Evaluation of Aflatoxins Occurrence and Exposure in Cereal-Based Baby Foods: An Update Review

PURPOSE OF REVIEW

The first stages of human life, which include the fetal period, infancy, and early childhood, are the most critical for human growth and development. This is the most vulnerable phase to health challenges due to the immature immune system and rapid development. Mycotoxins such as aflatoxins, ochratoxin A, patulin, fumonisins, zearalenone, and deoxynivalenol are secondary metabolites secreted by various fungal species, primarily Aspergillus, Fusarium, Penicillium, and Alternaria. Aflatoxins are one of the major mycotoxins produced in cereals and cereal-based foods by several species of Aspergillus, mainly Aspergillus flavus. In this context, this review provides a brief overview of the occurrence, exposure, legal regulations, and health effects of aflatoxins (B1, B2, G1, G2, and M1) in cereal-based baby foods and breast milk.

RECENT FINDINGS

Human aflatoxin exposure in utero and through breast milk, infant formulas, cereals, and cereal-based foods has been linked to various health consequences, including adverse birth outcomes, impaired growth and development, immune system suppression, and hepatic dysfunction. Recent evidence suggests that especially infants and children are more susceptible to aflatoxins due to their lower body weight, lowered capacity to detoxify harmful substances, more restrictive diet, immature metabolism and elimination, and faster rates of growth and development. It is essential for both food safety and infant and child health that aflatoxins in cereal and cereal-based products are precisely detected, detoxified, and managed.

Gender-Affirming Nutrition: An Overview of Eating Disorders in the Transgender Population

PURPOSE OF REVIEW

Transgender individuals are vulnerable to many nutrition-related conditions, especially eating disorders due to gender dysphoria. This review aims to summarize the current literature on eating disorders in transgender individuals. The issues that should be considered in nutrition care for the transgender population are discussed regarding public health.

RECENT FINDINGS

Transgender individuals can exhibit disordered eating behaviors to overcome the stress they experience due to stigma, discrimination, social exclusion, and abuse. Recent studies showed that disordered eating and clinical eating disorders are more prevalent among transgender than cisgender people. It is very important for a multidisciplinary team working in the clinic to understand the epidemiology, etiology, diagnostic criteria, and treatment of eating disorders in the transgender population. However, multidisciplinary nutritional care is limited due to the lack of transgender-specific nutrition guidelines. It is safe to say that adhering to a generally healthy nutritional pattern and using standardized nutrition guidelines. We recommend that health professionals working with patients/clients with eating disorders receive continuing education in transgender health, be empowering and inclusive, address patients/clients with their gender identity nouns and pronouns, and develop nutritional treatment plans that are not gender-specific. Eating disorders are a significant public health problem in the transgender population. Therefore, clinical screening and early intervention are necessary to identify and treat eating disorders in transgender people. Eating disorders in the transgender population should be monitored routinely, and gender-affirming care should be provided as well as treatment of eating disorders.

A Little Pepper-Upper? Systematic Review of Randomized Controlled Studies on Capsaicinoids, Capsinoids, and Exercise Performance

Capsaicinoids and capsinoids are bioactive compounds mostly found in peppers. Although preclinical studies have reported that these compounds can improve exercise performance due to transient receptor potential vanilloid subtype 1 (TRPV1)-mediated thermogenesis, sympathetic modulation, and releasing calcium, it is still unclear how they affect exercise performance in humans as ergogenic supplements. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guide 2020, this systematic review examined the ergogenic effect of capsaicinoids and capsinoids on exercise performance in healthy adults. A total of 19 randomized placebo-controlled trials were included in the study. Studies were accessed by searching five databases (PubMed, Scopus, SPORTDiscus, Web of Science, and Cochrane Library). The quality of the studies was evaluated using the Cochrane risk-of-bias assessment tool. According to the study results, 10 studies examining the effect of capsaicinoid and capsinoid supplements on exercise performance reported positive effects. Also, the effect of capsaicinoids and capsinoids on exercise performance is more pronounced in resistance training. This difference, which varies according to the type of exercise, may be due to the correlation between capsaicin transient receptor potential vanilloid subtype 1 and insulin-like growth factor-1.

Nutritional Epigenetics and Phytochemicals in Cancer Formation

Nutrigenetics and nutrigenomics are two concepts in the area of nutritional genomics. Epigenetics is a new discipline with significant potential in the prevention and management of certain carcinomas and diseases. Epigenetics consists of DNA methylation, histone modification, non-coding RNAs, and telomerase activity. Epigenetic-based mechanisms act on the inhibition of cancer cells by modulating enzymes such as DNA methyltransferase and histone deacetylase, as well as non-coding RNAs. Phytochemicals are natural bioactive components of plant origin that have antioxidant, anti-inflammatory, and anti-angiogenic effects on various diseases, especially cancer. The epigenetic diet is a nutritional model based on the consumption of various phytochemicals such as epigallocatechin-3-gallate, morin, caffeic acid phenyl ester, apigenin, genistein, curcumin, resveratrol, and sulforaphane. Phytochemicals exert their effects on cancer-based by reducing cell proliferation, invasion, and metastasis and increasing cell apoptosis. Simultaneously, it has functions such as reducing oncogenes that have effects on cancer etiology and increasing tumor suppressor genes.Key teaching pointsCancer is a chronic disease with a high mortality rate, in which various genetic and environmental factors are involved in its etiology.Protooncogenes, tumor suppressor genes, and DNA repair genes are among the gene groups that form the basis of cancer and genetic structure.The bidirectional interaction between nutrition and the human genome has been effective in the emergence of the concepts of nutrigenetics and nutrigenomics.Epigenetic diet is a diet based on the consumption of foods such as soy, grapes, blueberries, turmeric, cruciferous vegetables, and green tea, which induce epigenetic mechanisms that protect against cancer and aging.

Investigating Bioaccessibility of Advanced Glycation Product Precursors in Gluten-Free Foods Using In Vitro Gastrointestinal System

Background and Objectives: Gluten-free products have been produced as part of medical therapy and have gained popularity among individuals seeking weight loss or healthier dietary options. Assessing the potential risks associated with these products is essential in optimizing their compositions and developing new dietetic approaches. This study aimed to determine the glyoxal (GO) and methylglyoxal (MGO) contents in gluten-free bread, biscuits, and cookies and to examine their bioaccessibility using an in vitro gastrointestinal model. Materials and Methods: A total of 26 gluten-free and 19 gluten-containing (control) products were analyzed for their GO and MGO levels utilizing a high-performance liquid chromatography (HPLC) device. Results: Post-digestion, the GO and MGO values increased significantly across all food groups compared with pre-digestion values (p < 0.05), and the bioaccessibility exceeded 100%. Specifically, gluten-free bread exhibited higher post-digestion GO and MGO values than the control group (p < 0.05). Conversely, gluten-containing biscuits and cookies had higher post-digestion GO and MGO values compared to gluten-free products (p < 0.05). Conclusions: The detection of precursors to advanced glycation end products (AGEs) in gluten-free products has drawn attention to the potential health risks associated with their consumption. Therefore, reevaluation of the formulations and technologies used in these products and the introduction of new strategies are crucial in mitigating AGE content.

Functional Constipation in Elderly and Related Determinant Risk Factors: Malnutrition and Dietary Intake

AIM

The objective of this study was to evaluate the relationship between FC and physical activity, dietary intake and malnutrition in the elderly.

METHOD

A cross-sectional study was conducted on 883 adults aged >65 years from nursing homes and community health centers in Turkey. Constipation status was evaluated according to Rome IV criteria and Bristol Stool Form Scale. Dietary intake was assessed using a food consumption record (24-hour food recall). The dietary energy and nutrients were analyzed using the "Nutrition Information Systems Package Program". The nutritional status of participants was evaluated using the Mini-Nutritional Assessment (MNA) test. The International Physical Activity Questionnaire (IPAQ, short form) was used to assess physical activity status.

RESULTS

Among the 883 participants, 29.6% were classified into the FC group (32.2% of females, 25.8% of males). The FC group had significantly lower total energy, fluid, water, protein, carbohydrate, magnesium, zinc, phosphorus, potassium, soluble fiber, insoluble fiber, total fiber, and fiber (g)/1000 kcal intake than the non-FC group (p < 0.05). The multivariate logistic regression analysis showed that total dietary fiber intake was significantly associated with a lower prevalence of FC (OR: 0.98, 95% Cl: 0.96-0.99). According to MNA, participants at risk of malnutrition (OR: 5.21, 95% Cl: 3.09-9.77) and malnourished participants (OR: 3.03, 95% Cl: 1.62-5.68) had a greater likelihood of FC compared with normal participants. Participants in the middle lower quartile of water intake (OR: 0.63, 95% CI: 0.42-0.95) had a decreased likelihood of FC compared with participants in the lowest quartile.

CONCLUSION

FC is a common gastrointestinal disorder among the elderly in Turkey. Low dietary fiber intake, low water intake and malnutrition were important risk factors associated with FC in the elderly.

The Effect of the Covid-19 Pandemic on Nutritional Status and Anxiety Levels in Turkish Young Adults

Background

The pandemic called “Coronavirus Disease 2019” (COVID-19), which first appeared in China, then spread to the whole world, has had negative consequences in many areas, especially in health. The long-term quarantine process caused by the pandemic and the experienced stress had a great impact on nutritional habits.

Aim

In this study, it was aimed to determine the change in anxiety levels and eating habits of young adults after the COVID-19 pandemic.

Methods

The data were obtained through an online questionnaire between April and July 2020. In the questionnaire, the general and health information of the individuals, their nutritional habits, and anthropometric measurements (height and body weight) were questioned. In addition, the food frequency questionnaire form and Beck Anxiety Inventory were applied.

Results

A total of 823 (174 males and 649 females) participants were included in the study. The median ages of males and females were 27.0 (18.0) and 26.0 (8.0), respectively. According to the results of the food frequency questionnaire; it was found that among females, the consumption of egg, cheese, milk, yogurt, pickles, fruit, onion, garlic, lemon, salad, legumes, pastry, sweets, red meat, turmeric, and herbal tea were increased significantly in the post-pandemic period; and the consumption of milk, yogurt, garlic, and lemon significantly increased in males. It was also found that the anxiety levels of the females increased statistically significantly in the post-pandemic period.

Conclusion

It was determined that during the COVID-19 pandemic, there were statistically significant changes in the food intake patterns and anxiety levels of the participants. It is thought that the results obtained from this study may be a guide for further studies to determine the nutritional habits in the COVID-19 pandemic.

The effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non-alcoholic fatty liver disease: A randomized controlled trial

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in children and adolescents. The optimal dietary strategy to improve hepatic stetatosis and reduce oxidative stress and inflammation in adolescents is unknown.

OBJECTIVE

This study was conducted to evaluate the effect of Mediterranean diet (MD) versus low-fat diet (LFD) on hepatic steatosis, inflammation, and oxidative stress in adolescents with obesity and NAFLD.

METHODS

Adolescents diagnosed with NAFLD between the ages of 11-18 years were randomized to either a MD or conventional LFD (control diet) for 12 weeks. Dietary status, anthropometry, body composition, and biochemical parameters were evaluated. Hepatic steatosis was determined by ultrasonography.

RESULTS

A total of 44 participants completed the study. At the end of the study, severity of hepatic steatosis, serum transaminase levels, and insulin resistance decreased significantly in both groups with no significant differences between groups except for aspartate aminotransferase (AST). The amount of decrease in AST levels in the MD group was greater than the LFD group (p < 0.05). In the MD group, serum total antioxidant capacity, paraoxanase-1, and glutathione peroxidase levels increased (p < 0.05); it did not change in the LFD group compared to baseline (p > 0.05). C-Reactive Protein (CRP) levels decreased only in the MD group (p = 0.008), interleukine-6 decreased only in the LFD group (p = 0.031).

CONCLUSION

Consumption of MD and LFD for 12 weeks in adolescents with obesity and NAFLD reduced BMI, fat mass, hepatic steatosis, and insulin resistance, improved high transaminase levels, and had positive effects on inflammation and oxidative stress. Registered under ClinicalTrials.gov Identifier no. NCT04845373.

The relationship between intuitive eating, eating disorders, and body image perceptions in young adult women

BACKGROUND: The term intuitive eating is a new concept that has emerged in recent years. It is a way of eating that is based on responding to the body’s natural signals of hunger and satiety. OBJECTIVE: The study was conducted to evaluate the relationship between intuitive eating and eating disorders and body image perception in young adult women. METHODS: The study was conducted with 400 women aged 19–35 years. The data were collected with the Figure Rating Scale, the Intuitive Eating Scale-2 (IES-2), and the Eating Attitude Test-26. RESULTS: The mean body mass index was significantly higher in individuals who misperceived their body image. While 51.4% of the participants with normal eating behavior had appropriate body image perception, 38.8% of the participants with abnormal eating behavior had appropriate body image perception. The IES-2 total score was significantly lower in women with abnormal eating behavior and overweight/obese women. CONCLUSIONS: Our findings showed that intuitive eating is negatively associated with abnormal eating behavior and obesity in young adult women and that women with low intuitive eating inclinations misperceived their body image.

The relationship between death risk and nutritional factors in individuals with acute coronary syndrome

There is a relationship between low food intake and risk of death in patients with acute coronary syndrome. In this study aimed to examine the relationship between The Global Registry of Acute Coronary Events (GRACE risk score) and food intake.: 140 men over 35 years of age with Acute Coronary Syndrome were included in the study. The 1-day energy and nutrient consumption of individuals was determined using a 24-hour food consumption recording method. Based on the GRACE risk score classification system, the patients were divided into four quartiles (89.5≥Q1≥72, 102.5≥Q2≥89.5, 117.75≥Q3≥102.51, 152≥Q4≥117.76). The macro and micronutrient intakes of individuals were compared between the four groups. Nutrient intake decreased in the group with the highest grace risk score. inadequate nutrient intake further increased the GRACE risk score. A negative correlation was found between the GRACE risk score and macro and micronutrients (p<0.05). We found that the increase in the GRACE risk score decreased the food intake otherwise a low level of food intake increased the risk of death.

Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update

The coronavirus disease 2019 (COVID-19) is caused by the newly discovered SARS-CoV-2. Hematopoietic stem cell transplantation (HSCT) is a high-risk procedure. The novelty of COVID-19 has created more uncertainty during all phases of HSCT. It is thought that HSCT patients taking immunosuppressive agents are more likely to contract COVID-19 than healthy individuals are. Appropriate care precautions should be taken with patients undergoing HSCT to minimize the risk of COVID-19, and appropriate treatment methods must be followed in patients infected with COVID-19. Malnutrition has become a significant problem in HSCT patients during the COVID-19 pandemic. The causes of malnutrition in HSCT patients are multifactorial. However, the most important reason is the decrease in energy and nutrient intake. The HSCT procedure can lead to many complications such as dysgeusia, mucositis, diarrhea, constipation, xerostomia and vomiting/nausea. Improving the nutritional status of HSCT patients by managing each of these special complications with an appropriate nutritional approach is essential for successful engraftment. This review aims to provide a comprehensive overview of the specific complications affecting the nutritional status of HSCT patients and their nutritional approach during the challenging COVID-19 pandemic.

Mediterranean meal favorably effects postprandial oxidative stress response compared with a western meal in healthy women

Oxidative stress and inflammation are underlying factors in the pathogenesis of chronic diseases. The postprandial state is characterized by low-grade oxidative and inflammatory responses, but the impact of different dietary patterns on these responses is unclear. The objective of this study was to investigate postprandial oxidative and inflammatory responses to Mediterranean diet (MED) and Western diet (WD) meals. In a randomised crossover design, eleven healthy women, aged between 19-45 years with a body mass index of 20.0-24.9 kg/m², consumed two different isocaloric meals: MED and WD. Blood samples were collected at fasting and 2, 3, 4 h postprandially and analyzed for oxidative [total antioxidant status (TAS), total oxidant status (TOS), total thiol, native thiol, malondialdehyde (MDA)] and inflammatory [high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-17, IL-23, tumor necrosis factor alpha (TNF-α) and nuclear factor kappa B (NF-κB)] markers. MED meal intake resulted in increases in TAS (0.05±0.02 mmol/L; p=0.017), total thiol (23.00±7.69 μmol/L; p=0.013) and native thiol (12.82±4.94 μmol/L; p=0.027), while a decrease in MDA (-0.17±0.06 nmol/L; p=0.022) at 2 h. On the other hand, TAS reduced significantly overall (p=0.005) after WD meal intake. There was a significant increase after WD meal intake for IL-6 (1.39±0.49 pg/mL; p=0.017), IL-17 (4.30±1.50 pg/mL; p=0.017), IL-23 (8.38±3.51 pg/mL; p=0.038) at 4 h. However, serum hs-CRP, TNF-α and NF-κB levels were not changed significantly by meal intake. The results indicate that MED meal induces favorable effects on oxidative stress, while WD meal partially increases inflammation in daily life.

Is the nuclear factor kappa-b (NF-κB) pathway and inflammatory status associated with colorectal cancer?

BACKGROUND

Although genetic predisposition has a role in the etiology of colorectal cancer, there are many other factors that affect its development. In this study, it was aimed to evaluate the NF-κB pathway, inflammatory status and dietary antioxidant capacity in individuals with colorectal cancer.

METHODS

The study was carried out with 40 male subjects diagnosed with colorectal cancer aged between 39-65, years and a control group of the same number of healthy men. Subjects in the case and control groups were subdivided according to body mass index (BMI), as normal (BMI 20-24.9 kg/m²) or overweight/obese (BMI ≥25 kg/m²).

RESULTS

At the end of the study, NF-κB and interleukin-22 levels were higher in the case group, but no significant difference was found between the groups. Interleukin-23 and 8-Hydroxy-2-deoxyguanosine levels in the case group classified as overweight/obese according to BMI were significantly higher than in the control group (P = 0.001 and P < 0.001, respectively). Considering diet antioxidant capacity, it was higher in individuals in the control group than in the case group. However, there was no significant difference between the groups.

CONCLUSION

Inflammatory status and reduced dietary antioxidant capacity are risk factors in the development of colorectal cancer.

Evaluation of hydration status during the COVID-19 pandemic: a study of Turkish young adults

Adequate hydration is an essential component of health at every stage of life. Although many factors such as age, gender, physical activity, drug use, and illness affect hydration status, it is vital to maintain water balance, especially in infectious diseases. This study was conducted to estimate the hydration status of young adults living in Turkey during the COVID-19 pandemic. The total water intake (TWI) and total water loss of the individuals were determined using the Water Balance Questionnaire (WBQ), which consists of questions about physical activity status, frequency of food and beverage consumption, water consumption, and water loss with urine and feces. The TWI of men and women was found to be 4,776.1 and 4,777.3 mL/day, respectively (p > 0.05). It was determined that 29% of the total water was obtained from drinking water, 49% from other beverages, and 22% from food. A positive net water balance was found in all body mass index (BMI) groups, men, and women. The net water balance was statistically lower in men (2,230.6 mL) than women (2,783.8 mL) (p < 0.05). As the COVID-19 pandemic continues, studies should be done on hydration status in the more balanced populations in terms of BMI and age groups.

Medical nutritional therapy for renal transplantation in the COVID-19 pandemic

Nutritional therapy is very important at renal transplantation. Nutrition has become more vital for transplantation patients owing to the coronavirus disease 2019 (COVID-19) pandemic. Inadequate nutrition can negatively affect the immune system. For this reason, adequate protein and energy intake should be provided to the patients. Also, overconsumption of saturated fat, sugar, and refined carbohydrates can both negatively affect the immune system and trigger chronic diseases in transplantation patients. In addition, vitamins and minerals should be monitored and inadequacy should be prevented due to immunomodulatory effects. Applying nutritional therapy suitable for the symptoms of renal transplantation patients and preventing comorbidities may reduce the risk and severity of COVID-19 infection.

Risk Factors for Constipation in Adults: A Cross-Sectional Study

Aim: The objective of this study was to determine associations between physical activity, dietary fiber intake, water and fluid intake, and constipation as well as other possible risk factors for constipation in adults.Method: A cross-sectional study was conducted in 4561 (1812 male and 2749 female) adults, aged between 18-65 years, living in Ankara, Turkey. Participants having three or fewer bowel movements per week were considered constipated. Dietary fiber and fluid intake data were ascertained from a 62-item food frequency questionnaire (FFQ). The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to evaluate participant physical activity.Results: Of the total cohort, 16.6% were diagnosed with constipation (13.6% males, 18.5% females). Logistic regression analysis showed a significantly greater risk of constipation in participants with female gender, advancing age, being obese. Participants who were moderately active (OR: 0.77, 95% CI: 0.62-0.91) and active (OR: 0.74, 95% CI: 0.59-0.90) had a decreased likelihood of constipation, when compared with inactive participants (p < 0.05). Participants in the middle upper quartile for water intake (OR: 0.71, 95% CI: 0.57-0.88), had a decreased likelihood of constipation, when compared with participants in the lowest quartile. Participants in the middle upper quartile (OR: 0.74, 95% CI: 0.58-0.92) and the highest quartile for dietary fiber intake (OR: 0.66, 95% CI: 0.52-0.84), had a decreased likelihood of constipation, when compared with participants in the lowest quartile (p < 0.05).Conclusion: Constipation is common in the Turkish adult population. Insufficient physical activity, decreasing fiber and water intake, obesity, advancing age and female gender were associated with increased constipation risks. Combining regular physical activity and increasing fiber and water intake may protect from constipation, and relieve constipation symptoms.

The effect of dietary salt restriction on hypertension in peritoneal dialysis patients

BACKGROUND/AIM

To investigate the effect of dietary salt restriction on blood pressure levels, total sodium removal, and hydration status of peritoneal dialysis (PD) patients.

MATERIALS AND METHODS

Thirty-one stable PD patients who consulted a renal dietitian monthly for dietary recommendations, including restricted salt intake <5 g/day, and education about hypertension and hypervolemia were included in this study. Baseline and third month clinical and laboratory findings, bioelectrical impedance analysis results, and urinary and peritoneal sodium removal values were recorded.

RESULTS

The mean age of the patients was 47.6 years and the mean time on PD was 39.6 months. The mean total sodium removal decreased slightly from 139.4 ± 69.1 to 136.2 ± 64.8 mmol/day (P > 0.05) for the whole sample, and from 164.3 ± 70.9 to 154.2 ± 72.3 mmol/day (P > 0.05) for the hypertensive subgroup (n: 17). Systolic blood pressure (from 134.3 ± 20.1 to 127.2 ± 19.5 mmHg, P: 0.01), diastolic blood pressure (from 83.2 ± 12.0 to 77.4 ± 10.5 mmHg, P: 0.01) and total body water (from 39.2 ± 10.9 to 38.3 ± 9.3 L, P: 0.04) decreased significantly.

CONCLUSION

We demonstrated that even a little reduction in daily dietary sodium intake caused significant decreases in blood pressure levels and fluid overload.

Comparison of energy balance-related behaviours and measures of body composition between Turkish adolescents in Turkey and Turkish immigrant adolescents in the Netherlands

OBJECTIVE

To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL).

DESIGN

Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study.

SETTING

Primary and secondary schools.

SUBJECTS

A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.

RESULTS

Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.

CONCLUSIONS

Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Plasma orexin-A and ghrelin levels in patients with chronic obstructive pulmonary disease: Interaction with nutritional status and body composition

Orexin-A and ghrelin are two important polypeptides that stimulate food intake, however, there is a lack of sufficient information concerning their plasma levels in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the association between plasma orexin-A and ghrelin levels with food consumption and body composition in patients with stable phase COPD. In total, 40 patients (age, 44–80 years; male, 31; female 9) who were in the stable phase of COPD were included in the study. Blood samples for plasma orexin-A and ghrelin analysis were collected after 8–12 h of fasting; certain anthropometric measurements were obtained and a 24-h dietary recall was recorded. The mean plasma orexin-A levels in the male and female patients were 1.3±0.37 and 1.4±0.13 ng/ml, respectively, while the mean plasma ghrelin levels were 25.9±7.31 and 27.3±8.54 ng/ml, respectively. No significant correlation was observed between the body mass index and plasma orexin-A and ghrelin levels or between the plasma ghrelin levels and dietary nutrient intake (P>0.05). The plasma orexin-A levels were demonstrated to be higher in patients with a higher dietary total fibre intake (r=0.303, P=0.022). A similar correlation was observed between plasma orexin-A levels and dietary intake of soluble (r=0.033, P=0.029) and insoluble (r=0.335, P=0.024) fibre, as well as between the daily consumption of calcium and the levels of plasma orexin-A (r=0.065, P=0.046). Therefore, the results of the present study indicated that a positive correlation existed between dietary nutrient intake and plasma orexin-A levels in patients with COPD.

Daily dietary energy and macronutrient intake and anthropometric measurements of the peritoneal dialysis patients

INTRODUCTION

This study was planned to investigate the relation between dietary macronutrient status and anthropometric measurements in peritoneal dialysis (PD) patients.

MATERIALS AND METHODS

A total of 28 clinically stable patients were enrolled in this study. All patients were taken a dietary therapy according to the guidelines of the American Journal of Kidney Foundation for 12 weeks. The anthropometric measurements were taken by bioelectrical impedance analyzer. The daily macronutrient intakes of the patients were calculated by the food consumption records.

RESULTS

The mean age was 48.3 ± 13.10 years [56.3 ± 7.41 years for males (n = 14) and 40.3 ± 12.84 years for females (n = 14)]. There were significant changes in fat percentage (%), total body water (TBW; %, L), extracellular water (ECW; %, L), basal metabolic rate over body weight (BMR/BW), and body fat mass index (BMFI) in males (p < 0.05), but there was no change in females (p > 0.05). The daily dietary energy and protein intakes were under the recommended level in the study period.

CONCLUSION

Patients undergoing PD frequently have low intakes of protein and energy. It is recommended that individuals undergoing PD periodically maintain 3-day dietary records followed by dietary interviews conducted by a dietitian.

Intestinal obstruction due to bezoars: a retrospective clinical study

PURPOSE

The purpose of this study was to compare the results of surgical procedures applied to rare intestinal obstruction cases due to bezoars and to identify effective factors for determining the type of surgical procedure to be applied.

METHODS

The records of 62 patients who had received gastrointestinal surgical treatment due to bezoars were assessed retrospectively. The preoperative characteristics, perioperative findings and postoperative results of cases that had and had not undergone an enterotomy were compared

RESULTS

The average patient age was 57.7 years (range, 26-84 years), and all patients had phytobezoars, except one. The most common location for bezoars was the jejunum (28 cases, 45.1 %). Sixteen cases (25.8 %) had multiple bezoars located in different parts of the gastrointestinal tract. While milking was applied to 26 cases (41.9 %) with small intestinal bezoars, an enterotomy was used to remove bezoars in 23 cases (37 %). More complications tended to be identified in patients who underwent an enterotomy; however, the difference was not significant (p = 0.553).

CONCLUSIONS

The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary.

The protective effects of Ginkgo biloba extract (EGb-761) on radiation-induced dermatitis: an experimental study

BACKGROUND

Irradiation of the skin induces production of free radicals, resulting in oxidative stress. EGb-761, an extract from the leaves of the Ginkgo biloba tree, has been reported to be an effective exogenous antioxidant based on its free-radical scavenger properties.

AIM

To investigate the protective effect of G. biloba extract (EGb-761) on radiation-induced dermatitis in rats.

METHODS

Forty male Wistar rats were divided equally into four groups: group 1 received sham radiotherapy (RT) without EGb-761, group 2 received sham RT with EGb-761, group 3 received RT without EGb-761, and group 4 received RT with EGb-761. Levels of malondialdehyde (MDA), nitric oxide (NOx) and glutathione (GSH) were measured. Dermatitis was assessed with a semiquantitative dermatitis item score. The intensity of staining and diffusion of expression for proliferating cellular nuclear antigen (PCNA) and transforming growth factor (TGF)-β3 were also evaluated.

RESULTS

The enhanced oxidative stress seen after RT was markedly diminished when EGb-761 was administered with RT; significantly lower mean MDA (P < 0.005) and higher mean GSH (P < 0.001) levels were seen in group 4 compared with group 3. Although there was a decrease in NOx levels, this was not significant. All (100%) of the animals in group 3 developed dermatitis, whereas only 13% of the animals in group 4 did so (P < 0.0001). There was a significant difference between group 1 and group 3 in PCNA and TGF-β3 staining (P < 0.05), whereas no difference was seen between groups 3 and 4; however, the intensity of staining and diffusion of expression were lower in group 4 than in group 3.

CONCLUSIONS

Prophylactic administration of EGb-761 seems to have a protective effect against radiation-induced dermatitis.

Lung tissue apoptosis in abdominal hypertension : Apoptosis and necrosis of lung tissue in abdominal hypertension

OBJECTIVES

The aim of this study was to evaluate lung tissue histopathologic changes and the number of apoptosis with the increase of abdominal pressure.

METHODS

The study rats were randomly assigned into the following five groups: a sham operated group and groups 1, 2, 3 and 4, in which the intra-abdominal pressure was increased to 11, 15, 18 and 22 mmHg for 60 min, respectively. Lungs were harvested for histopathologic changes and the tissue apoptotic analysis were carried out in a blinded manner.

RESULTS

All of the data showed that the number of apoptotic cells and necrosis were increased in accordance with the pressure level. However, this increase was statistically significant, especially in groups 3 and 4 (18 and 22 mmHg, respectively; p < 0.05) when compared to the sham operated rats. There were no differences observed between groups 1 and 2 (11 and 15 mmHg, respectively) and the sham operated rats. There was also no difference between groups 1 and 2. There were findings of coagulation necrosis and the number of apoptotic cells linearly increased when the abdominal pressure was increased. The cut-off value was 15 mmHg.

CONCLUSION

The available findings suggest that intra-abdominal pressure greater than 15 mmHg could irreversibly damage pulmonary cells and both coagulation necrosis parameters and the number of apoptosis increase in accordance with the pressure level.

The association of anthropometric measurements and lipid profiles in Turkish hypertensive adults

BACKGROUND

Few studies have associated anthropometric measurements and lipid profile with hypertension in adult populations and to the best of our knowledge none has been done in Turkey

OBJECTIVES

To relate anthropometric derivatives of overweight/obesity with hyperlipidemia status in a group of Turkish hypertensive adults.

METHODS

Six hundred forty nine (307 male, 342 female) hypertensive adults aged between 20 and 64 years were included in the study.

RESULTS

The mean systolic and diastolic blood pressure (BP) of participants were measured as 147.6 ± 17.2 and 91.4 ± 10.4 mmHg for males and 149.9 ± 16.3 and 91.1 ± 9.4 mmHg for females, respectively. With respect to BMI classification systolic BP was significantly higher in obese males and females, and diastolic BP was only higher in obese females (p<0.05). According to BMIs for lipid profile, high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC) levels were found to be lower in normal females than other BMI groups. Age and waist circumference (WC) in particular was the most related factor for systolic and diastolic BP in both genders (p<0.05).

CONCLUSIONS

This study indicates most hypertensive adults surveyed were overweight and obese. Furthermore, age and WC were the important factors that affects the systolic and diastolic BP in both genders.

Evaluation of dietary quality of adolescents using Healthy Eating Index

The aim of this study was to use the Healthy Eating Index-2005 (HEI-2005) to assess diet quality and determine the relationship between the HEI-2005 and the energy and nutrient intakes of adolescents. A cross-sectional study was conducted on 1,104 healthy adolescents, mean age of 15.8 ± 1.24 years. Dietary intake was measured with the 24-hour dietary recall method, and dietary quality was assessed by means of the HEI-2005. Diet quality scores ranged from 23.7 to 77.5. The mean score was found to be 51.5 ± 9.07 according to the HEI-2005. There were no differences according to gender; 42.8% had a poor diet and 57.2% had a diet that needs improvement. No subjects had a "good diet". Lower mean subgroup scores were found for whole grains, total vegetables, total fruits, dairy products, and meat and beans. Fruits and vegetables scores were significantly high in girls, whereas sodium, oil, and meat and beans scores were significantly high in boys. Total HEI-2005 scores were increasingly associated with parental education level when age and gender were adjusted. There was a negative correlation between HEI-2005 scores and age, total energy intake, and fat intake. Positive correlation was only observed in the HEI-2005 scores for protein and dietary fibre intakes. Consequently, the overall diet quality and nutritional habits of Turkish adolescents need modification and improvement. In the family, measures should be initiated by the government, including advertisements and campaigns.

New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition

Cancer and its treatment result in severe biochemical and physiological alterations associated with a deterioration of quality of life (QoL). Cancer-related malnutrition may evolve into cancer cachexia due to complex interactions between pro-inflammatory cytokines and the host metabolism. Depending on the type of cancer treatment (either curative or palliative), the clinical condition of the patient and nutritional status, adequate and patient-tailored nutritional intervention should be prescribed (diet counseling, oral supplementation, enteral or total parenteral nutrition). Nutritional support has been widely advocated as adjunctive therapy for a variety of underlying illnesses, including surgery and medical oncotherapy (radiation or chemotherapy for cancer). Glutamine, n-3 fatty acids and probiotics/prebiotics are therapeutic factors that potentially modulate gastrointestinal toxicity related to cancer treatments. Enteral and parenteral nutrition may help improve patient survival, functional status and QoL, yet the benefits appear to be primarily limited to patients with good functional status and with gastrointestinal disease affecting nutritional intake. Parenteral nutrition offers the possibility of increased or maintenance of the nutrient intake in patients for whom normal food intake is inadequate and for whom enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. This article reviews evidence on issues relevant to enteral and parenteral nutrition in patients with cancer.

Metabolic syndrome (MS) in elderly: a cross sectional survey

This study was conducted to determine the prevalence of metabolic syndrome (MS) in Turkish elderly. All data were collected in a cross-sectional based survey on 266 elderly aged above 65 years living in capital city of Turkey, Ankara. MS was defined according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP ATP III) criteria. In the total sample of participants, the 61.7% (n=164) of the group has been diagnosed as MS. High blood pressure (BP) and waist circumference (WC) and low high density lipoprotein cholesterol (HDL-C) were the criteria of MS with highest prevalence in both gender. In addition female participants have higher systolic blood pressure (93.4%) and WC (79.1%) and lower HDL-C (69.2%) than the men (74.4%, 31.1% and 52.2% respectively). Weight correlated significantly with triglyceride (TG) and MS (p<0.001). WC was the anthropometric variable which had the highest correlation with the MS (r=0.338, p<0.001). Our study indicates that MS is highly prevalent in the elderly people particularly among women. Our findings may be helpful in formulating public health policies and prevention strategies focus on elderly population.

Procalcitonin Levels as an Early Marker in Patients with Multiple Trauma under Intensive Care

This prospective study investigated the levels of procalcitonin (PCT) and C-reactive protein (CRP) in patients with various types and severity of multiple trauma, and their relationship to trauma-related complications. Adult multiple-trauma patients ( n = 113) admitted to the intensive care unit (ICU) in the first 24 h after trauma were included. The Injury Severity Scores (ISS), and PCT and CRP levels were measured in the first 24 h (day 1), on day 7 and on the final day of their ICU stay. Survival at 30 days was recorded. Mean PCT and CRP levels were both significantly higher on day 7 compared with day 1 and the final assessment day in patients with an ISS > 20. Levels of PCT were significantly higher in cases with sepsis, severe sepsis or septic shock compared with cases who developed systemic inflammatory response syndrome (SIRS), however levels of CRP were significantly higher only in cases with severe sepsis or septic shock, but not in cases with sepsis alone. These data support the view that PCT levels may be a better indicator than CRP levels in the early diagnosis of septic complications in patients with multiple trauma.

Histopathological Effects of Bipolar Vessel Sealing Devices on Liver Parenchyma and Comparison with Suture Method: An Experimental Study

BACKGROUND

LigaSureand SurgRx are bipolar vessel sealing devices providing hemostasis by denaturating collagen and elastin from the vessel wall and surrounding connective tissue. We aimed to histopathologically evaluate the lateral injury during rat liver resection with LigaSure and SurgRx.

METHODS

Suture technique was used in group A, LigaSure was used in group B and SurgRx was used in group C to resect one lobe of liver from midline. One of the resected pieces was histopathologically examined the same day and the other piece was left in the animal to be examined at the 7th day. Relaparotomy was performed at the 7th day.

RESULTS

Necrosis, exudate formation, chronic inflammation, histiocytes and fibroblasts scores were significantly lower in SurgRx group compared to the other groups.

CONCLUSION

Our findings suggest that LigaSure and SurgRx can be safely used in liver resection as compared to suture technique while SurgRx was superior than LigaSure in inflammatory response as it causes lower lateral thermal injury and inflammatory scores probably due to its different technical properties.

The effect of NG-nitro L-arginine methyl ester on colonic anastomosis after increased intra-abdominal pressure

BACKGROUND

Intestinal ischemia-reperfusion (I/R) is associated with augmented nitric oxide (NO) production. Increased intra-abdominal pressure (IAP) during surgical pneumoperitoneum (P) facilitates I/R injury. We previously demonstrated decreased strength and healing of colocolic anastomoses after high IAPs. The effect of an NO synthase inhibitor, N (G)-nitro-arginine methyl ester (L: -NAME), on anastomoses realized in colonic tissue exposed to high IAPs was investigated in this study, a randomized, controlled, and experimental study with blind outcome assessment.

METHOD

Fifty Wistar-albino rats were randomized to five groups; all underwent colocolic anastomosis. P was maintained for 60 min at IAPs of 14, 20, 25, and 30 mmHg in study groups 1, 2, 3, and 4, respectively; P was preceded by intraperitoneal L: -NAME (2.5 mg/kg) and followed by anastomosis. The control group was not subjected to IAP or L: -NAME.

RESULTS

Anastomosis bursting pressure (ABP) values and histopathological findings were determined on the 7th-14th postoperative days. The ABPs of groups 3-4 were significantly lower than the others. Groups 1-2 had results similar to controls. Histopathological findings of the groups were consistent with their ABPs.

CONCLUSION

Administration of a 2.5-mg/kg intraperitoneal L: -NAME dose was found to provide a beneficial role, implying a role in impaired anastomotic healing after IAPs of 14 and 20 mmHg.

The use of a vessel sealing system in thyroid surgery

Thyroidectomy is one of the most common operations performed for thyroid diseases throughout the world and has an extremely low morbidity rate. Although the technique of thyroidectomy has changed little for several years, different techniques have been developed for haemostasis in addition to the conventional methods. The vessel sealing system (Ligasure) is a new technology that can be applied in several surgical situations. However, there is no data in the literature regarding its use in thyroid surgery. Fifteen consecutive euthyroid patients (ten women, five men) with a range of 37-71 years of age who met the inclusion criteria were studied. The surgical procedures were performed by a single surgeon using standard techniques, but all vascular structures encountered were sealed by Ligasure and no suture material was used. The pre-operative, intraoperative and postoperative parameters were recorded and analyzed. Fluid collection was evaluated by ultrasonography and clinical examination on the 3rd postoperative day, The results were compared with the conventional knot tying method in a group of 25 patients. A Ligasure device was successfully used in 15 consecutive procedures, including ten total thyroidectomies, three hemithyroidectomies, one subtotal thyroidectomy and one near-total thyroidectomy. There was no operative mortality or technique-related morbidity in patients. The operating time was 75 +/- 11 minutes. The mean volume of the resected thyroid specimens was 68.3 +/- 18.9 cm3. The mean fluid collection at postoperative day three was 7.5 +/- 1.6 cm3. In conclusion, we have found that a Ligasure device can be safely used for haemostasis in thyroid surgery. It has the potential to decrease the operating time, fluid collection and blood loss.

Ischemic preconditioning decreases laparoscopy-induced oxidative stress in small intestine

BACKGROUND/AIMS

Laparoscopy is advantageous but its adverse effects have not yet been completely elucidated. Pneumoperitoneum performed to facilitate laparoscopy causes the organ perfusion decrease such as in the intestine. Oxidative stress reflects the tissue injury related to ischemia and reperfusion. We previously showed that laparoscopy causes oxidative stress in intestinal tissues. To assess whether the preconditioning phenomenon could be taken advantage of during laparoscopy we designed this randomized, controlled, experimental study with blind outcome assessment. We evaluated the effect of preconditioning, including sequential periods of pneumoperitoneum and desufflation on laparoscopy-induced tissue injury of small bowel with the help of two important markers of oxidative stress, thiobarbituric acid reactive substances and reduced glutathione.

METHODOLOGY

Forty Sprague-Dawley male rats were used. After anesthesia, an intraperitoneal catheter was inserted. Pneumoperitoneum was created in all except controls, by CO2 insufflation under a pressure of 15 mmHg. The rats were randomized into the groups below: Group P was subjected to 60 minutes of pneumoperitoneum; Group P/D was subjected to 60 minutes of pneumoperitoneum followed by 45 minutes of desufflation; Group IP + P was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation and 60 minutes of pneumoperitoneum; Group IP + P/D was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation, 60 minutes of pneumoperitoneum and 45 minutes of desufflation; Group C (Control) was subjected to a sham operation, without pneumoperitoneum. Small bowel tissue malondialdehyde and reduced glutathione activities were measured, as applicable, by investigators blinded to the study design. The results were decoded and statistically analyzed with Kruskal-Wallis test. Mann-Whitney U test was used to compare the paired groups. p < 0.05 was considered significant.

RESULTS

Small bowel tissue malondialdehyde levels were increased, whereas glutathione values were decreased in Groups P and P/D, as compared to Groups PRE/P and PRE/P/D; the latter two groups had results similar to the Control Group.

CONCLUSIONS

Laparoscopic preconditioning may reduce the oxidative injury in intestine following laparoscopic procedures.

A comparison of the oxidative stress response and antioxidant capacity of open and laparoscopic hernia repairs

BACKGROUND

Free radical-induced lipid peroxidation that is associated with a decrease in the antioxidant status of plasma occurs in many kinds of surgical procedures. In this study, we aimed to investigate markers of oxidative stress--malondialdehyde (as thiobarbituric acid reactive substances), protein carbonyls, and protein sulfhydryls--in patients undergoing Lichtenstein tension-free hernioplasty (LH) or laparoscopic preperitoneal hernia (LPPH) repair.

METHODS

Seventeen patients with unilateral inguinal hernia and no complications or recurrence were included in this study. Ten were randomized to undergo LH and seven to LPPH repair. Heparinized blood samples were taken to measure the levels of oxidative stress markers in the patients undergoing hernia repair. Levels of malondialdehyde, protein carbonyls, and protein sulfhydryls were measured preoperatively and at 6 and 24 hours postoperatively in all patients.

RESULTS

Both types of hernia repair caused a significant increase in the oxidative stress response and a decrease in antioxidant activity. Plasma levels of malondialdehyde and carbonyls (indicators of oxidant activity) were significantly higher in the LH than in the LPPH repair group (P<.05), and plasma sulfhydryl levels (indicators of antioxidant activity) were significantly lower in the LH than in the LPPH group (P<.05). In both groups, significant differences were also found between the preoperative levels and the postoperative levels 6 and 24 hours (P<.05).

CONCLUSIONS

These data demonstrate that both LH and LPPH repair cause a significant increase in markers of oxidative stress; however, the oxidative stress response associated with LH is greater than that associated with LPPH repair.

Can preconditioning reduce laparoscopy-induced tissue injury?

BACKGROUND

Pneumoperitoneum (P) created to facilitate laparoscopy (L) is associated with splanchnic perfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. In this randomized controlled experimental study with blind outcome assessment, we evaluated the effect of preconditioning (PRE) on L-induced I/R injury.

METHODS

The subjects were 40 Sprague-Dawley male rats. P was created in all except controls, using carbondioxide (CO2) insufflation under a pressure of 15 mmHg. PRE consisted of 10 min of P, followed by 10 min of deflation (D). The rats were randomized to the following groups: Group P was subjected to 60 min of P. Group P/D was subjected to 60 min of P, followed by 45 min of D. Group PRE/P was subjected to PRE, followed by 60 min of P. Group PRE/P/D was subjected to PRE, followed by 60 min of P and 45 min of D. Group C (control) was subjected to a sham operation, without P. Its anesthesia time was equal to that for group PRE/P/D. At the end of the experiments, the rats were killed; blood, liver, and kidney samples were then obtained and coded. Plasma alanine aminotransferase (ALT) and malondialdehyde (MDA), as well as homogenized tissue MDA levels and glutathione (GSH) activities, were measured; tissue samples were assessed for histopathological evidence of injury; all assessments were done by investigators blinded to the study design. The results were decoded and analyzed statistically with the Kruskal-Wallis and Mann Whitney tests. A p <0.05 was considered significant.

RESULTS

Plasma ALT as well as plasma, liver, and kidney MDA levels and liver and kidney injury scores were increased, whereas liver and kidney GSH values were decreased in groups P and P/D, as compared to group C. Rats subjected to PRE before P had plasma ALT, kidney MDA, and kidney and liver GSH levels comparable to controls; their kidney and liver injury scores were higher than controls but significantly lower than nonpreconditioned animals. PRE enabled decreased plasma, kidney, and liver MDA as well as increased kidney GSH if applied before P; its efficacy on oxidative stress was limited to providing decreased kidney MDA and increased kidney GSH if applied before P/D. However, PRE significantly attenuated kidney and liver injury after P as well as P/D.

CONCLUSION

PRE consisting of 10 min of P followed by 10 min of D decreases the oxidative stress induced by sustained P in the plasma, liver, and kidney. PRE significantly limits liver and kidney injury after prolonged P and P/D. After further studies to define its ideal timing, PRE before L incorporating P may have clinical relevance, especially for elderly patients or those with impaired hepatic and/or renal function or perfusion.

The effects of increased intraabdominal pressure on colonic anastomoses

BACKGROUND

This experimental, randomized, controlled study was designed to investigate the effects of increased intraabdominal pressure (IAP) on colocolic anastomoses. To our knowledge, this is the first study to address this important issue.

METHODS

For this study, 50 Wistar albino rats were randomized into five groups. The animals in all the groups underwent laparotomy and colocolic anastomosis. The rats in the control group were not subjected to increased IAP. Accordingly, IAP's of 14, 20, 25, and 30 mmHg were established by carbon dioxide insufflation and maintained for 60 min in study groups 1, 2, 3 and 4, respectively. Colocolic anastomosis was realized after these periods of IAP in the study groups. Half of the surviving rats in all the groups were sacrificed on postoperative days 7 and 14 to allow comparison between the control and study groups with respect to their mean body weights, mean anastomosis bursting pressures, and histopathologic characteristics of their anastomosis sites.

RESULTS

The mean body weights of all the groups were comparable at all times during the study. The anastomosis bursting pressures of the animals subjected to increased IAP were lower than that of the control group, with the differences reaching statistical relevance for the animals subjected to an IAP of 20 mmHg or higher on postoperative day 7 (p <0.0005 for study groups 2, 3, and 4 vs the control group) and becoming more pronounced by the day 14 (p <0.0005 for study groups 2, 3, and 4 vs the control group). The anastomosis bursting pressure showed an inverse correlation with IAP. The adequacy of mucosal layer formation at the anastomosis line was lower and the degree of inflammation was higher in the groups exposed to an IAP of 20 mmHg or higher in the control group (p <0.05 for both comparisons among study groups 2, 3 and 4 vs the control group).

CONCLUSIONS

An IAP increased to 20 mmHg and higher was found to result in impaired strength and wound healing in colocolic anastomoses, as reflected by the decreased bursting pressure and mucosal layer formation, and by the increased inflammation at the anastomosis sites of animals subjected to high IAP values.