The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability

PURPOSE

To assess the relationship between adherence to the Mediterranean Diet (MD) /individual Dietary Inflammatory Index (DII) and disease activity, disease impact, and functional status in Rheumatoid Arthritis (RA) patients.

METHODS

RA patients followed at a hospital in Lisbon, Portugal, were recruited. DII was calculated using dietary intake data collected with a food frequency questionnaire (FFQ). Adherence to the MD was obtained using the 14-item Mediterranean Diet assessment tool. Disease Activity Score of 28 Joints (DAS28) and the DAS28 calculated with C-Reactive Protein (DAS28-CRP) were used to assess disease activity. Impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively.

RESULTS

120 patients (73.3% female, 61.8 ± 10.1 years of age) were included. Patients with higher adherence to the MD had significantly lower DAS28-CRP (median 3.27(2.37) vs 2.77(1.49), p = 0.030), RAID (median 5.65(2.38) vs 3.51(4.51), p = 0.032) and HAQ (median 1.00(0.56) vs 0.56(1.03), p = 0.013) scores. Higher adherence to the MD reduced the odds of having a higher DAS28 by 70% (OR = 0.303, 95%CI = (0.261, 0.347), p = 0.003). Lower adherence to MD was associated with higher DAS28-CRP (β = - 0.164, p = 0.001), higher RAID (β = - 0.311, p < 0.0001), and higher HAQ scores (β = - 0.089, p = 0.001), irrespective of age, gender, BMI and pharmacological therapy. Mean DII of our cohort was not significantly different from the Portuguese population (0.00 ± 0.17 vs - 0.10 ± 1.46, p = 0.578). No associations between macronutrient intake or DII and RA outcomes were found.

CONCLUSIONS

Higher adherence to the MD was associated with lower disease activity, lower impact of disease, and lower functional disability in RA patients.

Beyond Seasoning-The Role of Herbs and Spices in Rheumatic Diseases

Although we have witnessed remarkable progress in understanding the biological mechanisms that lead to the development of rheumatic diseases (RDs), remission is still not achieved in a substantial proportion of patients with the available pharmacological treatment. As a consequence, patients are increasingly looking for complementary adjuvant therapies, including dietary interventions. Herbs and spices have a long historical use, across various cultures worldwide, for both culinary and medicinal purposes. The interest in herbs and spices, beyond their seasoning properties, has dramatically grown in many immune-mediated diseases, including in RDs. Increasing evidence highlights their richness in bioactive molecules, such as sulfur-containing compounds, tannins, alkaloids, phenolic diterpenes, and vitamins, as well as their antioxidant, anti-inflammatory, antitumorigenic, and anticarcinogenic properties. Cinnamon, garlic, ginger, turmeric, and saffron are the most popular spices used in RDs and will be explored throughout this manuscript. With this paper, we intend to provide an updated review of the mechanisms whereby herbs and spices may be of interest in RDs, including through gut microbiota modulation, as well as summarize human studies investigating their effects in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia.

Mediterranean diet: a dietary pattern related to nutritional benefits for hemodialysis patients

INTRODUCTION

In adults with CKD, not on dialysis, there is a recent recommendation suggesting the prescription of a Mediterranean Diet pattern but there is still no evidence to suggest a specific dietary pattern for hemodialysis (HD) patients. The aim of this study was to identify dietary patterns in HD patients and analyze their relationship with nutritional status, physical activity, and survival.

METHODS

This was a longitudinal prospective multicenter study with 12 months of follow-up that included 582 HD patients from 37 dialysis centers. Clinical parameters, dietary intake and physical activity were assessed. Dietary patterns were derived from principal component analysis. A p-value lower than 0.05 was considered statistically significant.

RESULTS

Three different dietary patterns were identified: "Mediterranean", "Western" and "Low animal protein". Patients in the Mediterranean pattern group showed higher intakes of protein (p=0.040), omega 3 fatty acids (p< 0.001), vitamins B12 (p< 0.001), B6 (p< 0.001), C (p< 0.001), D (p< 0.001), folic acid (p< 0.001) and presented a higher practice of moderate physical activity (p=0.010). Despite the lower number of deaths that occurred in the Mediterranean dietary pattern group, we did not observe a statistically significant lower mortality risk (p=0.096).

CONCLUSION

The Mediterranean style pattern was associated with a better nutritional intake profile and in lifestyle related factors such as a higher practice of moderate physical activity in HD patients.

Nutritional Genomics in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a common chronic condition associated with genetic and environmental factors in which fat abnormally accumulates in the liver. NAFLD is epidemiologically associated with obesity, type 2 diabetes, and dyslipidemia. Environmental factors, such as physical inactivity and an unbalanced diet, interact with genetic factors, such as epigenetic mechanisms and polymorphisms for the genesis and development of the condition. Different genetic polymorphisms seem to be involved in this context, including variants in PNPLA3, TM6SF2, PEMT, and CHDH genes, playing a role in the disease's susceptibility, development, and severity. From carbohydrate intake and weight loss to omega-3 supplementation and caloric restriction, different dietary and nutritional factors appear to be involved in controlling the onset and progression of NAFLD conditions influencing metabolism, gene, and protein expression. The polygenic risk score represents a sum of trait-associated alleles carried by an individual and seems to be associated with NAFLD outcomes depending on the dietary context. Understanding the exact extent to which lifestyle interventions and genetic predispositions can play a role in the prevention and management of NAFLD can be crucial for the establishment of a personalized and integrative approach to patients.

Let’s review the gut microbiota in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, immune-mediated disease associated with significant morbidity and mortality. New evidence suggests that diet, gut microbiota, intestinal permeability, and endotoxemia may modulate chronic inflammation and disease activity in SLE. This review focus on what is known about the gut microbiota in lupus mouse models and SLE patients and the possible mechanisms that connect the gut microbiota with SLE. It included 29 studies (12 animal studies, 15 human studies, and 2 included data on both), with variable results regarding alpha and beta-diversity and gut microbiota composition between lupus-mouse models and SLE patients. Ruminococcus (R.) gnavus was significantly increased in lupus nephritis (LN) in one study, but this was not corroborated by others. Despite the different results, mechanistic lupus mouse model studies have shown that gut microbiota can modulate disease activity. Interestingly, pathobiont translocation in monocolonized and autoimmune-prone mice induced autoantibodies and caused mortality, which could be prevented by a vaccine targeting the pathobiont. Moreover, studies on fecal transplants and diet on different lupus mouse models showed an effect on disease activity. In SLE patients, a higher adherence to the Mediterranean diet was associated with lower disease activity, which may be explained by the connection between diet and gut microbiota. Although gut dysbiosis has been observed in SLE patients and lupus mouse models, it remains to clarify if it is a cause or a consequence of the disease or its treatments. Further studies with larger and well-characterized populations will undoubtedly contribute to deciphering the role of gut microbiota in SLE development, progression, and outcome.

Potassium Intake-(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers

As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43−104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.

MO904: Potassium Intake Does Not Predict High Serum Potassium Levels in Haemodialysis Dash Diet Consumers

BACKGROUND AND AIMS

As high serum potassium levels can lead to adverse outcomes in haemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. Dietary approaches to stop hypertension (DASH) emphasizes the consumption of potassium rich foods, specially from plant sources, such as: fruits, vegetables, whole grains, nuts and seeds. The aim of this study was to analyze the association between the DASH dietary pattern and serum potassium levels.

METHOD

This was an observational cross-sectional multicentre study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to DASH dietary pattern was obtained from Fung´s DASH index (8–40 points). For the statistical analysis, Fung´s DASH index was categorized into terciles and mean differences were analyzed with one-way ANOVA. Linear regression was used to analyze the relationship between serum potassium and adherence to the Dash dietary pattern. The multivariate model was adjusted to age, gender, presence of diabetes mellitus, energy intake, dietary potassium intake, residual diuresis, dialysis adequacy (Kt/V), dialysis vintage and intake of potassium binders. All statistical tests were performed using SPSS 26.0 software. A P-value lower than 0.05, was considered statistically significant.

RESULTS

Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L,  dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Of the whole sample, 36.4% of the patients presented low adherence to the DASH dietary pattern (0–22 points), 39.0% presented a moderate adherence (23–26 points) whereas 24.6% a high adherence (≥27 points).

Comparing to the lower adherence, patients with a higher adherence to the DASH dietary pattern were older (P &lt; 0.005), presented lower serum potassium (P = 0.021), serum sodium (P = 0.028), albumin (P = 0.030), creatinine (P &lt; 0.005), energy intake (P = 0.006), protein intake (P = 0.010), total fat intake (P = 0.001), sodium intake (P &lt; 0.005), lean tissue index (P = 0.006) and higher carbohydrates intake (P = 0.007), fiber intake (P &lt; 0.005), potassium intake (P &lt; 0.005), body mass index (P = 0.002) and fat tissue index (P &lt; 0.005). No differences were observed in potassium binders, Kt/V, C-reactive protein nor haemoglobin. A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (P = 0.004), even in the adjusted model (P = 0.016).

CONCLUSION

Most of the patients presented a moderate adherence to the DASH dietary pattern. Following this dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. What is more, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, tight dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan as a more flexible diet, especially regarding plant-based foods rich in potassium, may promote other health benefits and reduce patient´s dietary plan limitations.

[Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic]

Introduction and Objectives

Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program.

Methods

A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions.

Results

Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred.

Conclusion

During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.

Zinc Deficient Intake in Hemodialysis Patients: A Path to a High Mortality Risk

BACKGROUND

Zinc is essential for human nutrition and plays an important role in hemodialysis (HD) patients. The aim of this study is to analyze the relationship between zinc intake and mortality in HD patients.

METHODS

This is a longitudinal, prospective, multicenter study with 582 HD patients from 37 dialysis centers. We recorded clinical and body composition parameters. Dietary intake and physical activity data were obtained using the Food Frequency Questionnaire and International Physical Activity Questionnaire. All statistical tests were performed using SPSS 24.0 software. A P value lower than 0.05 was considered statistically significant.

RESULTS

Patients' mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43-104) months. About 53.6% of the patients presented a deficient daily intake of zinc. Patients with the highest zinc intake were those who had a higher lean tissue index (P = .022), energy (P < .001), and protein (p = .022) intakes. Zinc intake was positively correlated with energy (r = 0.709) and protein intake (r = 0.805) and negatively correlated with the malnutrition screening tool score (r = -0.087). A higher energy, protein, and lower carbohydrates intake, as well as lower HD vintage and higher lean tissue index were predictors of zinc intake. A higher mortality risk was observed in patients with zinc intake below the recommended values, even after the adjustment for age, presence of diabetes, gender, dialysis vintage, albumin, lean tissue index, energy intake/kilogram, and level of physical activity (P = .021).

CONCLUSION

There is a high prevalence of HD patients with an inadequate zinc intake, which is related to worse nutritional and body composition parameters and with a higher mortality risk.

Probiotic Supplementation for Rheumatoid Arthritis: A Promising Adjuvant Therapy in the Gut Microbiome Era

Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease that ultimately leads to joint destruction and functional disability. Although the exact etiology of RA is not fully understood, it is well established that gut microbiota (GM) plays a vital role in the pathogenesis of RA, with accumulating evidence suggesting that gut dysbiosis induces a chronic inflammatory response that may be linked to disease development. Of interest, patients with RA have significant changes in the intestinal microbiota compared to healthy controls, and several studies have suggested the use of probiotics as a possible adjuvant therapy for RA. Benefits of probiotic supplementation were reported in animal models of arthritis and human studies, but the current evidence regarding the effect of probiotic supplementation in the management of RA remains insufficient to make definite recommendations. Several different strains of Lactobacillus and Bifidobacteria, as single species or in mixed culture, have been investigated, and some have demonstrated beneficial effects on disease activity in RA human subjects. As of now, L.casei probiotic bacteria seems to be the strongest candidate for application as adjuvant therapy for RA patients. In this review, we highlight the role of GM in the development and progression of RA and summarize the current knowledge on the use of probiotics as a potential adjuvant therapy for RA. We also review the proposed mechanisms whereby probiotics regulate inflammation. Finally, the role of fermented foods is discussed as a possible alternative to probiotic supplements since they have also been reported to have health benefits.

MO904DIETARY PATTERNS IN HEMODIALYSIS PATIENTS: RELATIONSHIP WITH CLINICAL AND NUTRITIONAL PARAMETERS

Background and Aims

Nutritional recommendations for hemodialysis (HD) patients focus on the achievement of a sufficient energy and protein intake without exceeding phosphorus, potassium, sodium and/or fluids intake limits. This study aimed to identify different dietary patterns of HD patients and analyze their relationship with clinical and nutritional parameters.

Method

This was a longitudinal prospective multicenter study with 582 HD patients from 37 dialysis centers. Dry weight, Kt/V, serum potassium, phosphorus, calcium, sodium, creatinine and C-reactive protein were measured. Dietary intake was obtained using the Food Frequency Questionnaire. Dietary patterns were derived from principal component analysis based on 20 food groups which were adjusted for total energy intake. Linear regression was used to analyze patterns and the variables of interest. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05, was considered statistically significant.

Results

Patients’ mean age was 67.8±17.7 years and median HD vintage was 65 (43-104) months. Three different dietary patterns were identified: “Western” (31.3% of the patients) with high intake of soft drinks, home-made fried potatoes, caffeinated drinks, red and processed meat, and low intake of fruit and vegetables soup; “Mediterranean” (33.5% of the patients) with high intake of vegetables, beans, fish, olive oil, eggs, and low intake of milk and milk products. Finally, “Low animal protein” (35.2% of the patients) with high intake of whole grain bread, cookies and sweets, vegetables soup and low intake of white bread, rice, pasta and potatoes. Regarding clinical parameters, the Mediterranean pattern was predictor of a higher dry weight (p=0.001), higher creatinine (p=0.032) and lower serum calcium (p=0.024), whereas Western pattern predicted higher phosphorus (p=0.006), sodium (p=0.014) and creatinine (p=0.001). Low animal protein pattern predicted lower creatinine levels (p=0.011). After adjusting for age, gender, presence of diabetes, HD vintage and Kt/V, serum calcium was the only parameter which remained statistical significant within the Mediterranean pattern. Comparing the nutritional parameters studied, the Mediterranean pattern was the strongest predictor of a higher intake of protein (%) (p&lt;0.001), folate (p&lt;0.001), vitamin B12 (p&lt;0.001), vitamin B6 (p&lt;0.001), vitamin C (p&lt;0.001), vitamin D (p&lt;0.001), potassium (p=0.015) and omega 3 fatty acids (p&lt;0.001) and a lower intake of carbohydrates (%) (p&lt;0.001), calcium (p&lt;0.001) and sodium (p=0.006).

Conclusion

Three different dietary patterns were identified in these HD population. The pattern which was closer to the well-known Mediterranean diet was associated with a better nutritional intake profile, which, at least theoretically, are associated with better clinical outcomes.

The validity of the Patient-Generated Subjective Global Assessment Short-form© in cancer patients undergoing chemotherapy

BACKGROUND & AIMS

The high prevalence of malnourished cancer patients highlights the importance of sensitive and specific tools for nutritional risk and status assessment screening, namely the Patient-Generated Subjective Global Assessment (PG-SGA®). This study aimed to assess whether the short-form version of the PG-SGA® (PG-SGA© SF) would be appropriate to identify the nutritional risk of patients when compared with the final global score of PG-SGA© (long-form version).

METHODS

This transversal and observational study comprised a convenience sample of cancer patients undergoing chemotherapy at the Champalimaud Clinical Centre between December 2016 and February 2018. Clinical data and anthropometric parameters were collected in order to apply PG-SGA® and PG-SGA© SF. The data was statistically analysed through SPSS version 22 (SPSS Inc, Chicago, IL, USA).

RESULTS

In this study 355 patients were enrolled and PG-SGA© SF results showed that 69.3% (n = 246) of the population presented at least one risk factor for malnourishment (Σ (box A) ≥1). Additionally, PG-SGA® revealed that 50% of patients (n = 177) have a risk of developing malnourishment or are already malnourished (B and C classification). The concordance of results showed to be high (coefficient k = 0.62; p < 0.001), meaning that PG-SGA SF© has a good sensibility (95%) and specificity (67%) for the identification of nutritional risk and assessment of nutritional status when compared with the complete version of PG-SGA©.

CONCLUSIONS

According to our results, PG-SGA© SF is a useful and sufficient tool, representing an easier and faster way to identify at-risk or malnourished patients.

Functional Food Components, Intestinal Permeability and Inflammatory Markers in Patients with Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are characterized by a chronic inflammatory process that affects the intestinal barrier structure. Recent evidence suggests that some food components can influence the integrity of the intestinal barrier and thus its permeability. We aimed at assessing the effect of food components on the intestinal permeability (IP) and on inflammatory markers in individuals with IBD by a single-blind randomized clinical study. Of the 53 individuals included, 47% (n = 25) had been diagnosed with IBD. The participants were divided into 4 groups. IBD patients were allocated to intervention group (n = 14) vs. no intervention group (n = 11), and the same happened with 28 control participants without disease (n = 14 in intervention group vs. n = 14 without intervention). Symptomatology, nutritional status, biochemical parameters (specifically serum zonulin (ZO) to measure IP) were evaluated on all individuals on an eight week period following a diet plan with/without potentially beneficial foods for the IP. At the beginning of the study, there were no significant differences in ZO values between individuals with and without IBD (p > 0.05). The effect of specific food components was inconclusive; however, a trend in the reduction of inflammatory parameters and on the prevalence of gastrointestinal symptomatology was observed. More controlled intervention studies with diet plans, including food components potentially beneficial for the integrity of the intestinal barrier, are of the utmost importance.

Diet as a Modulator of Intestinal Microbiota in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic immune-driven inflammatory disease characterised by synovial inflammation, leading to progressive cartilage and bone destruction, impacting patients' functional capacity and quality of life. Patients with RA have significant differences in gut microbiota composition when compared to controls. Intestinal dysbiosis influences the intestinal barrier strength, integrity and function, and diet is considered the main environmental factor impacting gut microbiota. Over the last few years, researchers have focused on the influence of single components of the diet in the modulation of intestinal microbiota in RA rather than whole dietary patterns. In this review, we focus on how the Mediterranean diet (MD), a whole dietary pattern, could possibly act as an adjuvant therapeutic approach, modulating intestinal microbiota and intestinal barrier function in order to improve RA-related outcomes. We also review the potential effects of particular components of the MD, such as n-3 polyunsaturated fatty acids (PUFAs), polyphenols and fibre.

P0928PHYSICALLY ACTIVE PATIENTS IN HEMODIALYSIS: DO THEY HAVE A DIFFERENT EATING PATTERN AND BODY COMPOSITION?

Background and Aims

Body composition influences outcomes in hemodialysis (HD) patients. These patients need to follow specific nutritional recommendations and physical activity has been highly encouraged. The aim of this study was to evaluate if there are differences in body composition and in dietary patterns between physically active and no physically active HD patients.

Method

This was a multicenter observational cross-sectional study where 582 HD patients from 38 dialysis centers were enrolled. Clinical parameters were recorded and body composition analysis was performed with the Body Composition Monitor®. Dietary intake and physical activity were obtained respectively from the Food Frequency Questionnaire and from the International Physical Activity Questionnaire, both validated for the Portuguese population. For the analysis, patients were divided in 2 groups: physically active (PA), if they follow the World Health Organization recommendations, and no physically active (NPA). T-student and non-parametric tests were performed to compare means and medians respectively. A p&lt;0.05 was considered significant.

Results

Mean age was 67.8 ±17.7 years, 41.4% were female, 31.6 % had diabetes mellitus and median HD vintage was 65 (Interquartil range:43-104) months. PA patients were younger (p&lt;0.001) and had a higher energy intake (p= 0.017), protein (p=0.016), total fat (p=0.023) and omega 3 fatty acids (p=0.006). Regarding body composition; higher total body water (p=0.027), intracellular water (p=0.002), lean tissue index (p=0.002), % lean tissue mass (p=0.001), body cell mass (p=0.001) and lower % fat (p=0.003) was found in PA patients. Urea pre-dialysis (p=0.013), albumin (p=0.026), creatinine (p&lt; 0.001) and 6 months weight gain (p=0.047) were higher in PA patients whereas age-adjusted Charlson comorbidity index (p&lt;0.001) was lower in these patients. No statistically significant differences were observed among other nutrients or parameters studied nor in body mass index, HD vintage or overhydration.

Conclusion

These data shows that, after comparing PA patients with NPA, differences were observed in body composition and clinical parameters related to a better nutritional status. Moreover, the PA patients` dietary intake was more approximated to the existing recommendations for this population, namely for energy and protein daily intake.

Effectiveness of Two Dietary Approaches on the Quality of Life and Gastrointestinal Symptoms of Individuals with Irritable Bowel Syndrome

To evaluate the effectiveness of a low FODMAP (fermentable oligosaccharides, monosaccharaides, disaccharides and polyols) diet in the relief of symptoms and an improvement of the quality of life in individuals with irritable bowel syndrome in comparison to a standard diet according to the British Dietetic Association's guidelines. A non-randomized clinical trial of adult patients with IBS was compared two diet interventions. An assessment of symptoms, quality of life, and nutritional status was performed before and after the four-week mark of intervention. Individuals from the Low FODMAP Diet (LFD) group were evaluated on a third moment, after the controlled reintroduction of FODMAPs. A total of 70 individuals were divided in two groups: Low FODMAP Diet (LFD; n = 47) and Standard Diet (SD; n = 23). 57 individuals completed the four-week intervention (LFD; n = 39; SD; n = 18). At the completion of four weeks, the symptoms improved in both groups (LFD: p < 0.01; DC: p < 0.05) but LFD led to a higher relief (p < 0.05), primarily with respect to abdominal pain and diarrhoea. Quality of life improved significantly in both groups, with no significant differences between SD vs LFD (p > 0.05). In the LFD group, the relief of symptoms observed at the four-week mark remained constant after reintroduction of FODMAPs. Both interventions seem to be effective for the relief of symptoms and quality of life, however LFD had higher effectiveness in the former. The results with LFD suggest it can be a preferred approach in individuals with diarrhoeal profile.

Irritable bowel syndrome: how can symptoms and quality of life be improved with diet?

PURPOSE OF REVIEW

This article aims to review the current scientific evidence of dietary approaches to control the symptoms of irritable bowel syndrome (IBS).

RECENT FINDINGS

In the last decade, there was an important evolution in the study of the low fermentable oligo, di, mono-saccharides and polyols (FODMAP) diet (LFD). Current scientific evidence suggests a significant efficacy in the overall control of symptoms. LFD seems to be effective in improving quality of life. Recent studies suggest that LFD is effective and nutritionally well tolerated also in the long term, and longer adherence may contribute to greater effectiveness in improving depression. There is insufficient scientific evidence for the recommendation of gluten exclusion in IBS therapy, and some authors still suggest that the efficacy of this approach results from the limited ingestion of fructans. There is a promising efficacy of pre, pro, and symbiotic supplements, but there is no consensus on the most appropriate and effective strains in each case.

SUMMARY

Given the poor evidence and the pathophysiological variability of IBS, the interest of each therapeutic option should be always evaluated individually. Nevertheless, LFD is currently the dietary approach with a higher degree of scientific evidence.

Nutritional support in cirrhotic patients with sarcopenia

Sarcopenia has been linked to oncologic and chronic diseases such as liver cirrhosis. In fact, sarcopenia is present in 25-70% of patients with liver cirrhosis. Furthermore, sarcopenia is an independent predictor of poor prognosis in many diseases. Currently cirrhotic patients are recommended to adopt a high protein diet (1.5 g/kg/day) with 30-40 kcal/kg/day and several meals throughout the day, being late evening snack intake with at least 50 g of carbohydrates of special importance. Despite the growing interest in the impact of sarcopenia in cirrhotic patients, there are still gaps in knowledge in the appropriate diagnostic criteria for this syndrome, the role of gut microbiota, as well as the most appropriate nutritional therapy.

Diet, Microbiota, and Gut Permeability-The Unknown Triad in Rheumatoid Arthritis

Growing experimental and clinical evidence suggests that a chronic inflammatory response induced by gut dysbiosis can critically contribute to the development of rheumatic diseases, including rheumatoid arthritis (RA). Of interest, an adherence to a Mediterranean diet has been linked to a reduction in mortality and morbidity in patients with inflammatory diseases. Diet and intestinal microbiota are modifying factors that may influence intestinal barrier strength, functional integrity, and permeability regulation. Intestinal microbiota may play a crucial role in RA pathogenesis, but up to now no solid data has clarified a mechanistic relationship between gut microbiota and the development of RA. Nonetheless, microbiota composition in subjects with RA differs from that of controls and this altered microbiome can be partially restored after prescribing disease modifying antirheumatic drugs. High levels of Prevotella copri and similar species are correlated with low levels of microbiota previously associated with immune regulating properties. In addition, some nutrients can alter intestinal permeability and thereby influence the immune response without a known impact on the microbiota. However, critical questions remain to be elucidated, such as the way microbiome fluctuates in relation to diet, and how disease activity may be influenced by changes in diet, microbiota or diet-intestinal microbiota equilibrium.

Risk factors for metabolic bone disease in Crohn's disease patients

BACKGROUND

The aim was to evaluate the presence of metabolic bone disease (MBD) in patients with Crohn's disease (CD) and to identify potential etiologic factors.

METHODS

The case-control study included 99 patients with CD and 56 controls with a similar age and gender distribution. Both groups had dual-energy x-ray absorptionmetry and a nutritional evaluation. Single nucleotide polymorphisms at the IL1, TNF-α, LTα, and IL-6 genes were analyzed in patients only. Statistical analysis was performed using SPSS software.

RESULTS

The prevalence of MBD was significantly higher in patients (P = 0.006). CD patients with osteoporosis were older (P < 0.005), small bowel involvement and surgical resections were more frequent (P < 0.005), they more often exhibited a penetrating or stricturing phenotype (P < 0.05), duration of disease over 15 years (P < 0.005), and body mass index (BMI) under 18.5 kg/m(2) (P < 0.01) were more often found. No association was found with steroid use. Patients with a Z-score < -2.0 more frequently had chronic active disease (P < 0.05). With regard to diet, low vitamin K intake was more frequent (P = 0.03) and intake of total, monounsaturated, and polyunsaturated fat was higher in patients with Z-score < -2.0 (P < 0.05). With respect to genetics, carriage of the polymorphic allele for LTα252 A/G was associated with a higher risk of osteoporosis (P = 0.02). Regression analysis showed that age over 40 years, chronic active disease, and previous colonic resections were independently associated with the risk of developing MBD.

CONCLUSIONS

The prevalence of MBD was significantly higher in CD patients. Besides the usual risk factors, we observed that factors related to chronic active and long-lasting disease increased the risk of MBD.

Fatty acids, IL6, and TNFalpha polymorphisms: an example of nutrigenetics in Crohn's disease

OBJECTIVES

The aim of this work was to study the interaction between genetic polymorphisms (single-nucleotide polymorphisms, SNPs) of pro- and anti-inflammatory cytokines and fat intake on the risk of developing Crohn's disease (CD) or modifying disease activity.

METHODS

Seven SNPs in interleukin 1 (IL1), tumor necrosis factor alpha (TNFalpha), lymphotoxin alpha (LTalpha), and IL6 genes were analyzed in 116 controls and 99 patients with CD. The type of fat intake was evaluated, and the interaction between SNPs and dietary fat in modulating disease activity was analyzed.

RESULTS

Individuals who were homozygous for the IL6-174G/C polymorphism had a six-fold higher risk for CD (odds ratio (OR)=6.1; 95% confidence interval (95% CI)=1.9-19.4), whereas the TT genotype on the TNFalpha-857C/T polymorphism was associated with more active disease (OR=10.4; 95% CI=1.1-94.1). A high intake of total, saturated, and monounsaturated fats, as well as a higher ratio of n-6/n-3 polyunsaturated fatty acid (PUFA), was associated with a more active phenotype (P<0.05). Furthermore, there was an interaction between dietary fat intake and SNPs, with a high intake of saturated and monounsaturated fats being associated with active disease, mainly in patients carrying the variant alleles of the 857 TNFalpha polymorphism (OR=6.0, 95% CI=1.4-26.2; OR=5.17; 95% CI=1.4-19.2, respectively) and the 174 IL6 polymorphism (OR=2.95; 95% CI=1.0-9.1; OR=3.21; 95% CI=1.0-10.4, respectively). Finally, low intake of n-3 PUFA and high n-6/n-3 PUFA ratio in patients with the TNFalpha 857 polymorphism were associated with higher disease activity (OR=3.6; 95% CI=1.0-13.0; OR=5.92; 95% CI=1.3-26.5, respectively).

CONCLUSIONS

These results show that different types of fat may interact with cytokine genotype, modulating disease activity.

Risk of colorectal cancer associated with the C677T polymorphism in 5,10-methylenetetrahydrofolate reductase in Portuguese patients depends on the intake of methyl-donor nutrients

BACKGROUND

Polymorphisms located in genes involved in the metabolism of folate and some methyl-related nutrients are implicated in colorectal cancer (CRC).

OBJECTIVE

We evaluated the association of 3 genetic polymorphisms [C677T MTHFR (methylene tetrahydrofolate reductase), A2756G MTR (methionine synthase), and C1420T SHMT (serine hydroxymethyltransferase)] with the intake of methyl-donor nutrients in CRC risk.

DESIGN

Patients with CRC (n = 196) and healthy controls (n = 200) matched for age and sex were evaluated for intake of methyl-donor nutrients and the 3 polymorphisms.

RESULTS

Except for folate intake, which was significantly lower in patients (P = 0.02), no differences were observed in the dietary intake of other methyl-donor nutrients between groups. High intake of folate (>406.7 microg/d) was associated with a significantly lower risk of CRC (odds ratio: 0.67; 95% CI: 0.45, 0.99). The A2756G MTR polymorphism was not associated with the risk of developing CRC. In contrast, homozygosity for the C677T MTHFR variant (TT) presented a 3.0-fold increased risk of CRC (95% CI: 1.3, 6.7). Similarly, homozygosity for the C1420T SHMT polymorphism also had a 2.6-fold increased risk (95% CI: 1.1, 5.9) of developing CRC. When interactions between variables were studied, low intake of all methyl-donor nutrients was associated with an increased risk of CRC in homozygous participants for the C677T MTHFR polymorphism, but a statistically significant interaction was only observed for folate (odds ratio: 14.0; 95% CI: 1.8, 108.5). No significant associations were seen for MTR or SHMT polymorphisms.

CONCLUSION

These results show an association between the C677T MTHFR variant and different folate intakes on risk of CRC.

A comprehensive approach to evaluate nutritional status in Crohn's patients in the era of biologic therapy: a case-control study

OBJECTIVES

Evaluate the nutritional status of patients with inactive or mildly active Crohn's disease (CD), and identify possible causes for potential deficiencies.

METHODS

A total of 78 CD patients and 80 healthy controls were evaluated in respect of nutritional status, dietary intake, and life styles factors.

RESULTS

These 73/78 CD patients were on immunomodulating therapies. Mean body mass index (BMI) was lower in patients as compared to controls (P= 0.006) but 32% of CD patients and 33.8% of controls had a BMI > 25, whereas 8% and 23.8% in each group, respectively, were obese (BMI > 30Kg/m(2)). Fat free mass was significantly decreased in both genders (P < 0.05) whereas fat mass was decreased only in males (P= 0.01). Energy intake was significantly lower in CD patients (P < 0.0001) and we observed significantly lower adjusted mean daily intakes of carbohydrates, monounsaturated fat, fiber, calcium, and vitamins C, D, E, and K (P < 0.05). 29% of patients had excluded grains from their usual diet, 28% milk, 18% vegetables, and 11% fruits. Milk exclusion resulted in a significantly lower consumption of calcium and vitamin K (P < 0.001) and the exclusion of vegetables was associated to a lower consumption of vitamins C and E (P < 0.05). Physical activity was significantly lower in CD patients (P= 0.01) and this lack of physical activity was inversely correlated with increased fat mass percentage (r=-0.315, P= 0.001).

CONCLUSIONS

Results showed that the most prevalent form of malnutrition in CD patients was an excess of body weight, which was concomitant with an inadequate dietary intake, namely micronutrients, clearly related to dietary exclusion of certain foods.