High salt-induced morphological and glycocalyx remodeling of human vascular smooth muscle cells is reversible but induces a high sodium salt-like sensitive memory

Our recent work showed that short-term treatment (1-2 days) with high sodium salt had no effect on the morphology of human vascular smooth muscle cells (hVSMCs). However, chronic (long-term treatment, 6-16 days) high sodium salt (CHSS) induced hypertrophy and decreased the relative density of the glycocalyx in hVSMCs. Whether this CHSS effect is reversible at both the morphological and the intracellular calcium and sodium levels is unknown. In the present study, we tested the hypothesis that the effect of CHSS on the morphological and functional levels of hVSMCs is reversible. However, it induced an irreversible increase in the sensitivity of the cells following short-term treatment with high extracellular Na+. We tested the effects of the removal of CHSS treatment on the morphology and intracellular sodium and calcium of hVSMCs. Our results showed that restoring average sodium concentration (145 mM) modeled back the relative density of the glycocalyx, the intracellular resting calcium and sodium levels, and the whole cell and nuclear volumes of hVSMCs. In addition, it induced a permanent remodeling of hVSMCs' response to a short-term increase in the extracellular level of sodium salt by developing spontaneous cytosolic and nuclear calcium waves. Our results showed that CHSS is reversible at both the morphological and basal intracellular ionic levels. However, it maintained a high sensitivity to short-term elevation of extracellular sodium. These results suggest that even if chronic high salt is corrected, it induces a high sodium salt-like sensitive memory.

Involvement of Oxidative Stress and Nutrition in the Anatomy of Orofacial Pain

Pain is a very important problem of our existence, and the attempt to understand it is one the oldest challenges in the history of medicine. In this review, we summarize what has been known about pain, its pathophysiology, and neuronal transmission. We focus on orofacial pain and its classification and features, knowing that is sometimes purely subjective and not well defined. We consider the physiology of orofacial pain, evaluating the findings on the main neurotransmitters; in particular, we describe the roles of glutamate as approximately 30-80% of total peripheric neurons associated with the trigeminal ganglia are glutamatergic. Moreover, we describe the important role of oxidative stress and its association with inflammation in the etiogenesis and modulation of pain in orofacial regions. We also explore the warning and protective function of orofacial pain and the possible action of antioxidant molecules, such as melatonin, and the potential influence of nutrition and diet on its pathophysiology. Hopefully, this will provide a solid background for future studies that would allow better treatment of noxious stimuli and for opening new avenues in the management of pain.

Dietary Oncopharmacognosy as a Crosswalk between Precision Oncology and Precision Nutrition

While diet and nutrition are modifiable risk factors for many chronic and infectious diseases, their role in cancer prevention and control remains under investigation. The lack of clarity of some diet-cancer relationships reflects the ongoing debate about the relative contribution of genetic factors, environmental exposures, and replicative errors in stem cell division as determinate drivers of cancer risk. In addition, dietary guidance has often been based upon research assuming that the effects of diet and nutrition on carcinogenesis would be uniform across populations and for various tumor types arising in a specific organ, i.e., that one size fits all. Herein, we present a paradigm for investigating precision dietary patterns that leverages the approaches that led to successful small-molecule inhibitors in cancer treatment, namely understanding the pharmacokinetics and pharmacodynamics of small molecules for targeting carcinogenic mechanisms. We challenge the scientific community to refine the paradigm presented and to conduct proof-in-concept experiments that integrate existing knowledge (drug development, natural products, and the food metabolome) with developments in artificial intelligence to design and then test dietary patterns predicted to elicit drug-like effects on target tissues for cancer prevention and control. We refer to this precision approach as dietary oncopharmacognosy and envision it as the crosswalk between the currently defined fields of precision oncology and precision nutrition with the goal of reducing cancer deaths.

Unilateral Variant of NGT Syndrome: An Uncommon Complication of a Very Common Intervention

The common complications of nasogastric tube placement include gastrointestinal-tube malposition, coiling, or knotting, impaired function of the lower esophageal sphincter leading to reflux of gastric contents, esophagitis, gastrointestinal bleeding, and aspiration pneumonia. Sofferman et al. in 1990, described a clinical entity constituted by life-threatening bilateral vocal cord paralysis, presenting as throat pain, stridor and respiratory compromise as Nasogastric syndrome (NGTS). There are fewer than 50 cases of NGTS described in the literature, till date, let alone a unilateral variant of the same. Here we have described two cases of unilateral variant of NGTS, the management, outcome, and a detailed literature review of the previous reported cases. The two cases described were identified in the same year, highlighting the fact that, the entity might be more common, and needs more clinical attention than previously estimated.

Association Between Ultraprocessed Food Consumption and Risk of Incident CKD: A Prospective Cohort Study

RATIONALE & OBJECTIVE

Ultraprocessed foods have become readily available in the global food supply in the past few decades. Several adverse health outcomes have been linked with higher consumption of ultraprocessed foods. However, the impact of ultraprocessed foods on chronic kidney disease (CKD) risk remains unknown.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

14,679 middle-aged adults without CKD at baseline in the Atherosclerosis Risk in Communities (ARIC) study.

EXPOSURE

Ultraprocessed foods consumption (servings per day) calculated using dietary data collected via a food frequency questionnaire at visit 1 and visit 3.

OUTCOME

Incident CKD defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 accompanied by ≥25% eGFR decline, CKD-related hospitalization or death, or kidney failure with kidney replacement therapy.

ANALYTICAL APPROACH

Multivariable-adjusted Cox proportional hazards models were used to assess the association between ultraprocessed foods consumption and CKD. Restricted cubic splines were used to examine the shape of the association.

RESULTS

During a median follow-up period of 24 years, there were 4,859 cases of incident CKD. The incidence rate for the highest quartile of ultraprocessed foods consumption was 16.5 (95% CI, 15.6-17.4) per 1,000 person-years and 14.7 (95% CI, 13.9-15.5) per 1,000 person-years for the lowest quartile of consumption. After adjusting for a range of confounders including lifestyle factors, demographic characteristics, and health behaviors, participants in the highest quartile of ultraprocessed foods consumption had a 24% higher risk (HR, 1.24 [95% CI, 1.15-1.35]) of developing CKD compared with those in the lowest quartile. There was an approximately linear relationship observed between ultraprocessed food intake and risk of CKD. By substituting 1 serving of ultraprocessed foods with minimally processed foods, there was a 6% lower risk of CKD observed (HR, 0.94 [95% CI, 0.93-0.96]; P < 0.001).

LIMITATIONS

Self-reported data and residual confounding.

CONCLUSIONS

Higher ultraprocessed foods consumption was independently associated with a higher risk of incident CKD in a general population.

An Assessment of Behavior Change Techniques in Two Versions of a Dietary Mobile Application: The Change4Life Food Scanner

The Change4Life Food Scanner app is a UK Government dietary app designed to provide feedback on the nutritional content of packaged foods to parents and their children. To understand its intended mechanism of behavior change and how Behavior Change Technique (BCT) content evolves with app updates, this research aimed to map out the BCTs of two versions of the Change4Life Food Scanner app. Two coders undertook a descriptive comparative analysis of the use of BCTs in the Food Scanner app using the Behavior Change Technique Taxonomy [both the outdated (v1.6) and updated (v2.0) versions of the app were coded]. Results showed that both versions encompass the BCTs "goal setting (behavior)", "feedback on behavior", "social support (unspecified)", "instruction on how to perform behavior", "salience of consequences", "prompts/cues" and "credible source". The outdated version contained the BCT "behavior substitution" which had been dropped in the updated version. The updated version featured the additional BCTs "information about social and environmental consequences", "information about emotional consequences", "social reward" and "social incentive" and was comparatively more BCT intensive in terms of content and occurrence. The BCT content of the Food Scanner app resembles that of existing dietary apps and incorporates several BCTs which have previously been found to be effective. Future work to evaluate the effectiveness of the app is recommended. This will provide insight into whether the combination of BCTs used in the Change4Life Food Scanner app are effective in improving dietary choices.

Climate Solutions Double as Health Interventions

The climate crisis threatens to exacerbate numerous climate-sensitive health risks, including heatwave mortality, malnutrition from reduced crop yields, water- and vector-borne infectious diseases, and respiratory illness from smog, ozone, allergenic pollen, and wildfires. Recent reports from the Intergovernmental Panel on Climate Change stress the urgent need for action to mitigate climate change, underscoring the need for more scientific assessment of the benefits of climate action for health and wellbeing. Project Drawdown has analyzed more than 80 solutions to address climate change, building on existing technologies and practices, that could be scaled to collectively limit warming to between 1.5° and 2 °C above preindustrial levels. The solutions span nine major sectors and are aggregated into three groups: reducing the sources of emissions, maintaining and enhancing carbon sinks, and addressing social inequities. Here we present an overview of how climate solutions in these three areas can benefit human health through improved air quality, increased physical activity, healthier diets, reduced risk of infectious disease, and improved sexual and reproductive health, and universal education. We find that the health benefits of a low-carbon society are more substantial and more numerous than previously realized and should be central to policies addressing climate change. Much of the existing literature focuses on health effects in high-income countries, however, and more research is needed on health and equity implications of climate solutions, especially in the Global South. We conclude that adding the myriad health benefits across multiple climate change solutions can likely add impetus to move climate policies faster and further.

Higher Ultra-Processed Food Consumption Is Associated with Increased Risk of Incident Coronary Artery Disease in the Atherosclerosis Risk in Communities Study

BACKGROUND

Higher ultra-processed food intake has been linked with several cardiometabolic and cardiovascular diseases. However, prospective evidence from US populations remains scarce.

OBJECTIVES

To test the hypothesis that higher intake of ultra-processed foods is associated with higher risk of coronary artery disease.

METHODS

A total of 13,548 adults aged 45-65 y from the Atherosclerosis Risk in Communities study were included in the analytic sample. Dietary intake data were collected through a 66-item FFQ. Ultra-processed foods were defined using the NOVA classification, and the level of intake (servings/d) was calculated for each participant and divided into quartiles. We used Cox proportional hazards models and restricted cubic splines to assess the association between quartiles of ultra-processed food intake and incident coronary artery disease.

RESULTS

There were 2006 incident coronary artery disease cases documented over a median follow-up of 27 y. Incidence rates were higher in the highest quartile of ultra-processed food intake (70.8 per 10,000 person-y; 95% CI: 65.1, 77.1) compared with the lowest quartile (59.3 per 10,000 person-y; 95% CI: 54.1, 65.0). Participants in the highest compared with lowest quartile of ultra-processed food intake had a 19% higher risk of coronary artery disease (HR: 1.19; 95% CI: 1.05, 1.35) after adjusting for sociodemographic factors and health behaviors. An approximately linear relation was observed between ultra-processed food intake and risk of coronary artery disease.

CONCLUSIONS

Higher ultra-processed food intake was associated with a higher risk of coronary artery disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed foods may affect health.

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

BACKGROUND

Increased malnutrition risk has been observed in more than 40% people on haemodialysis in Israel. It is not clear that this risk is homogeneously distributed among people with versus without diabetes.

OBJECTIVES

To examine the influence of diabetes on malnutrition risk among people on haemodialysis.

METHODS

This cross-sectional study included a representative sample of 375 individuals on haemodialysis treated in hospital dialysis centres throughout Israel. Of these, 126 had diabetes. Dietary intake, biochemistry, anthropometric and hemodynamic measures were recorded. Malnutrition risk categories were defined: "minimal": body mass index (BMI) ≥23 kg/m2 and serum albumin ≥38 mmol/L; "mild": BMI <23 kg/m2 and albumin ≥38 mmol/L; "moderate": BMI ≥23 kg/m2 and albumin <38 mmol/L; "severe": BMI<23 k/m2 and serum albumin <38 mmol/L. These categories were dichotomized to "minimal" versus elevated malnutrition risk.

RESULTS

Despite greater BMI, elevated malnutrition risk was identified in 58.8% of individuals with versus 39.3% without diabetes. Adherence to International Society for Renal Nutrition and Metabolism nutrition guidelines was poor regardless of diabetes status. In multivariable logistic regression analysis, diabetes: OR 2.15; C-reactive protein (nmol/L): OR 1.02; delivered dialysis dose (Kt/V): OR 6.07; and haemoglobin (g/L): OR 0.79, predicted elevated malnutrition risk, even after controlling for age, sex and years on haemodialysis.

DISCUSSION

Individuals on haemodialysis who have diabetes have elevated malnutrition risk compared to those without diabetes despite greater BMI.

A Randomized Controlled Trial Testing the Effectiveness of Coping with Cancer in the Kitchen, a Nutrition Education Program for Cancer Survivors

Following a diet rich in whole grains, vegetables, fruit, and beans may reduce cancer incidence and mortality. The aim of this study was to investigate the effect of Coping with Cancer in the Kitchen (CCK), an 8 week in-person program offering education, culinary demonstrations and food tasting, and psychosocial group support, compared to receiving CCK printed materials by mail on knowledge, confidence, and skills in implementing a plant-based diet. A total of 54 adult cancer survivors were randomly assigned to intervention (n = 26) and control groups (n = 27) with assessments at baseline, 9, and 15 weeks via self-administered survey. The response rate was 91% at 9 weeks and 58% at 15 weeks. The majority of our study participants were female breast cancer survivors (58%) who had overweight or obesity (65%). Compared with the control, there were significant (p < 0.05) increases in intervention participants’ knowledge about a plant-based diet at weeks 9 and 15, reductions in perceived barriers to eating more fruits and vegetables at week 9, and enhanced confidence and skills in preparing a plant-based diet at week 15. There was a significant reduction in processed meat intake but changes in other food groups and psychosocial measures were modest. Participation in CCK in person increased knowledge, skills, and confidence and reduced barriers to adopting a plant-based diet. Positive trends in intake of plant-based foods and quality of life warrant further investigation in larger-scale studies and diverse populations.

Healthy eating in pregnancy, education for midwives: A pre-post intervention study

INTRODUCTION

Midwives have an important role in providing education in healthy eating to pregnant women, which is essential for maternal and foetal health and wellbeing. Importantly, midwives require continual professional development to ensure they provide up-to-date education.

METHODS

A pre-post intervention study utilised a purpose-designed questionnaire to collect data at three time points. Forty-four midwives completed the pre education questionnaire, 29 of these midwives attended the education intervention (workshop/webinar) and completed the immediately after questionnaire. Nineteen midwives then completed a questionnaire at 6–8 weeks follow-up. The study aimed to evaluate midwives’ knowledge and level of confidence to discuss healthy eating in pregnancy.

RESULTS

Education in healthy eating improved midwives’ knowledge and level of confidence, which were maintained for six to eight weeks. The mean difference of total scores on knowledge and confidence between pre and immediately after education questionnaires showed a statistically significant improvement in nutrition knowledge (4.93 ± 1.62 vs 7.55 ± 1.55; p<0.001) and confidence level (22.05 ± 6.87 vs 31.48 ± 7.47; p<0.001). In terms of the mode of education, there was a significant increase in total knowledge scores for midwives who attended a workshop compared to a webinar.

CONCLUSIONS

Overall, healthy eating education improved midwives’ knowledge and confidence immediately after receiving education and also at 6–8 weeks follow-up. This study is unique as it evaluated midwives’ knowledge and level of confidence at 6–8 weeks post education. This study concludes that midwives benefited from receiving further knowledge on cultural food choices, eating behaviours, and dental care.

Nutrition, Energy Expenditure, Dysphagia, and Self-Efficacy in Stroke Rehabilitation: A Review of the Literature

While significant research has been performed regarding the use of thrombolytic agents and thrombectomy in the setting of acute stroke, other factors, such as nutritional status of stroke patients, is a less explored topic. The topic of nutrition is critical to the discussion of stroke, as up to half of stroke survivors may be considered malnourished at discharge. Dysphagia, old age, restricted upper limb movement, visuospatial impairment, and depression are all important risk factors for malnutrition in this cohort. The purpose of this review is to analyze current literature discussing neuroprotective diets, nutritional, vitamin, and mineral supplementation, dysphagia, and post-stroke coaching in stroke patients.

Feline Obesity in Veterinary Medicine: Insights from a Thematic Analysis of Communication in Practice

Feline obesity has become a common disease and important animal welfare issue. Little is known about how, or how often, veterinarians and feline-owning clients are addressing obesity during clinical appointments. The purpose of this qualitative study was to characterize verbal and non-verbal communication between veterinarians and clients regarding feline obesity. The sample consisted of video-recordings of 17 veterinarians during 284 actual appointments in companion animal patients in Eastern Ontario. This audio-visual dataset served to identify 123 feline appointments. Of these, only 25 appointments were identified in which 12 veterinarians and their clients spoke about feline obesity. Thematic analysis of the videos and transcripts revealed inconsistencies in the depth of address of feline obesity and its prevention by participating veterinarians. In particular, in-depth nutritional history taking and clear recommendations of management rarely took place. Veterinarians appeared to attempt to strengthen the veterinary-client relationship and cope with ambiguity in their role managing obesity with humor and by speaking directly to their animal patients. Clients also appeared to use humor to deal with discomfort surrounding the topic. Our findings have implications for communication skills training within veterinary curricula and professional development among practicing veterinarians. As obesity is complex and potentially sensitive subject matter, we suggest a need for veterinarians to have further intentionality and training toward in-depth nutritional history gathering and information sharing while navigating obesity management discussions to more completely address client perspective and patient needs.

Multiple Infectious Agents and the Origins of Atherosclerotic Coronary Artery Disease

Although deaths due to atherosclerotic coronary artery disease (ACAD) have fallen dramatically during the past 50 years, ACAD remains as the leading cause of death in all continents, except Africa, where deaths due to infections are still dominant. Although food and nutrition have a proven role in atherosclerosis, the underlying causes of ACAD remain unknown. This is despite a century of intensive research dominated by investigations into the saturated fat hypothesis. In this review, it is hypothesized that the rise and fall in ACAD during the past 100 years is primarily due to the parallel rise and fall in the prevalence of coronary atheroma, the underlying disease. It is further hypothesized that infectious pathogens initiate atherosclerosis mainly during infancy and childhood. It is speculated that widespread use of antibiotics and vaccines against bacterial and viral infections may be the reason for the dramatic fall in coronary atheroma and ACAD during the past 50 years. The relevant evidence and a working hypothesis are included in this review.

Complementary and alternative medicine use in pregnancy in Mashhad, Iran, 2007-8

BACKGROUND

This study was done to assess the use of traditional/complementary and alternative medicine (TM/CAM) during pregnancy and the reasons behind it from the mother's perspective.

MATERIALS AND METHODS

In a cross-sectional study, 919 pregnant mothers attending at prenatal care units of governmental health centers recruited through a multistage sampling and completed a self-report questionnaire about the use of TM/CAM during pregnancy.

FINDINGS

TM/CAM was used by 83.7% of women during pregnancy. Diet/nutrition change was applied by 42.3%, herbal preparations by 49.2%, vitamin and mineral by 30.1%, body based practices by 24.7% and spiritual methods by 22.9% of mothers. Most frequently used herbal products were frankincense in 28.6% and date fruit in 26.4% of mothers. The most common indication of diet/nutrition changes and herbal products used related to mothers was gastro-intestinal disorders. Most of the TM/CAM methods used (64.32%) were happening or beginning from the first trimester of pregnancy.

CONCLUSIONS

The use of TM/CAM methods in pregnancy is very common, mainly included the methods suggested by traditional Islamic Iranian medicine. Thus, clinicians should be informed to address CAM methods at each obstetric visit. Safety and efficacy of CAM must be explored and taught in every health education program. Future studies should focus on the safety and efficacy of TM/CAM in pregnancy and clinicians should be educated to address these methods at prenatal visits.

Could the health decline of prehistoric California indians be related to exposure to polycyclic aromatic hydrocarbons (PAHs) from natural bitumen?

BACKGROUND

The negative health effects of polycyclic aromatic hydrocarbons (PAHs) are well established for modern human populations but have so far not been studied in prehistoric contexts. PAHs are the main component of fossil bitumen, a naturally occurring material used by past societies such as the Chumash Indians in California as an adhesive, as a waterproofing agent, and for medicinal purposes. The rich archaeological and ethnohistoric record of the coastal Chumash suggests that they were exposed to multiple uptake pathways of bituminous PAHs, including direct contact, fume inhalation, and oral uptake from contaminated water and seafood.

OBJECTIVES

We investigated the possibility that PAHs from natural bitumen compromised the health of the prehistoric Chumash Indians in California.

CONCLUSIONS

Exposure of the ancient Chumash Indians to toxic PAHs appears to have gradually increased across a period of 7,500 years because of an increased use of bitumen in the Chumash technology, together with a dietary shift toward PAH-contaminated marine food. Skeletal analysis indicates a concurrent population health decline that may be related to PAH uptake. However, establishing such a connection is virtually impossible without knowing the actual exposure levels experienced by these populations. Future methodological research may provide techniques for determining PAH levels in ancient skeletal material, which would open new avenues for research on the health of prehistoric populations and on the long-term effects of human PAH exposure.