplement x fish oil interaction; P < 0.01). During the growing phase, the 48 steers (352 +/- 32 kg initial BW) from the grazing phase were moved to drylot pens and were stratified by BW and previous dietary treatment (three calves per pen; eight pens per dietary treatment) for a 56-d growing trial. Dietary treatments consisted of 1) control, and 2) the control diet with 3% (as-fed basis) fish oil. Calves supplemented with fish oil had decreased ADG, ADFI, and G:F (P < or = 0.02) compared with controls. Fish oil supplementation during the grazing phase modulated the immune system; however, the decreased growth performance associated with fish oil in both trials may limit its practical use as an immune stimulant.
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Affiliation(s)
- T J Wistuba
- Department of Animal Science, University of Arkansas, Fayetteville, 72701, USA
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P. Møller A, Martín-Vivaldi M, Merino S, J. Soler J. Density-dependent and geographical variation in bird immune response. OIKOS 2006. [DOI: 10.1111/j.2006.0030-1299.15312.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Changhua L, Jindong Y, Defa L, Lidan Z, Shiyan Q, Jianjun X. Conjugated linoleic acid attenuates the production and gene expression of proinflammatory cytokines in weaned pigs challenged with lipopolysaccharide. J Nutr 2005; 135:239-44. [PMID: 15671220 DOI: 10.1093/jn/135.2.239] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We investigated the anti-inflammatory role of conjugated linoleic acid (CLA) in inflammation-challenged weaned pigs and in in vitro cultured peripheral blood mononuclear cells (PBMCs). To test the hypothesis that inflammation responses can be attenuated by dietary CLA supplementation, we used an acute inflammation model in which pigs were injected with lipopolysaccharide (LPS). After 14 d of dietary supplementation with either 2% soybean oil or 2% CLA, half of the pigs in each diet group were challenged with LPS. Dietary CLA alleviated growth depression and prevented the elevations in production and mRNA expression of proinflammatory cytokines [i.e., interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha] induced by the LPS challenge. CLA enhanced the expression of interleukin-10 (IL-10) and peroxisome proliferator-activated receptor-gamma (PPARgamma) in spleen and thymus. To further elucidate the inhibitory effects and the mechanism of action of CLA on cytokine profiles (i.e., IL-1beta, IL-6, and TNF-alpha), PBMCs were isolated from weaned pigs and cultured in media containing cis-9, trans-11 (9c,11t) CLA and trans-10, cis-12 (10t,12c) CLA. Each CLA isomer suppressed the production and expression of IL-1beta, IL-6, and TNF-alpha, and enhanced PPARgamma activation and gene expression in cultured PBMCs. At the molecular level, the inhibitory actions of CLA on IL-1beta, IL-6, and TNF-alpha are attributable mainly to 10t,12c-CLA and the anti-inflammatory properties of CLA are mediated, at least in part, through a PPARgamma-dependent mechanism.
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Affiliation(s)
- Lai Changhua
- College of Animal Science and Technology, China Agricultural University, Beijing, P.R. China
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18
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Geerling BJ, Badart-Smook A, van Deursen C, van Houwelingen AC, Russel MG, Stockbrügger RW, Brummer RJ. Nutritional supplementation with N-3 fatty acids and antioxidants in patients with Crohn's disease in remission: effects on antioxidant status and fatty acid profile. Inflamm Bowel Dis 2000; 6:77-84. [PMID: 10833065 DOI: 10.1097/00054725-200005000-00002] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with Crohn's disease (CD), malnutrition is frequently observed and is generally accepted to be an important issue. The aim of this study was to investigate the effects of 3 months of supplementation with a liquid formula containing either antioxidants (AO) or n-3 fatty acids plus AO on the antioxidant status and fatty acid profile of plasma phospholipids and adipose tissue, respectively, in patients with long-standing CD currently in remission. In a randomized, double-blind placebo-controlled study, CD patients received either placebo, AO, or n-3 fatty acids plus AO for 3 months in addition to their regular diet. In all, 25/37 CD patients completed the study. AO status was assessed by blood biochemical parameters. A statistical per-protocol analysis was performed. Serum concentrations of selenium, vitamin C, and vitamin E, the activity of superoxide dismutase and total antioxidant status were significantly (p < 0.05) increased after AO supplementation. Furthermore, compared with controls, serum concentrations of beta-carotene, selenium, and vitamin C and the activity of glutathione peroxidase (GPx) were significantly (p < 0.05) lower before supplementation; however, after AO supplementation these levels were not significantly different from controls (except for GPx). N-3 fatty acids plus AO supplementation significantly (p < 0.05) decreased the proportion of arachidonic acid, and increased the proportion of eicosapentanoic acid and docosahexanoic acid in both plasma phospholipids and adipose tissue. Supplementation with antioxidants improved antioxidant status in patients with CD in remission. In addition, supplementation with n-3 fatty acids plus antioxidants significantly changed the eicosanoid precursor profile, which may lead to the production of eicosanoids with attenuated proinflammatory activity. This study indicates that an immunomodulating formula containing n-3 fatty acids and/or AO may have the potential to play a role in the treatment of CD.
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Affiliation(s)
- B J Geerling
- Department of Gastroenterology, University of Maastricht, The Netherlands
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Abstract
The interactions between host nutrition and parasitism in ruminants are viewed within a framework that accounts for the allocation of scarce nutrient resources, such as energy and protein, between the various competing body functions of the host. These include functions that are the direct result of parasitism. Since it is proposed that the host gives priority to the reversal of the pathophysiological consequences of parasitism over other body functions, it is to be expected that improved nutrition will always lead to improved resilience. On the other hand, it is proposed that the function of growth, pregnancy and lactation are prioritised over the expression of immunity. Thus, improved nutrition may affect the degree of expression of immunity during these phases. The framework is useful at highlighting areas of future research on host/parasite/nutrition interactions. Its suggestions can account for the observations of the periparturient relaxation of immunity in reproducing females, as well as the reduction in worm burden in small ruminants supplemented with additional protein. Although developed for gastrointestinal nematodes in ruminants, the concepts of the framework should be applicable to the interactions of nutrition in other parasitic diseases.
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Affiliation(s)
- R L Coop
- Moredun Research Institute, Edinburgh, Scotland, UK
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DeWitt RC, Kudsk KA. The gut's role in metabolism, mucosal barrier function, and gut immunology. Infect Dis Clin North Am 1999; 13:465-81, x. [PMID: 10340178 DOI: 10.1016/s0891-5520(05)70086-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The gastrointestinal tract functions not only to absorb nutrients, it also plays an important immunologic role during health and critical illness. Under experimental and certain clinical conditions, stimulating the gut attentuates the stress response and avoids mucosal atrophy and increases permeability. Gut stimulation prevents atrophy of the gut-associated lymphoid tissue, the body's major defender of moist mucosal surfaces. A better understanding of gut function and improved nutrient delivery has clinical implications in the treatment of critically ill patients.
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Affiliation(s)
- R C DeWitt
- Department of Surgery, University of Tennessee College of Medicine, Memphis, USA
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21
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Obukowicz MG, Raz A, Pyla PD, Rico JG, Wendling JM, Needleman P. Identification and characterization of a novel delta6/delta5 fatty acid desaturase inhibitor as a potential anti-inflammatory agent. Biochem Pharmacol 1998; 55:1045-58. [PMID: 9605428 DOI: 10.1016/s0006-2952(97)00665-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The anti-inflammatory properties of essential fatty acid deficiency or n-3 polyunsaturated fatty acid supplementation have been attributed to a reduced content of arachidonic acid (AA; 20:4 n-6). An alternative, logical approach to depleting AA would be to decrease endogenous synthesis of AA by selectively inhibiting the delta5 and/or the delta6 fatty acid desaturase. High-throughput radioassays were developed for quantifying delta5, delta6, and delta9 desaturase activities in vitro and in vivo. CP-24879 (p-isopentoxyaniline), an aniline derivative, was identified as a mixed delta5/delta6 desaturase inhibitor during the screening of chemical and natural product libraries. In mouse mastocytoma ABMC-7 cells cultured chronically with CP-24879, there was a concentration-dependent inhibition of desaturase activity that correlated with the degree of depletion of AA and decreased production of leukotriene C4 (LTC4). Production of LTC4 was restored by stimulating the cells in the presence of exogenous AA, indicating that endogenous AA was limiting as substrate. In the livers of mice treated chronically with the maximally tolerated dose of CP-24879 (3 mg/kg, t.i.d.), combined delta5/delta6 desaturase activities were inhibited approximately 80% and AA was depleted nearly 50%. These results suggest that delta5 and/or delta6 desaturase inhibitors have the potential to manifest an anti-inflammatory response by decreasing the level of AA and the ensuing production of eicosanoids.
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Affiliation(s)
- M G Obukowicz
- Discovery Pharmacology, G.D. Searle, St. Louis, MO 63198, USA.
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Raz A, Kamin-Belsky N, Przedecki F, Obukowicz M. Dietary fish oil inhibits Δ6-desaturase activity in vivo. J AM OIL CHEM SOC 1998. [DOI: 10.1007/s11746-998-0037-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Amiram Raz
- ; Department of Biochemistry, George S. Wise Faculty of Life Sciences; Tel-Aviv University; Tel-Aviv 69978 Israel
| | - Nurit Kamin-Belsky
- ; Department of Biochemistry, George S. Wise Faculty of Life Sciences; Tel-Aviv University; Tel-Aviv 69978 Israel
| | - Fiorenza Przedecki
- ; Department of Biochemistry, George S. Wise Faculty of Life Sciences; Tel-Aviv University; Tel-Aviv 69978 Israel
| | - Mark Obukowicz
- Discovery Pharmacology, G.D. Searle; St. Louis Missouri 63198
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23
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Harrison J, McKiernan J, Neuberger JM. A prospective study on the effect of recipient nutritional status on outcome in liver transplantation. Transpl Int 1997. [PMID: 9287402 DOI: 10.1111/j.1432-2277.1997.tb00931.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In a prospective study, we have examined the effect of nutritional status, using anthropometric measurements, on outcome in 102 consecutive adult patients undergoing elective orthotopic liver transplantation. Mid-arm muscle circumference was calculated from these two measurements. Patient outcome variables were time spent in the intensive therapy unit, total time in hospital, infective complications and mortality within 6 months. Graft outcome variables were early graft function, peak aspartate transaminase, alkaline phosphatase, bilirubin and prothrombin time. Group A patients were below and group B patients above the 25th percentile for mid-arm circumference and triceps skin fold thickness. Eighty-four patients (79%) were at or below the 25th percentile of anthropometric measurements and 30 patients (28%) were below the 5th percentile. The median mid-arm muscle circumference in group A was 22.3 (range 16.4-28.9) cm and 25.7 (range 21.7-31.8) cm in group B. The medial albumin level was similar in the two groups. There were significantly more bacterial infections in group A (27/84, 32%) than in group B (2/22, 8%; chi(2) = 5.4, P = 0.02). There was a difference in mortality up to 6 months post-operatively that failed to reach statistical significance (Wilcoxon-Gehan statistic -199, P = 0.09). There were 11/84 (13%) deaths in group A and no deaths in group B (chi(2) = 2.8, P = 0.09). Post transplantation, there were significant differences (Kruskal-Wallis Anova) between groups A and B for peak alkaline phosphatase (683 vs 334 IU/I, P = 0.05) and peak prothrombin time [16 (range 13-25) vs 19.5 (range 12-65), P = 0.03]. These data suggest that a significant proportion of patients undergoing liver transplantation are nutritionally compromised and that this has effects on patient infection, susceptibility, graft function and mortality, which may possibly be improved by nutritional intervention.
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Affiliation(s)
- J Harrison
- Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Chinn KS, Welsch DJ, Salsgiver WJ, Mehta A, Raz A, Obukowicz MG. Modulation of adjuvant-induced arthritis by dietary arachidonic acid in essential fatty acid-deficient rats. Lipids 1997; 32:979-88. [PMID: 9307941 DOI: 10.1007/s11745-997-0128-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Controlled feeding of linoleic acid (LA) or arachidonic acid (AA) to essential fatty acid-deficient (EFAD) rats was used to define the relationship between dietary AA and the inflammatory response evoked during adjuvant-induced arthritis. Based on energy percentage, EFAD rats were fed AA at the human daily equivalent (1x; 5.5 mg/day) or 10 times that amount (10x; 55 mg/day) or, alternatively 0.5x of LA (273 mg/day). Feeding of 0.5x LA restored the plasma level of AA to that in chow-fed controls. In contrast, feeding of 1x AA only partially restored the plasma level of AA; 10x AA was required to fully replete AA. In parallel to the degree of repletion of AA in plasma, there were accompanying decreases in the levels of palmitoleic acid, oleic acid, and Mead acid. Compared to rats fed the standard laboratory chow diet (Control), edema in the primary hind footpads was decreased by 87% in EFAD, 71% in EFAD + 1x AA, 45% in EFAD + 10x AA, and 30% in EFAD + 0.5x LA. The decrease in edema in the footpads of EFAD rats was nearly identical to the decrease in edema in the footpads of Control rats dosed with indomethacin. Hind footpad edema correlated with the final AA plasma level and eicosanoid levels extracted from hind footpad tissue, but not with neutrophil infiltration. The data showed that 0.5x LA and 10x AA, but not 1x AA, could quickly replete AA, accompanied by the synthesis of AA-derived eicosanoids and restoration of edema. These results suggest that in humans consumption of the average daily amount of AA without concurrent ingestion of LA would not alleviate an EFAD state.
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Affiliation(s)
- K S Chinn
- G.D. Searle, St. Louis, Missouri 63198, USA
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Berclaz PY, Benedek C, Jequier E, Schutz Y. Changes in protein turnover and resting energy expenditure after treatment of malaria in Gambian children. Pediatr Res 1996; 39:401-9. [PMID: 8929858 DOI: 10.1203/00006450-199603000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To explore the changes in resting energy expenditure (REE) and whole body protein turnover induced by malaria, 23 children aged 6 to 14 y (23.9 +/- 1.0 kg, 1.3 +/- 0.02 m) were studied on three separate days after treatment (d 1, d 2, and 15 d later). REE was assessed by indirect calorimetry (hood), whereas whole body protein turnover was estimated using a single dose of [15N]glycine administered p.o. by measuring the isotopic enrichment of [15N]ammonia in urine over 12 h. Within the first 3.5 h after treatment, the body temperature dropped from 39.8 +/- 0.1 to 37.8 +/- 0.1 degrees C (p < 0.0001), and REE followed the same pattern, decreasing rapidly from 223 +/- 6 to 187 +/- 4 kJ/kg/d (p < 0.0001). Whole body protein synthesis and breakdown were significantly higher during the 1st day (5.65 +/- 0.38 and 6.21 +/- 0.43 g/kg/d, respectively) than at d 15 (2.95 +/- 0.17 and 2.77 +/- 0.2 g/kg/d). It is concluded that Gambian children suffering from an acute episode of malaria have an increased REE averaging 37% of the control value (d 15) and that this was associated with a substantial increase (by a factor of 2) in whole body protein turnover. A rapid normalization of the hypermetabolism and protein hypercatabolism states after treatment was observed.
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Affiliation(s)
- P Y Berclaz
- Institute of Physiology, Faculty of Medicine, University of Lausanne, Switzerland
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Takahashi K, Yodogawa S, Akiba Y, Tamura K. Effect of dietary protein concentration on responses to Escherichia coli endotoxin in broiler chickens. Br J Nutr 1995; 74:173-82. [PMID: 7547835 DOI: 10.1079/bjn19950121] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effect of dietary protein concentration on stress responses against injection of Escherichia coli lipopolysaccharide (LPS) was studied in male broiler chickens. Chickens (7 d of age) were fed on a 100 (low-protein; LP) or 300 g protein/kg (high-protein; HP) diet for 2 weeks. LPS was injected intraperitoneally every 2 d during the final 6 d, or once 16 h before the end of the experiment, at a concentration of 900 micrograms/chick. The LPS injection did not affect body-weight gain, feed intake, gain:intake ratio, or plasma Fe concentration. The single injection of LPS reduced plasma Zn concentration, but the repeated injections did not. Feeding the HP diet increased the response of plasma Zn concentration to the single injection of LPS. Plasma albumin concentration was reduced by LPS injection. Feeding the HP diet resulted in a higher plasma alpha 1-acid glycoprotein (AGP) concentration than feeding the LP diet, in chicks untreated with LPS. An increase in plasma AGP concentration observed after LPS injection in chicks fed on the LP diet was greater than that seen in chicks fed on the HP diet. No significant changes in plasma AGP concentration in response to repeated injections of LPS were observed in chicks fed on the HP diet. Plasma interleukin-1 (IL-1)-like activity was greater in chicks fed on the LP diet than in those fed on the HP diet, when LPS was injected. The response of plasma IL-1-like activity to the single injection of LPS in chicks fed on the LP diet was the greatest among the treatment groups. These results suggest that acute-phase responses to LPS injection are much greater in chicks fed on a LP diet than in those fed on a HP diet, and multiple injection of LPS weakens the responses.
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Affiliation(s)
- K Takahashi
- Department of Animal Science, Faculty of Agriculture, Tohoku University, Sendai-shi, Japan
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BARRAVIERA B, LOMONTE B, TARKOWSKI A, HANSON LÅ, MEIRA D. ACUTE-PHASE REACTIONS, INCLUDING CYTOKINES, IN PATIENTS BITTEN BY BOTHROPS AND CROTALUS SNAKES IN BRAZIL. ACTA ACUST UNITED AC 1995. [DOI: 10.1590/s0104-79301995000100003] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | - D.A. MEIRA
- School of Medicine of Botucatu; CEVAP-UNESP
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28
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Enwonwu CO. Cellular and molecular effects of malnutrition and their relevance to periodontal diseases. J Clin Periodontol 1994; 21:643-57. [PMID: 7531721 DOI: 10.1111/j.1600-051x.1994.tb00782.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In response to periodontal pathogens, the leukocytes (PMN) elaborate destructive oxidants, proteinases, and other factors. The balance between these factors, the antioxidants and endogenously synthesized antiproteinases determine the extent of periodontal damage. Malnutrition (PEM) is characterized by marked tissue depletion of the key antioxidant nutrients, including GSH (gamma-glutamyl-cysteinyl-glycine), and impaired acute-phase protein response (APR) to infections. The latter results in diminished production of the acute-phase proteins (APP). The APR plays a key role in promoting healing, and its deficit in PEM is due to impairment in the production and cellular action of the cytokines. Other features of malnutrition include inverted helper-suppressor T-cell ratio, histaminemia, hormonal imbalance with increased blood and saliva levels of free cortisol, and defective mucosal integrity. Malnutrition, particularly of the PEM type which usually involves concomitant deficiencies of several essential macro- and micronutrients, therefore has the potential to adversely influence the prognosis of periodontal infections.
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Affiliation(s)
- C O Enwonwu
- Department of Biochemistry, University of Maryland Dental School, Baltimore 21201-1586
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29
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Park KG. The Sir David Cuthbertson Medal Lecture 1992. The immunological and metabolic effects of L-arginine in human cancer. Proc Nutr Soc 1993; 52:387-401. [PMID: 8302881 DOI: 10.1079/pns19930080] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- K G Park
- Department of Surgery, Aberdeen University, Foresterhill
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30
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Abstract
Renal, hepatic, and cardiac transplantation are now recognized as acceptable methods for treating end-stage organ failure. Obtaining optimum results in such patients requires not only skillful surgical technique and postoperative immunosuppression but also stabilization of the patient preoperatively. This stabilization includes a number of physiologic parameters. One of the most important of these is the correction of preexisting nutritional deficits. Each type of end-stage organ disease creates unique nutritional problems. This article reviews these deficiencies and makes recommendations as to the appropriate nutrition protocols that can optimize results in the patient who undergoes organ transplantation.
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Hayes ME, Rai A, Cooper RG, Bayley D, Freemont AJ, Mawer EB. Inhibition by prostaglandin E1 and E2 of 1,25-dihydroxyvitamin D3 synthesis by synovial fluid macrophages from arthritic joints. Ann Rheum Dis 1992; 51:632-7. [PMID: 1616328 PMCID: PMC1005696 DOI: 10.1136/ard.51.5.632] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Previous work has shown that renal metabolism of 25-dihydroxyvitamin D3 (25(OH)D3) to the active metabolite, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) is stimulated by prostaglandin E2 and inhibited by acetylsalicylate (aspirin). As prostaglandins are primary inflammatory mediators and synovial fluid macrophages are known to synthesise 1,25(OH)2D3 in vitro, the effects of prostaglandin E1, prostaglandin E2, and aspirin on the metabolism of 25(OH)D3 by cells cultured from synovial fluid of patients with inflammatory arthritis were investigated. Most cultures contained non-proliferating macrophages which formed 1,25(OH)2D3; however, two of 13 cultures contained colonies of rapidly proliferating fibroblast-like cells which formed 24,25(OH)2D3 (24,25(OH)2D3). Prostaglandin E1 and prostaglandin E2 (0.01-10 mumol/l) induced marked inhibition of 1,25(OH)2D3 synthesis (up to 94%) in a dose dependent manner after preincubations of 24 hours but not over straightforward six hour incubations. Exposure of macrophages to aspirin (1 mumol/l-1 mmol/l) for 24 hours did not affect 1,25(OH)2D3 synthesis unless the cells had been pretreated with lipopolysaccharides, in which instance 1 mM aspirin increased 1,25(OH)2D3 synthesis. Lipopolysaccharide is a macrophage activating factor which stimulates macrophages to form 1,25(OH)2D3, and it also induces prostaglandin synthesis which would be inhibited by aspirin. Taken together these results suggest that prostaglandin E1 and prostaglandin E2 synthesised by macrophages may act in an autocrine manner to attenuate the ability of macrophage activating factors, such as lipopolysaccharide, to stimulate 1,25(OH)2D3 synthesis. Prostaglandins synthesised by other inflammatory cells may also inhibit 1,25(OH)2D3 synthesis in a paracrine manner. In contrast, prostaglandin E2 and aspirin had limited effects on fibroblast 24,25(OH)2D3 synthesis. This study shows that the effects of prostaglandin E1, prostaglandin E2, and aspirin in macrophages contrast with those previously reported for the renal 25(OH)D3-1alpha-hydroxylase, where prostaglandin E2 stimulated and aspirin inhibited enzyme activity. These results further emphasise that synthesis of 1,25(OH)2D3 in non-renal sites is independently regulated, which is consistent with it having an immunological role at a local level rather than playing a part in systemic calcium homeostasis.
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Affiliation(s)
- M E Hayes
- Manchester University Bone Disease Research Centre, United Kingdom
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Bagley JS, Wan JM, Georgieff M, Forse RA, Blackburn GL. Cellular nutrition in support of early multiple organ failure. Chest 1991; 100:182S-188S. [PMID: 1909226 DOI: 10.1378/chest.100.3_supplement.182s] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- J S Bagley
- Nutrition/Metabolism Laboratory, New England Deaconess Hospital, Harvard Medical School, Boston
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Aggett PJ, Haschke F, Heine W, Hernell O, Koletzko B, Launiala K, Rey J, Rubino A, Senterre J. Comment on the content and composition of lipids in infant formulas. ESPGAN Committee on Nutrition. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:887-96. [PMID: 1957613 DOI: 10.1111/j.1651-2227.1991.tb11969.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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35
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Discriminating effects of a nucleotide-rich yeast extract, ProbioticumR, as an immunomodulator contrasted with actions in chronic immuno-inflammatory disease (adjuvant-induced arthritis) in rodents. Inflammopharmacology 1991. [DOI: 10.1007/bf02735397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Despite provision of adequate calories and nitrogen, patients receiving current nutrition support formulations often have suppression of immune function. Certain nutrients may act pharmacologically on the immune system. The choice of nutrients appropriate for a given disease state must take into consideration the nutritional status of the subject, presence of infection, injury or hypermetabolism, and the specific immune defect. Nutritional therapy specific for certain disease states is complex and in its infancy but may hold promise for improved patient outcome. Randomized prospective trials to evaluate efficacy are mandatory. Continued research into individual nutrients to elucidate mechanisms of immunomodulation must follow. In the meantime, broad application of products shown to be effective for a specific indication is inappropriate.
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Driscoll DF, Blackburn GL. Total parenteral nutrition 1990. A review of its current status in hospitalised patients, and the need for patient-specific feeding. Drugs 1990; 40:346-63. [PMID: 2121457 DOI: 10.2165/00003495-199040030-00003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The decision to initiate total parenteral nutrition (TPN) in hospitalised patients should be based on the presence of clinically significant starvation and dysfunction of the gastrointestinal tract. It must also take into account the clinical status of the patient, considering major treatment strategies and the need for prolonged hospitalisation, the benefits of feeding and the attendant risks of central venous alimentation. Recent evidence in surgical patients in intensive care provides the impetus for early parenteral feeding; withholding TPN and inducing a cumulative caloric deficit of greater than or equal to 10,000 calories has been associated with a survival disadvantage compared to those patients with a positive caloric balance. Moreover, the incidence of serious organ failure was consistently higher in the group with cumulative caloric deficits. Additional evidence favouring the provision of TPN exists, but the axiom 'if the gut works, use it' still prevails. Exceptions to this precept do exist, however, particularly in critically ill patients. The metabolic derangements encountered in these patients could be so severe that it may be impossible to correct the electrolyte and acid-base abnormalities via the enteral route. For example, such patients may have large potassium requirements and/or severe alkalaemia necessitating systemic acidification with hydrochloric acid, precluding enteral delivery due to gastrointestinal intolerance. In this setting, combined enteral feeding with 10 to 20 ml/h to maintain gut integrity (via a post-pyloric feeding tube) and TPN during the acute phases of illness is an exciting possibility. Once the decision to feed is made, the amount of nutrition prescribed may assume equal importance with respect to patient outcome. The frequent use of the Harris-Benedict equation, plus a multiplying factor for stress, may overestimate caloric requirements; this is particularly true during critical illness. The dangers of overfeeding may be just as harmful as not feeding at all. The use of indirect calorimetry provides the most accurate measurement of resting energy expenditure. However, in the absence of indirect calorimetry, modified equations to estimate caloric needs are available. Caution must be observed as caloric intakes exceeding the range of 25 to 35 kcal/kg may be dangerous, particularly in the severely ill patient with preexisting organ failure. The amount of protein and the 'calorie-mix' necessary for optimal nutritional support is open to debate. Recent evidence has demonstrated no additional benefit to nitrogen balance in severely septic patients when protein was given at a level exceeding 1.5 g/kg/day.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- D F Driscoll
- Nutrition Support Service, New England Deaconess Hospital, Boston
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