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Prado Y, Aravena D, Gatica S, Llancalahuen FM, Aravena C, Gutiérrez-Vera C, Carreño LJ, Cabello-Verrugio C, Simon F. From genes to systems: The role of food supplementation in the regulation of sepsis-induced inflammation. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166909. [PMID: 37805092 DOI: 10.1016/j.bbadis.2023.166909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Systemic inflammation includes a widespread immune response to a harmful stimulus that results in extensive systemic damage. One common example of systemic inflammation is sepsis, which is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Under the pro-inflammatory environment of sepsis, oxidative stress contributes to tissue damage due to dysfunctional microcirculation that progressively causes the failure of multiple organs that ultimately triggers death. To address the underlying inflammatory condition in critically ill patients, progress has been made to assess the beneficial effects of dietary supplements, which include polyphenols, amino acids, fatty acids, vitamins, and minerals that are recognized for their immuno-modulating, anticoagulating, and analgesic properties. Therefore, we aimed to review and discuss the contribution of food-derived supplementation in the regulation of inflammation from gene expression to physiological responses and summarize the precedented potential of current therapeutic approaches during systemic inflammation.
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Affiliation(s)
- Yolanda Prado
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Diego Aravena
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Sebastian Gatica
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Felipe M Llancalahuen
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Cristobal Aravena
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Cristián Gutiérrez-Vera
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Leandro J Carreño
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Chile
| | - Claudio Cabello-Verrugio
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Laboratory of Muscle Pathology, Fragility and Aging, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago, Chile
| | - Felipe Simon
- Laboratory of Integrative Physiopathology, Faculty of Life Sciences, Universidad Andres Bello, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Millennium Nucleus of Ion Channel-Associated Diseases, Santiago, Chile.
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Alarcon G, Sierra L, Roco J, Van Nieuwenhove C, Medina A, Medina M, Jerez S. Effects of Cold Pressed Chia Seed Oil Intake on Hematological and Biochemical Biomarkers in Both Normal and Hypercholesterolemic Rabbits. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2023; 78:179-185. [PMID: 36515802 DOI: 10.1007/s11130-022-01036-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Most of the studies on the beneficial effects of chia have been conducted with its seeds. There is less evidence about the effects of cold pressed chia seeds oil on hypercholesterolemia-induced alterations. Thus, this study investigated the effects of cold pressed chia seed oil supplementation on certain hematological and biochemical biomarkers in both normal and hypercholesterolemic rabbits. Thirty two male rabbits were assigned to four different groups and fed on: 1) a regular diet (CD), 2) CD supplemented with 10% chia oil, 3) CD supplemented with 1% cholesterol, 4) CD supplemented with 1% cholesterol and 10% chia oil. After six weeks of dietary interventions, mean arterial blood pressure and visceral fat were measured and blood samples were analyzed for lipid profiles and hematological parameters while erythrocyte membranes and retroperitoneal fat were analyzed for fatty acids composition and biochemical biomarkers. Dietary intervention with chia oil achieved control of the hypercholesterolemia-induced increase of mean arterial blood pressure, neutrophil to lymphocytes ratio, erythrocyte membrane fluidity, and improved erythrocyte morphological alterations. With regard to inflammatory biomarkers, chia oil supplementation reduced omega-6/omega-3 polyunsaturated fatty acids ratios and arachidonic/linolenic fatty acids ratios both in erythrocytes and fat from normal and hypercholesterolemic rabbits. The increase of linolenic fatty acid into the retroperitoneal fat was about 9 times higher than its respective controls. These results provide support for the potential health benefits of chia oil intake on hypercholesterolemia-associated clinical, hematological and biochemical alterations.
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Affiliation(s)
- Gabriela Alarcon
- Instituto Superior de Investigaciones Biológicas (INSIBIO, UNT-CONICET), Av. Independencia 1800, 4000, San Miguel de Tucumán, Tucumán, Argentina
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina
| | - Liliana Sierra
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina
| | - Julieta Roco
- Instituto Superior de Investigaciones Biológicas (INSIBIO, UNT-CONICET), Av. Independencia 1800, 4000, San Miguel de Tucumán, Tucumán, Argentina
| | - Carina Van Nieuwenhove
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina
- Centro de Referencia Para Lactobacilos (CERELA-CONICET), Chacabuco 145, 4000, San Miguel de Tucumán, Tucumán, Argentina
| | - Analia Medina
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina
| | - Mirta Medina
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina
| | - Susana Jerez
- Instituto Superior de Investigaciones Biológicas (INSIBIO, UNT-CONICET), Av. Independencia 1800, 4000, San Miguel de Tucumán, Tucumán, Argentina.
- Facultad de Ciencias Naturales, Universidad Nacional de Tucumán (UNT), Miguel Lillo 298, San Miguel de Tucumán, Tucumán, Argentina.
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Gholipur-Shahraki T, Vahdat S, Seirafian S, Pourfarzam M, Badri S. Effect of Omega-3 Fatty Acids Supplementation on Homocysteine Level in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. J Res Pharm Pract 2022; 11:80-86. [PMID: 36798100 PMCID: PMC9926915 DOI: 10.4103/jrpp.jrpp_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/05/2022] [Indexed: 12/15/2022] Open
Abstract
Objective One of the most common diseases with high morbidity and mortality rates is chronic kidney disease. Cardiovascular disease affects most patients with chronic kidney disorders, particularly patients undergoing dialysis; hence, appropriate prevention and management approaches are essential. This study aimed to evaluate the reduction of inflammatory biomarkers, especially homocysteine, by omega-3 fatty acids in peritoneal dialysis patients. Methods This study enrolled 60 peritoneal dialysis patients who met specified inclusion and exclusion criteria and were randomized to intervention or placebo groups. Omega-3 capsules were given at a dose of 3 g/d for 8 weeks. Inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), homocysteine, albumin, and lipid profile measured before and after the study. Findings Results of this trial revealed that the levels of homocysteine, hs-CRP, and albumin did not change significantly during the study. Analysis of lipid profiles before and after intervention showed omega-3 has no significant effect on the level of total cholesterol or low-density lipoprotein cholesterol; However, the level of triglyceride reduced remarkably (P = 0.002). In addition, serum levels of high-density lipoprotein cholesterol increased at the end of the study (P < 0.001). Conclusion Omega-3 does not seem to be able to change the inflammatory markers significantly, particularly homocysteine. More extensive trials must be conducted to better understand the impact of omega-3 on inflammatory and nutritional markers, particularly in peritoneal dialysis patients.
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Affiliation(s)
- Tahereh Gholipur-Shahraki
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vahdat
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Pourfarzam
- Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Shirinsadat Badri, E-mail:
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Appleton KM, Voyias PD, Sallis HM, Dawson S, Ness AR, Churchill R, Perry R. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev 2021; 11:CD004692. [PMID: 34817851 PMCID: PMC8612309 DOI: 10.1002/14651858.cd004692.pub5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly debilitating, difficult to treat, has a high rate of recurrence, and negatively impacts the individual and society as a whole. One potential treatment for MDD is n-3 polyunsaturated fatty acids (n-3PUFAs), also known as omega-3 oils, naturally found in fatty fish, some other seafood, and some nuts and seeds. Various lines of evidence suggest a role for n-3PUFAs in MDD, but the evidence is far from conclusive. Reviews and meta-analyses clearly demonstrate heterogeneity between studies. Investigations of heterogeneity suggest different effects of n-3PUFAs, depending on the severity of depressive symptoms, where no effects of n-3PUFAs are found in studies of individuals with mild depressive symptomology, but possible benefit may be suggested in studies of individuals with more severe depressive symptomology. Hence it is important to establish their effectiveness in treating MDD. This review updates and incorporates an earlier review with the same research objective (Appleton 2015). OBJECTIVES To assess the effects of n-3 polyunsaturated fatty acids (also known as omega-3 fatty acids) versus a comparator (e.g. placebo, antidepressant treatment, standard care, no treatment, wait-list control) for major depressive disorder (MDD) in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO together with trial registries and grey literature sources (to 9 January 2021). We checked reference lists and contacted authors of included studies for additional information when necessary. SELECTION CRITERIA We included studies in the review if they: used a randomised controlled trial design; provided n-3PUFAs as an intervention; used a comparator; measured depressive symptomology as an outcome; and were conducted in adults with MDD. Primary outcomes were depressive symptomology (continuous data collected using a validated rating scale) and adverse events. Secondary outcomes were depressive symptomology (dichotomous data on remission and response), quality of life, and non-completion of studies. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. We assessed the certainty of the evidence using GRADE criteria. MAIN RESULTS The review includes 35 relevant studies: 34 studies involving a total of 1924 participants investigated the impact of n-3PUFA supplementation compared to placebo, and one study involving 40 participants investigated the impact of n-3PUFA supplementation compared to antidepressant treatment. For the placebo comparison, n-3PUFA supplementation resulted in a small to modest benefit for depressive symptomology, compared to placebo: standardised mean difference (SMD) (random-effects model) -0.40 (95% confidence interval (CI) -0.64 to -0.16; 33 studies, 1848 participants; very low-certainty evidence), but this effect is unlikely to be clinically meaningful. An SMD of 0.40 represents a difference between groups in scores on the HDRS (17-item) of approximately 2.5 points (95% CI 1.0 to 4.0), where the minimal clinically important change score on this scale is 3.0 points. The confidence intervals include both a possible clinically important effect and a possible negligible effect, and there is considerable heterogeneity between studies. Sensitivity analyses, funnel plot inspection and comparison of our results with those of large well-conducted trials also suggest that this effect estimate may be biased towards a positive finding for n-3PUFAs. Although the numbers of individuals experiencing adverse events were similar in intervention and placebo groups (odds ratio (OR) 1.27, 95% CI 0.99 to 1.64; 24 studies, 1503 participants; very low-certainty evidence), the confidence intervals include a small decrease to a modest increase in adverse events with n-3PUFAs. There was no evidence for a difference between n-3PUFA and placebo groups in remission rates (OR 1.13, 95% CI 0.74 to 1.72; 8 studies, 609 participants, low-certainty evidence), response rates (OR 1.20, 95% CI 0.80 to 1.79; 17 studies, 794 participants; low-certainty evidence), quality of life (SMD -0.38 (95% CI -0.82 to 0.06), 12 studies, 476 participants, very low-certainty evidence), or trial non-completion (OR 0.92, 95% CI 0.70 to 1.22; 29 studies, 1777 participants, very low-certainty evidence). The evidence on which these results are based was also very limited, highly heterogeneous, and potentially biased. Only one study, involving 40 participants, was available for the antidepressant comparison. This study found no differences between treatment with n-3PUFAs and treatment with antidepressants in depressive symptomology (mean difference (MD) -0.70, 95% CI -5.88 to 4.48), rates of response to treatment (OR 1.23, 95% CI 0.35 to 4.31), or trial non-completion (OR 1.00, 95% CI 0.21 to 4.71). Confidence intervals are however very wide in all analyses, and do not rule out important beneficial or detrimental effects of n-3PUFAs compared to antidepressants. Adverse events were not reported in a manner suitable for analysis, and rates of depression remission and quality of life were not reported. AUTHORS' CONCLUSIONS At present, we do not have sufficient high-certainty evidence to determine the effects of n-3PUFAs as a treatment for MDD. Our primary analyses may suggest a small-to-modest, non-clinically beneficial effect of n-3PUFAs on depressive symptomology compared to placebo; however the estimate is imprecise, and we judged the certainty of the evidence on which this result is based to be low to very low. Our data may also suggest similar rates of adverse events and trial non-completion in n-3PUFA and placebo groups, but again our estimates are very imprecise. Effects of n-3PUFAs compared to antidepressants are very imprecise and uncertain. More complete evidence is required for both the potential positive and negative effects of n-3PUFAs for MDD.
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Affiliation(s)
| | - Philip D Voyias
- North Bristol NHS Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Hannah M Sallis
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Andrew R Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Werida RH, Abou-Madawy S, Abdelsalam M, Helmy MW. Omega 3 fatty acids effect on the vascular calcification biomarkers fetuin A and osteoprotegerin in hemodialysis patients. Clin Exp Med 2021; 22:301-310. [PMID: 34286397 DOI: 10.1007/s10238-021-00740-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022]
Abstract
Chronic renal failure patients on dialysis are at a high risk of death due to vascular calcification. This study aimed at investigating the effect of omega-3 fatty acids on the vascular calcification biomarkers fetuin-A and osteoprotegerin (OPG) in patients with chronic renal failure who are undergoing hemodialysis. This prospective, open-label, controlled, parallel study included 60 hemodialysis patients who were randomized to receive either omega-3 fatty acids capsule along with their standard care of treatment (omega-3 group) or their standard care of treatment only (control group). Serum levels of fetuin-A, OPG, calcium, phosphorus, hemoglobin, parathyroid hormone, blood urea nitrogen (BUN), albumin, serum creatinine (SCr), and serum triglycerides (TG) were measured at baseline and after six months of intervention and follow-up of both groups. Significantly increased levels of fetuin-A and OPG (p < 0.001) were observed in the omega-3 group six months after the intervention compared with the control group. Levels of TG, albumin, SCr, BUN, phosphorous, calcium, hemoglobin, and parathyroid hormone were not significantly different in the omega-3 group compared with the control group after six months of intervention. Our study concluded that omega-3 may have a clinically beneficial effect in decreasing cardiovascular events by increasing the levels of the protective vascular calcification inhibitors fetuin-A and osteoprotegerin in chronic renal failure patients who are undergoing hemodialysis.
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Affiliation(s)
- Rehab H Werida
- Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, 22514, Egypt.
| | - Sohaila Abou-Madawy
- Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, 22514, Egypt
| | - Mohamed Abdelsalam
- Nephrology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maged W Helmy
- Pharmacology and Toxicology, Faculty of Pharmacy, Damanhour University, Damanhour, 22514, Egypt
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Kasemy ZA, Hathout HM, Omar ZA, Samir MA, Bahbah WA. Effect of Omega-3 supplements on quality of life among children on dialysis: A prospective cohort study. Medicine (Baltimore) 2020; 99:e22240. [PMID: 33019398 PMCID: PMC7535790 DOI: 10.1097/md.0000000000022240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ± 13.31) than controls (22.70 ± 1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ± 4.22) than older ones (13.92 ± 6.84) (P = .049). Females had significantly higher total QoL score (25.53 ± 6.61) than males (20.06 ± 7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ± 10.36 vs 42.22 ± 13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ± 32.55 vs 169.35 ± 31.82) (P < .001) and (10.29 ± 4.39 vs 11.19 ± 4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ± 0.09, 70.0 ± 5.99 respectively) than pre n-3FA (1.31 ± 0.07 and 65.25 ± 6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.
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Affiliation(s)
| | | | - Zein A. Omar
- Pediatrics department, Menoufia Faculty of Medicine, Egypt
| | | | - Wael A. Bahbah
- Pediatrics department, Menoufia Faculty of Medicine, Egypt
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Saglimbene VM, Wong G, van Zwieten A, Palmer SC, Ruospo M, Natale P, Campbell K, Teixeira-Pinto A, Craig JC, Strippoli GF. Effects of omega-3 polyunsaturated fatty acid intake in patients with chronic kidney disease: Systematic review and meta-analysis of randomized controlled trials. Clin Nutr 2020; 39:358-368. [DOI: 10.1016/j.clnu.2019.02.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/29/2022]
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Valle Flores JA, Fariño Cortéz JE, Mayner Tresol GA, Perozo Romero J, Blasco Carlos M, Nestares T. Oral supplementation with omega-3 fatty acids and inflammation markers in patients with chronic kidney disease in hemodialysis. Appl Physiol Nutr Metab 2020; 45:805-811. [PMID: 31935118 DOI: 10.1139/apnm-2019-0729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic kidney disease (CKD) is an increasingly common public health problem that increases the risk of death because of cardiovascular complications by 2-3 times compared with the general population. This research concerns a prospective, randomized, double-blind study in patients with CKD undergoing hemodialysis. The participants were assigned to 1 of 2 groups: the study group (group A; 46 patients) received 4 capsules (2.4 g) of omega-3 fatty acids daily during the 12-week intervention, while patients in the control group (group B; 47 patients) received 4 capsules of paraffin oil. The patients' general characteristics, nutritional indicators, renal disease markers and inflammatory markers (C-reactive protein, interleukin (IL)-6, IL-10, and tumour necrosis factor alpha (TNF-α)) were evaluated. No differences were found between the general characteristics of the patients (P < 0.05), and no differences were shown in the nutritional indicators and markers of kidney disease (P < 0.05). Patients in group A showed significant decreases in levels of C-reactive protein, IL-6, TNF-α, and the IL-10/IL-6 ratio after 12 weeks of supplementation (P < 0.05). Patients in group B did not show any significant changes in concentrations of inflammatory markers during the intervention (P < 0.05). In conclusion, oral supplementation with omega-3 fatty acids produces a significant decrease in the concentrations of inflammation markers in patients with chronic kidney disease on hemodialysis. Novelty Oral supplementation with omega-3 fatty acids produced significant decreases in the concentrations of inflammation markers. This supplementation could be given to patients with uremic syndrome and coronary heart disease to reduce cardiovascular risk.
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Affiliation(s)
- José A Valle Flores
- Nutrition and Food Science Program, University of Granada, Spain.,Nutrition and Dietetics, Faculty of Medical Sciences, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, 150950
| | - Juan E Fariño Cortéz
- Carrera de Enfermería, Facultad de Ciencias Sociales y de la Salud, Universidad Estatal de Santa Elena, Santa Elena, Ecuador, 241702
| | - Gabriel A Mayner Tresol
- Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, 150950
| | - Juan Perozo Romero
- Servicio de Nefrología, Hospital Central Dr. Urquinaona, Facultad de Medicina, Universidad de Zulia, Maracaibo, Venezuela, 4001
| | - Miquel Blasco Carlos
- Instituto de Investigación e Innovación de Salud Integral, Universidad Católica de Santiago de Guayaquil, Avenue Carlos Julio Arosemena Tola, Guayaquil, Ecuador.,Escuela de Nutrición y Dietética, Universidad Espíritu Santo-Ecuador, Avenue Samborondón, Guayaquil, Ecuador
| | - Teresa Nestares
- Department of Physiology, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain, 18010
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Efficacy of Polyunsaturated Fatty Acids on Inflammatory Markers in Patients Undergoing Dialysis: A Systematic Review with Network Meta-Analysis of Randomized Clinical Trials. Int J Mol Sci 2019; 20:ijms20153645. [PMID: 31349671 PMCID: PMC6695890 DOI: 10.3390/ijms20153645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/07/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
The effects of polyunsaturated fatty acids (PUFAs) on inflammatory markers among patients receiving dialysis have been discussed for a long time, but previous syntheses made controversial conclusion because of highly conceptual heterogeneity in their synthesis. Thus, to further understanding of this topic, we comprehensively gathered relevant randomized clinical trials (RCTs) before April 2019, and two authors independently extracted data of C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) for conducting network meta-analysis. Eighteen eligible RCTs with 962 patients undergoing dialysis were included in our study. The result showed that with placebo as the reference, PUFAs was the only treatment showing significantly lower CRP (weighted mean difference (WMD): −0.37, 95% confidence interval (CI): −0.07 to −0.68), but the CRP in PUFAs group was not significantly lower than vitamin E, PUFAs plus vitamin E, or medium-chain triglyceride. Although no significant changes were noted for hs-CRP and IL-6 levels, PUFAs showed the best ranking among treatments according to surface under the cumulative ranking. Therefore, PUFAs could be a protective option for patients receiving dialysis in clinical practice.
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Tam K, Wu M, Siddiqui FJ, Chan ESY, Zhu Y, Jafar TH. Omega-3 fatty acids for dialysis vascular access outcomes in patients with chronic kidney disease. Cochrane Database Syst Rev 2018; 11:CD011353. [PMID: 30480758 PMCID: PMC6517057 DOI: 10.1002/14651858.cd011353.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Maintaining long-term vascular access patency is necessary for high quality haemodialysis (HD) treatment of patients with the terminal and most serious stage of chronic kidney disease (CKD) - end-stage kidney disease (ESKD). Oral supplementation with omega-3 fatty acids (ω-3FA) may help to prevent blockage of the vascular access by reducing the risk of thrombosis and stenosis. OBJECTIVES To evaluate the efficacy and safety of ω-3FA supplementation versus placebo or no treatment for maintaining vascular access patency in ESKD patients undergoing HD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 23 July 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) of omega-3 fatty acids versus placebo that assessed the patency of arteriovenous fistula (AVF) or arteriovenous graft (AVG) types of vascular access in ESKD patients. DATA COLLECTION AND ANALYSIS We assessed the risk of bias of each eligible study using the Cochrane Risk of Bias tool and made separate overall risk of bias judgments for the efficacy and safety outcomes. The certainty of evidence was assessed using the GRADE approach. The primary efficacy outcome was loss of vascular patency and the primary safety outcomes were occurrences of serious adverse events (e.g. death, hospitalisation, cardiovascular events, major bleeding). Secondary outcomes were the occurrence of non-serious adverse events (e.g. minor bleeding, gastrointestinal events and other adverse events). Efficacy effects were reported as risk ratios (RR) and safety effects as risk differences (RD) with 95% confidence intervals (CI). Studies were pooled separately by type of vascular access using a random-effects model. MAIN RESULTS Five studies (833 participants) were included; one was a very small pilot study of 7 participants. All studies compared oral ω-3FA supplements against placebo. Four studies enrolled participants with arteriovenous grafts (AVGs), and the other had participants with arteriovenous fistulas (AVFs). The risk of bias for both efficacy and safety outcomes was unclear for all studies, due mainly to incomplete reporting for allocation concealment and incompleteness of study follow-up.In AVF patients, ω-3FA supplementation probably makes little or no difference to the 12-month risk of patency loss (1 study, 536 participants: RR 1.01, 95% CI 0.84 to 1.21; moderate certainty evidence), risk of death (1 study, 567 participants: RD 0.00, 95% CI -0.03 to 0.02; moderate certainty evidence) and risk of hospitalisation (1 study, 567 participants: RD 0.00, 95% CI -0.08 to 0.08; low certainty evidence). There was no information on cardiovascular events and major bleeding.In AVG patients, it is very uncertain whether ω-3FA supplementation reduces the risk of patency loss within 6 months (2 studies, 41 participants: RR 0.91, 95% CI 0.36 to 2.28; very low certainty evidence) or 12 months (2 studies, 220 participants: RR 0.59, 95% CI 0.27 to 1.31; very low certainty evidence). ω-3FA supplementation may make little or no difference to the risk of death within 6 to 12 months in AVG patients (4 studies, 261 participants: RD 0.01, 95% CI -0.05 to 0.07; low certainty evidence). It is very uncertain if ω-3FA supplementation increases the risk of hospitalisation (3 studies, 65 participants: RD 0.08, 95% CI -0.11 to 0.28; very low certainty evidence), changes the risk of cardiovascular events (4 studies, 261 participants: RD -0.02, 95% CI -0.11 to 0.07; very low certainty evidence), or increases the risk of major bleeding (3 studies, 65 participants: RD 0.08, 95% CI -0.11 to 0.28; very low certainty evidence) within 6 to 12 months in AVG patients. There may be an increase in the risk of mild gastrointestinal adverse reactions (3 studies, 65 participants: RD 0.25, 95% CI 0.07 to 0.43; low certainty evidence) such as a sensation of bloatedness, gas or a fishy aftertaste. AUTHORS' CONCLUSIONS In CKD patients with an AVF, there is moderate certainty that ω-3FA supplementation makes little or no difference to preventing patency loss; and in patients with an AVG, it is very uncertain that ω-3FA supplementation prevents patency loss within 12 months.
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Affiliation(s)
- Ka‐Wai Tam
- Taipei Medical University‐Shuang Ho HospitalDivision of General Surgery, Department of Surgery291, Zhongzheng Road, Zhonghe DistrictNew Taipei CityTaiwan23561
- School of Medicine, College of Medicine, Taipei Medical UniversityDivision of General Surgery, Department of SurgeryTaipeiTaiwan
| | - Mei‐Yi Wu
- Taipei Medical University‐Shuang Ho HospitalDivision of Nephrology, Department of Internal Medicine291 Jhongjheng RdJhonghe DistrictNew Taipei CityTaiwan23561
- School of Medicine, College of Medicine, Taipei Medical UniversityDivision of Nephrology, Department of Internal MedicineTaipeiTaiwan
| | - Fahad Javaid Siddiqui
- The Hospital for Sick Children (SickKids)Centre for Global Child Health686 Bay StTorontoOntarioCanadaM5G 1X8
- Duke NUS Graduate Medical SchoolHealth Services & Systems Research ProgramSingaporeSingapore
| | - Edwin SY Chan
- Singapore Clinical Research InstituteCochrane SingaporeNanos Building #02‐0131 Biopolis WaySingaporeSingapore138669
| | - Yanan Zhu
- A*STARSingapore Institute of Clinical Sciences61 Compassvale Bow, #08‐21SingaporeSingapore544989
| | - Tazeen H Jafar
- Duke NUS Graduate Medical SchoolHealth Services & Systems Research ProgramSingaporeSingapore
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Update on the Impact of Omega 3 Fatty Acids on Inflammation, Insulin Resistance and Sarcopenia: A Review. Int J Mol Sci 2018; 19:ijms19010218. [PMID: 29324650 PMCID: PMC5796167 DOI: 10.3390/ijms19010218] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/12/2017] [Accepted: 01/08/2018] [Indexed: 12/25/2022] Open
Abstract
Elderly and patients affected by chronic diseases face a high risk of muscle loss and impaired physical function. Omega 3 fatty acids (FA) attenuate inflammation and age-associated muscle loss, prevent systemic insulin resistance and improve plasma lipids, potentially impacting on sarcopenia. This paper aims to review recent randomized clinical studies assessing the effects a chronic omega 3 FA supplementation on inflammatory and metabolic profile during conditions characterized by sarcopenia (aging, insulin resistance, type 2 diabetes, chronic renal failure). A comprehensive search of three online databases was performed to identify eligible trials published between 2012 and 2017. A total of 36 studies met inclusion criteria. Omega 3 FA yielded mixed results on plasma triglycerides in the elderly and no effects in renal patients. No changes in systemic insulin resistance were observed. Inflammation markers did not benefit from omega 3 FA in insulin resistant and in renal subjects while decreasing in obese and elderly. Muscle related parameters improved in elderly and in renal patients. In conclusion, in aging- and in chronic disease-associated sarcopenia omega 3 FA are promising independently of associated anabolic stimuli or of anti-inflammatory effects. The evidence for improved glucose metabolism in insulin resistant and in chronic inflammatory states is less solid.
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Zakaria H, Mostafa TM, El-Azab GA, Abd El Wahab AM, Elshahawy H, Sayed-Ahmed NAH. The impact of fish oil and wheat germ oil combination on mineral-bone and inflammatory markers in maintenance hemodialysis patients: a randomized, double-blind, placebo-controlled clinical trial. Int Urol Nephrol 2017; 49:1851-1858. [DOI: 10.1007/s11255-017-1643-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 01/07/2023]
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Tabibi H, Mirfatahi M, Hedayati M, Nasrollahi A. Effects of flaxseed oil on blood hepcidin and hematologic factors in hemodialysis patients. Hemodial Int 2016; 21:549-556. [DOI: 10.1111/hdi.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hadi Tabibi
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition and Food Technology; National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences; Tehran Islamic Republic of Iran
| | - Maryam Mirfatahi
- Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences; Tehran Islamic Republic of Iran
| | - Mehdi Hedayati
- Cellular and Molecular Research Center; Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences; Tehran Islamic Republic of Iran
| | - Alireza Nasrollahi
- Department of Nephrology; Taleghani hospital, Shahid Beheshti University of Medical Sciences; Tehran Islamic Republic of Iran
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Barrouin-Melo SM, Anturaniemi J, Sankari S, Griinari M, Atroshi F, Ounjaijean S, Hielm-Björkman AK. Evaluating oxidative stress, serological- and haematological status of dogs suffering from osteoarthritis, after supplementing their diet with fish or corn oil. Lipids Health Dis 2016; 15:139. [PMID: 27566551 PMCID: PMC5002171 DOI: 10.1186/s12944-016-0304-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023] Open
Abstract
Background Oxidative stress plays an important role in the pathogenesis of disease, and the antioxidant physiological effect of omega-3 from fish oil may lead to improvement of canine spontaneous osteoarthritis (OA). Methods In this prospective randomized, controlled, double-blinded study, we assessed haematological and biochemical parameters in dogs with OA following supplementation with either a concentrated omega-3 deep sea fish oil product or corn oil. Blood samples from 77 client-owned dogs diagnosed as having OA were taken before (baseline) and 16 weeks after having orally ingested 0.2 ml/Kg bodyweight/day of deep sea fish oil or corn oil. Circulating malondialdehyde (MDA), glutathione (GSH), non-transferrin bound iron (NTBI), free carnitine (Free-Car), 8-hydroxy-2-deoxyguanosine (8-OH-dG), and serum fatty acids, haemograms and serum biochemistry were evaluated. Differences within and between groups from baseline to end, were analysed using repeated samples T-test or Wilcoxon rank test and independent samples T-test or a Mann-Whitney test. Results Supplementation with fish oil resulted in a significant reduction from day 0 to day 112 in MDA (from 3.41 ± 1.34 to 2.43 ± 0.92 μmol/L; P < 0.001) and an elevation in Free-Car (from 18.18 ± 9.78 to 21.19 ± 9.58 μmol/L; P = 0.004) concentrations, whereas dogs receiving corn oil presented a reduction in MDA (from 3.41 ± 1.34 to 2.41 ± 1.01 μmol/L; P = 0.001) and NTBI (from −1.25 ± 2.17 to −2.31 ± 1.64 μmol/L; P = 0.002). Both groups showed increased (albeit not significantly) GSH and 8-OH-dG blood values. Dogs supplemented with fish oil had a significant reduction in the proportions of monocytes (from 3.84 ± 2.50 to 1.77 ± 1.92 %; P = 0.030) and basophils (from 1.47 ± 1.22 to 0.62 ± 0.62 %; P = 0.012), whereas a significant reduction in platelets counts (from 316.13 ± 93.83 to 288.41 ± 101.68 × 109/L; P = 0.029), and an elevation in glucose (from 5.18 ± 0.37 to 5.32 ± 0.47 mmol/L; P = 0.041) and cholesterol (from 7.13 ± 1.62 to 7.73 ± 2.03 mmol/L; P = 0.011) measurements were observed in dogs receiving corn oil. Conclusions In canine OA, supplementation with deep sea fish oil improved diverse markers of oxidative status in the dogs studied. As corn oil also contributed to the reduction in certain oxidative markers, albeit to a lesser degree, there was no clear difference between the two oil groups. No clinical, haematological or biochemical evidence of side effects emerged related to supplementation of either oil. Although a shift in blood fatty acid values was apparent due to the type of nutraceutical product given to the dogs, corn oil seems not to be a good placebo.
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Affiliation(s)
- Stella Maria Barrouin-Melo
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.,Department of Anatomy, Pathology and Clinics, School of Veterinary Medicine and Zootechny, Federal University of Bahia, Av. Adhemar de Barros, 500, CEP: 40170-110, Salvador, Bahia, Brazil
| | - Johanna Anturaniemi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | - Satu Sankari
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | | | - Faik Atroshi
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.,Rinnekoti Research Centre, Nousumäki 2, 02980, Espoo, Finland
| | | | - Anna Katrina Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.
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Belaïch R, Boujraf S. Facteurs inflammatoires et stress oxydant chez les hémodialysés : effets et stratégies thérapeutiques. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1957-2557(16)30009-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Major depressive disorder (MDD) is highly debilitating, difficult to treat, has a high rate of recurrence, and negatively impacts the individual and society as a whole. One emerging potential treatment for MDD is n-3 polyunsaturated fatty acids (n-3PUFAs), also known as omega-3 oils, naturally found in fatty fish, some other seafood, and some nuts and seeds. Various lines of evidence suggest a role for n-3PUFAs in MDD, but the evidence is far from conclusive. Reviews and meta-analyses clearly demonstrate heterogeneity between studies. Investigations of heterogeneity suggest differential effects of n-3PUFAs, depending on severity of depressive symptoms, where no effects of n-3PUFAs are found in studies of individuals with mild depressive symptomology, but possible benefit may be suggested in studies of individuals with more severe depressive symptomology. OBJECTIVES To assess the effects of n-3 polyunsaturated fatty acids (also known as omega-3 fatty acids) versus a comparator (e.g. placebo, anti-depressant treatment, standard care, no treatment, wait-list control) for major depressive disorder (MDD) in adults. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Registers (CCDANCTR) and International Trial Registries over all years to May 2015. We searched the database CINAHL over all years of records to September 2013. SELECTION CRITERIA We included studies in the review if they: were a randomised controlled trial; provided n-3PUFAs as an intervention; used a comparator; measured depressive symptomology as an outcome; and were conducted in adults with MDD. Primary outcomes were depressive symptomology (continuous data collected using a validated rating scale) and adverse events. Secondary outcomes were depressive symptomology (dichotomous data on remission and response), quality of life, and failure to complete studies. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We found 26 relevant studies: 25 studies involving a total of 1438 participants investigated the impact of n-3PUFA supplementation compared to placebo, and one study involving 40 participants investigated the impact of n-3PUFA supplementation compared to antidepressant treatment.For the placebo comparison, n-3PUFA supplementation results in a small to modest benefit for depressive symptomology, compared to placebo: standardised mean difference (SMD) -0.32 (95% confidence interval (CI) -0.12 to -0.52; 25 studies, 1373 participants, very low quality evidence), but this effect is unlikely to be clinically meaningful (an SMD of 0.32 represents a difference between groups in scores on the HDRS (17-item) of approximately 2.2 points (95% CI 0.8 to 3.6)). The confidence intervals include both a possible clinically important effect and a possible negligible effect, and there is considerable heterogeneity between the studies. Although the numbers of individuals experiencing adverse events were similar in intervention and placebo groups (odds ratio (OR) 1.24, 95% CI 0.95 to 1.62; 19 studies, 1207 participants; very low-quality evidence), the confidence intervals include a significant increase in adverse events with n-3PUFAs as well as a small possible decrease. Rates of remission and response, quality of life, and rates of failure to complete studies were also similar between groups, but confidence intervals are again wide.The evidence on which these results are based is very limited. All studies contributing to our analyses were of direct relevance to our research question, but we rated the quality of the evidence for all outcomes as low to very low. The number of studies and number of participants contributing to all analyses were low, and the majority of studies were small and judged to be at high risk of bias on several measures. Our analyses were also likely to be highly influenced by three large trials. Although we judge these trials to be at low risk of bias, they contribute 26.9% to 82% of data. Our effect size estimates are also imprecise. Funnel plot asymmetry and sensitivity analyses (using fixed-effect models, and only studies judged to be at low risk of selection bias, performance bias or attrition bias) also suggest a likely bias towards a positive finding for n-3PUFAs. There was substantial heterogeneity in analyses of our primary outcome of depressive symptomology. This heterogeneity was not explained by the presence or absence of comorbidities or by the presence or absence of adjunctive therapy.Only one study was available for the antidepressant comparison, involving 40 participants. This study found no differences between treatment with n-3PUFAs and treatment with antidepressants in depressive symptomology (mean difference (MD) -0.70 (95% CI -5.88 to 4.48)), rates of response to treatment or failure to complete. Adverse events were not reported in a manner suitable for analysis, and rates of depression remission and quality of life were not reported. AUTHORS' CONCLUSIONS At present, we do not have sufficient high quality evidence to determine the effects of n-3PUFAs as a treatment for MDD. Our primary analyses suggest a small-to-modest, non-clinically beneficial effect of n-3PUFAs on depressive symptomology compared to placebo; however the estimate is imprecise, and we judged the quality of the evidence on which this result is based to be low/very low. Sensitivity analyses, funnel plot inspection and comparison of our results with those of large well-conducted trials also suggest that this effect estimate is likely to be biased towards a positive finding for n-3PUFAs, and that the true effect is likely to be smaller. Our data, however, also suggest similar rates of adverse events and numbers failing to complete trials in n-3PUFA and placebo groups, but again our estimates are very imprecise. The one study that directly compares n-3PUFAs and antidepressants in our review finds comparable benefit. More evidence, and more complete evidence, are required, particularly regarding both the potential positive and negative effects of n-3PUFAs for MDD.
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Affiliation(s)
- Katherine M Appleton
- Bournemouth UniversityDepartment of PsychologyPoole House, Fern BarrowPooleUKBH12 5BB
| | | | - Rachel Perry
- University Hospitals Bristol Education CentreNIHR Biomedical Research Unit in Nutrition, Diet and LifestyleUpper Maudlin StreetBristolUKBS2 8AE
| | - Andrew R Ness
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNational Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleUpper Maudlin StreetBristolUKBS2 8AE
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineBarley HouseOakfield GroveBristolUKBS8 2BN
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Viramontes-Hörner D, Márquez-Sandoval F, Martín-del-Campo F, Vizmanos-Lamotte B, Sandoval-Rodríguez A, Armendáriz-Borunda J, García-Bejarano H, Renoirte-López K, García-García G. Effect of a Symbiotic Gel (Lactobacillus acidophilus + Bifidobacterium lactis + Inulin) on Presence and Severity of Gastrointestinal Symptoms in Hemodialysis Patients. J Ren Nutr 2015; 25:284-91. [DOI: 10.1053/j.jrn.2014.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/19/2014] [Accepted: 09/24/2014] [Indexed: 11/11/2022] Open
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