Sustained insulin treatment restoring metabolic status, body weight, and cognition in an anorexia nervosa-like animal model in mice

INTRODUCTION

Anorexia Nervosa (AN) is a psycho-socio-biological disease characterized by severe weight loss as result of dieting and hyperactivity. Effective treatments are scarce, despite its significant prevalence and mortality. AN patients show lower basal insulin levels and increased metabolic clearance, leading to weight loss, cognitive deficits, and hormonal imbalances. Low-dose polymer insulin could potentially reverse these effects by restoring brain function, reducing fear of weight gain, encouraging food intake, and restoring fat depots. This study evaluates an insulin delivery system designed for sustained release and AN treatment.

METHODS

AN-like model was established through dietary restriction (DR). On days 1-25, mice were on DR, and on days 26-31 they were on ad libitum regimen. An insulin-loaded delivery system was administered subcutaneously (1% w/w insulin). The impact of insulin treatment on gene expression in the hippocampus (cognition, regulation of stress, neurogenesis) and hypothalamus (eating behavior, mood) was assessed. Behavioral assays were conducted to evaluate motor activity and cognitive function.

RESULTS

The delivery system demonstrated sustained insulin release, maintaining therapeutic plasma levels. Diet restriction mice treated with the insulin delivery system showed body weight restoration. Gene expression analysis revealed enhanced expression of CB1 and CB2 genes associated with improved eating behavior and cognition, while POMC expression was reduced. Insulin-polymer treatment restored cognitive function and decreased hyperactivity in the AN-like model.

CONCLUSION

The PSA-RA-based insulin delivery system effectively restores metabolic balance, body weight, and cognitive function in the AN model. Its ability to steadily release insulin makes it a promising candidate for AN treatment."

Expert opinion survey on Israel's food system: implications for food and health policies

BACKGROUND

While there has been increasing global recognition and impetus for action to transform food systems towards greater food security, sustainability and better health outcomes, Israel has only recently begun to focus on the diverse challenges of its food system and its potential for transformation.

METHODS

An expert opinion survey (n = 50) on Israel's food system was conducted as part of a larger study on the systemic features of Israel's food system transition to understand its policy gaps and find strategies towards a healthy and sustainable food system. The survey ranks the relevance and importance of food system challenges and policy preferences. Policy implications are then examined by identifying potential priorities, gaps and dissensus.

RESULTS

The survey finds that there is a majority agreement (76%) that Israel's food policies are lacking or severely lacking. Respondents relate strongly to both concepts of nutritional security (90% think that access to nutritious food is relevant or highly relevant) and national food security (more than 80% perceive food security as part of national security). Respondents overwhelmingly recognize the benefits of Israeli agriculture with 60-90% agreeing or strongly agreeing that it benefits food security, economic value and national identity. Top-ranked problems include overall systemic problems such as the lack of national goals, strategic planning, and integrated policymaking across ministries, and specific ones such as food waste, costly farming inputs, and food affordability. The most preferred policy actions include establishing a national strategy for food and agriculture, making food affordable for vulnerable households, and incentivising sustainable farming methods. The key policy gaps include the lack of resilience in agriculture and the food system, insufficient data and knowledge for policy action, inadequate attention to the regulation of the food industry for better health and inadequate food policy attention for minority groups.

CONCLUSIONS

Building on this study's findings, further policy research and implementation areas to be covered include government responsibility for universal food security, strategic systemic policies for food systems, prevention and preparedness for future crises, and promoting resilience. The way forward may best be through an inter-ministerial committee with the responsibility, budgets, mandate and executive authority to plan data-driven policies for a sustainable food system for Israel's future.

Novel N-Acylethanolamide Derivatives Affect Body Weight and Energy Balance

Introduction - The obesity pandemic is multifactorial. Nutritional, pharmacologic and surgical interventions are limited in reach and efficacy, raising need for new therapeutics. Aims - Characterization of anorexigenic and cognitive effect and central mechanism of action of novel N-acylethanolamide derivatives. Methods - Sabra mice divided to similar experimental groups, injected IP with: oleyl-L-leucinolamide (1 A), linoleyl-L-leucinolamide (4 A), linoleyl-L-valinolamide (5 A), oleyl-oxycarbonyl-L-valinolamide (1 B), oleyl-oxycarbonyl-D-valinolamide (2 B), oleylamine-carbonyl-L-valinolamide (3 B), oleylamine-carbonyl-D-valinolamide (4 B), and oleyl-L-hydroxyvalineamide (5 B). Control group with vehicle. Body weight and food consumption followed for 39 days. Motor activity and cognitive function by open field test and eight-arm maze. Mice sacrificed and mechanism of action investigated by qPCR. The genes analyzed involved in energy balance and regulation of appetite. Catecholamines and serotonin evaluated. Results - Compounds 1 A, 5 A, 1 B-4 B, caused significant weight loss of 4.2-5.6 % and 5 A, 1 B-4 B, improved cognitive function following 8 i. p. injections of 1 mg/kg during 39 days, by different mechanisms. 5 A, 3 B and 4 B decreased food consumption, whereas 1 A, 5 A and 2 B increased motor activity. 1 A, 4 A, 1 B and 3 B elevated SIRT-1, associated with survival. POMC upregulated by 1 B and 2 B, CART by 1 B, 2 B and 1 A. NPY and CAMKK2 downregulated by 5 A. 4 B enhanced 5-HT levels. 4 A, 5 A, 1 B, 4 B, 5 B decreased FAAH, showing long lasting effect. Conclusions - These new compounds might be developed for the treatment of obesity and for improved cognitive function.

Developing Healthy Lifestyle Behaviors in Early Age-An Intervention Study in Kindergartens

Childhood obesity prevention is a leading public health challenge requiring the adoption of healthy lifestyles at an early age. We examined how the kindergarten environment can promote eating sensibly, drinking water and becoming physically active. The effects of an intervention program among 42 Israeli kindergartens (1048 children, aged 4-6) whose teachers participated in a health education training program were compared to 32 kindergartens (842 children) whose teachers did not undergo this training program. An eight-month intervention program focused on knowledge/mathematical/logical/critical thinking, self-regulation/control acquisition, and sensible decision-making abilities. We hypothesized that nutrition and physical-exercise-oriented intervention programs, combining knowledge/mathematical logical thinking, would positively impact the quality of children's mid-morning snack and water consumption, their ability to express feelings following physical exercise, and the adoption of healthy lifestyles at home. The quality of mid-morning snacks and water consumption were observed in both groups pre- and post-intervention. Qualitative interviews documented children's subjective feelings following physical exercise. A significant improvement (p < 0.001) was observed in the mid-morning snacks composition and in water drinking habits in the intervention group; 80% of children offered a physiological explanation regarding energy expenditure processes following intense physical exercise. In conclusion, kindergarten interventions implemented by trained teachers can promote adoption of health behaviors necessary for obesity prevention.

The Sapienza count-down for a healthy and sustainable diet

Abstract

The prevalence of obesity and of other non-communicable diseases related to overnutrition is significantly increasing in the past few years. Policy makers are called to counteract this pandemic, orienting consumers towards a healthier and more sustainable diet. Most of the proposed initiatives are dedicated to the content of nutrients with "unfavourable" effects but, in fact, focusing the attention only or mainly on single foods or nutrients is not effective in decreasing the incidence/prevalence of non-communicable diseases. Whole dietary patterns play by far a more important role than specific dietary components in promoting health and modulating survival; and the adherence to eating patterns like the Mediterranean diet reduces the risk of non-communicable diseases. The challenge is therefore to be able to transmit information relating to a healthy eating pattern through positive messages in a few simple indications which in turn represent the nutritional, but also the socio-cultural, environmental and economic characteristics of a healthy and sustainable dietary model. The Mediterranean Diet is normally proposed through a graphic depiction that represents a pyramid which is a simple and effective representation but not of immediate impact. For this reason, we are proposing to adopt the "Sapienza Count-down for a Healthy and Sustainable Diet" that will integrate the pyramid with a more immediate approach.

On radar and radio exposure and cancer in the military setting

INTRODUCTION

In 2018, we reported a case series of 47 patients diagnosed with cancer following several years of exposure to high-intensity whole-body radiofrequency radiation (RFR) using the parameter of percentage frequency (PF). Consistent high and statistically significant PFs of hematolymphoid (HL) cancers were found in this group and in four previous reports on RFR-exposed groups in Belgium, Poland and Israel together with increased all-cancers rates. In this paper we report a new series of 46 young cancer patients who were exposed during military service to such radiation.

MATERIALS AND METHODS

The new group of patients comprises Israeli soldiers previously exposed to occupational RFR. The patients were self-selected to enroll in the research in cooperation with an NGO assisting patients with administrative counseling and legal and social services. The new group of patients was studied with respect to distribution (proportion) of cancer types using the method of PF. When possible, cancer risk ratios (RR) were estimated too. The results are compared to those of other occupational groups in three countries.

RESULTS

Median age at diagnosis was 23 years; duration of exposure was between 1 and 3 years and the latencies were short, median 4.6 years. The PF of HL cancers was 41.3%, 95% CI (27%-57%), versus 22.7% expected in non-exposed subjects matched for age and gender profiles, p = 0.003; 19 out of the 46 patients had HL cancers. The PF of Hodgkin lymphoma cancers was 21.7%, 95%CI (11%-36%), versus 11.6% expected, p = 0.033. For a subgroup of 6 patients, the number of soldiers in the units was known, and we were able estimate approximately the overall cancer risk ratio (RR) after 8 years as being 8.0 with 95% CI (2.9, 17), p < 0.002, with only 0.75 cases expected from the Cancer Registry data. In this subgroup, there were 3 HL cancer cases and 3 non-HL cases. Sarcoma PF was higher than expected, 7 out of the 46 patients were diagnosed with sarcoma, PF = 15.2%, 95%CI (6.3%-28.9%), p = 0.04 versus the expected PF of 7%.

CONCLUSION

The HL PF was high and consistent with previous reports. Epidemiological studies on excess risk for HL and other cancers, brain tumors in cellphone users, and experimental studies on RFR and carcinogenicity strongly point to a cause-effect relationship. It is mandatory to reduce the RFR exposure of all personnel to that of the typical community levels, including the peak level of radar pulses. Radiation protection, safety instructions, cancer risk warnings and quantitative data on individual exposure together with regular medical monitoring must be instituted for all personnel exposed to such risks. The findings from our study add to the growing body of evidence underscoring the gross inadequacy of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) thermal standards. Based on our findings and on the previous accumulated research, we endorse the recommendations to reclassify RFR exposure as a human carcinogen, International Agency for Research on Cancer (IARC) group 1.

Front-of-pack labels: "Directive" versus "informative" approaches

Front-of-pack labels (FOPLs) aim at communicating to consumers the health value of food items in support of public health policies. Two main types can be discerned: directive and semidirective FOPLs using color schemes (e.g., Nutri-Score) and informative FOPLs (e.g., Nutrinform Battery). Directive approaches tend to show a "wear-out effect" and, additionally, they tend to have various underlying conceptual problems. Usually, their nutritional scores are calculated using changing, arbitrary algorithms and involve a reductionist set of parameters of debatable validity. Thus, they overstate the effects of selected nutritional factors, such as saturated fat and energy, while overlooking the food matrix and the more holistic aspects of nourishment. Moreover, they do not reflect the portion that is consumed, ignore the preparation steps at home, and fail to serve as a useful basis for composing a healthy diet. Also, so long as the nutritional formulations match the algorithmic standards, they tend to allow ultra-processed products. Thus, this might confuse and mislead consumers. Overconfidence in green-colored labels could even result in unbalanced dietary choices, whereas avoidance of red products may eliminate certain foods from the diet that are rich in essential nutrients (e.g., cheese), leading to opposite results than aimed for. The latter is particularly relevant to vulnerable populations, such as the young, pregnant women, and older adults, or for individuals with specific needs. Taken together, directive FOPLs such as Nutri-Score contradict the declared intent of the European Commission to empower consumers to undertake healthy and balanced diets based on easily accessible and robust information. Although informative systems usually also keep the focus on a few selected nutritional parameters, they have are less paternalizing and obviate the need to classify foods as healthy or unhealthy. They also focus attention on the individual portions that are consumed (even if the definition of portion size remains contentious). Given the importance of dietary patterns, rather than individual foods or nutrients, directiveFOPLs of the Nutri-Score type represent a regretful case of nutritionism. Finally, attempts to associate the adoption of a FOPL with an improvement in the health status are few and mainly applied in virtual settings; none of which are longitudinal, nor have they been able to identify a causal link.

Food Security and Nutrition as the Neglected Missing Links in Cultural Evolution: The Role of the Sociotype

Food security and nutrition were major drivers of cultural evolution by enabling sociotypic development and communal living after the Neolithic agricultural revolution some 12,000 years ago. The sociotype unites concepts from the sciences and the humanities; in concert with the genotype it determines an individual's phenotype (observable traits and behavior), and together they advance societal culture. As such, the sociotype relates to an individual's dynamic interactions with the surrounding social environment throughout life and comprises three domains: the Individual, Relationships, and Context. Nutrition affects each domain, respectively, by ensuring the following dimensions of food security: utilization (metabolic fuel and health); accessibility (physical and economic); and availability (the right to nutritious food for all citizens). The sociotype is influenced by multiple factors, including diet-gene interactions, allostasis, microbiota, oxytocin, and culturally through mate selection, family bonds, social communication, political ideologies, and values. Food security, sociotypes, and culture form a complex adaptive system to enable coping with the circumstances of life in health and disease, to achieve sustainable development, and to eradicate hunger. The current geopolitical unrest highlights the absolutely critical role of this system for global security, yet many challenges remain in implementing this paradigm for society. Therefore, sustainable food security must be considered a fundamental human right and responsibility for safeguarding the survival and progress of the sociotypes of humankind (Homo culturus) worldwide.

Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys

Background

Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years.

Methods

Demographic and health data from two representative national health cross-sectional surveys – MABAT ZAHAV 1 (MZ1) in 2005–2006, and MZ2 in 2014–2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI).

Results

Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1–3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications.

Conclusion

Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel's school feeding programs

Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30–50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are “selective”, in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a “universal” SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel’s firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.

Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016

PURPOSE

To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003-4 and in 2015-6, and associated factors.

METHODS

Adolescents (aged 11-19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003-4, n 5005) and II (2015-6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex.

RESULTS

The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015-6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003-4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys.

CONCLUSION

MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.

Goals in Nutrition Science 2020-2025

Five years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it (1). Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.

Coping with the Challenges of COVID-19 Using the Sociotype Framework: A Rehearsal for the Next Pandemic

The world, as a global village, is currently taking part in a real-time public health, medical, socio-cultural, and economic experiment on how best to combat the COVID-19 pandemic. Extraordinary times demand extraordinary measures. Depending on the time from the outbreak, strategies have ranged from minimal intervention to mitigation by quarantine for high-risk groups (elderly with chronic illnesses) to containment and lockdown. Adherence to such restrictions have depended on the individual and national psyche and culture. One can understand and forgive governments for being over-cautious, but not for being ill-prepared. It seems that Singapore after SARS (2003) and South Korea after MERS (2015) learnt from their experiences and have fared relatively well with minimal disruption to daily routines. Coping with the challenge of COVID-19 is an urgent global task. We use the Sociotype ecological framework to analyze different coping responses at three levels: Context (government and leadership, social context, health services, and media); Relationships; and the Individual. We describe the many negative outcomes (e.g. mortality [obviously], unemployment, economic damage, food insecurity, threat to democracy, claustrophobia) and the positive ones (e.g. new, remote teaching, working, and medical routines; social bonding and solidarity; redefining existential values and priorities) of this surreal situation, which is still evolving. We highlight the importance of humor in stress reduction. Regular and reliable communication to the public has to be improved, acknowledging incomplete data, and learning to deal with fake news, misinformation, and conspiracy theories. Excess mortality is the preferred statistic to follow and compare outcomes. When the health risks are over, the economic recovery responses will vary according to the financial state of countries. If world order is to be reshaped, then a massive economic aid plan should be launched by the rich countries-akin to the Marshall plan after the Second World War. It should be led preferably by the USA and China. The results of the tradeoffs between health and economic lockdowns will only become apparent in the months to come. The experiences and lessons learned from this emergency should be used as a rehearsal for the next epi-/pandemic, which will surely take place in the foreseeable future.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

BACKGROUND

Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets.

OBJECTIVE

To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns.

METHODS

We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it.

CONCLUSIONS

The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Food Insecurity, Social Inequity, and Sustainability

In his 1941 State of the Union address, Franklin D. Roosevelt articulated four fundamental freedoms that people "everywhere in the world" should enjoy - of speech and of worship, and from fear and from want. Food ("freedom from want") is a fundamental human right, and it is acknowledged that there is enough sustenance in the world to feed everyone. Yet, some 800 million people are hungry. Why? It is due to a combination of inequitable distribution and morally indefensible destruction of excess crops to keep market prices attractive for producers and "big-agro" industry. In addition, one third of food is lost or wasted from "farm to fork." The world financial and food crisis in 2008 led to an additional short-term dimension to food security - stability. Sustainability may be regarded as the long-term time element combining environmental protection, sociocultural, and economic development. To emphasize the interrelations between economics and sustainable diets, the first two of the 17 Sustainable Development Goals (SDG) are: (1) No Poverty and (2) Zero Hunger. Every country has marginalized populations with food insecurity, aggravated by natural and man-made disasters and whose numbers are always underestimates. We have developed a Global Nutrition Index to track the triple burden of malnutrition and it seems that the problems of obesity and the food industry are even greater than those of hunger. However, there is an essential difference: while people never choose to be hungry, there are elements of socioeconomic inequalities, personal choice, and parental responsibility in the development of obesity, especially in children. Nutrition, economics, and education are essential for improving human capital and come together in SDG 3 - Good Health and Well-Being - since "a well-fed nation is a healthy nation is a productive and sustainable nation."

Sustainable Food Systems and the Mediterranean Diet

During the past decade, the concept of sustainability has been added to the factors involved in food security. This has led to a more comprehensive and holistic approach to sustainable food systems which considers drivers—environment, geopolitics, demographics, policy regulations, socio-cultural-economic factors, science and technology and infrastructure. The outcomes, similarly, involve many dimensions—environment, food security and nutrition, health and socio-cultural-economic aspects. This article discusses the Mediterranean diet in the context of sustainable food systems and shows (as in all parts of the world) that there is food insecurity in every country as monitored by the Global Nutrition Index. Three recent, major reports published in 2019 suggest what measures need to be taken to improve sustainable food systems. All environmental analyses agree on the need to promote more plant-based diets—achieved practically by using “more forks than knives”. The Mediterranean Diet pattern is a case study for a sustainable diet. It has the best scientific evidence for being healthy, together with economic and socio-cultural benefits. A major challenge is that it is not consumed by the majority of the population in the Mediterranean region, and any solution must involve equity—the socially just allocation of resources. The task now is implementation with multi-stakeholder involvement, in the knowledge that “a well fed nation is a healthy nation is a sustainable and productive nation”.

Coping With Food Insecurity Using the Sociotype Ecological Framework

Ensuring Food Security (FS) for all citizens is a fundamental human right and policy for all countries. Dealing with Food Insecurity (FINS) is a challenge causing stress at many levels-national, household, and individual. The conceptual framework of the Sociotype has been developed as a summary ecological construct to organize the multiple, dynamic, reciprocal inputs from the environment that interact with the genotype to determine the expression of phenotypic behaviors such as coping with stress. The Sociotype ecological framework has three domains-Individual (intra-personal), Relationships (inter-personal, family and community), and Context (environment, national)-and their interactions determine an individual's resilience across the life trajectory from birth to old age. We have applied the principles of the Sociotype to classify both the stresses of, and the coping strategies to, FINS. The stresses of FINS may occur at any place along the FS pathway-Availability, Accessibility, Utilization, and Stability. The elicited coping responses may take place in one or more of the three Sociotype domains. The two processes are inter-related linearly with re-iterative feedback loops such that stress leads to coping responses that may or may not be adequate, thereby requiring modifications in the coping strategies until FS is regained. Resilience is considered to represent long-term coping strategies. The Sociotype framework is both a determinant of, and constant input to, building and strengthening resilience. However, the people with the most problems with FINS are rarely included in these discussions. They are the marginalized members of society: unemployed, homeless, displaced persons, special needs, elderly, single parents, mentally frail, and more. Applying the Sociotype ecological framework for coping with FINS stresses can allow better strategic planning for FS at national, household and individual levels and understanding the interactions between them to reach out to and help these sectors of the population.

Global nutrition 1990-2015: A shrinking hungry, and expanding fat world

Objectives

Following its publication in 2008, the Global Nutritional Index (GNI) which captures the triple burden of malnutrition, has been updated to assess the overall nutritional status and nutritional trends of countries, regions and the world, including both under-nutrition and over-nutrition.

Methods

The GNI was modeled on the Human Development Index, using geometric means of three normalized indicators: protein-energy malnutrition (PEM, measured by Disability-Adjusted Life Years (DALYs) from PEM), micronutrient deficiency (MID, measured by DALYs from MID), and penalizing obesity (percent female obesity). GNI (range 0–1) was calculated from 1990–2015 for 186 countries, in seven World Bank income and WHO region groupings.

Results

World GNI increased from 0.433 to 0.473 as decreased deficits overcompensated for the rise in obesity. GNI for African low- and middle-income countries (LMIC) (median 0.301 to 0.392) and South-East Asian LMIC (0.456 to 0.564) improved significantly (P<0.001), while for high-income countries (0.657 to 0.611) worsened significantly (P<0.001). GNI for American LMIC (0.459 to 0.457), European LMIC (0.571 to 0.575), Eastern Mediterranean LMIC (0.484 to 0.483) and Western Pacific LMIC (0.433 to 0.494) were unchanged. The disaggregation of the GNI showed that in nearly all the seven country groups there was a significant decrease in both PEM and MID (all P<0.01) (except in HIC where only PEM dropped), and a significant increase in obesity (all P<0.001).

Conclusion

These trends are the result of the reciprocal changes between decreased under-nutrition and increased over-nutrition, which has become a major cause of malnutrition worldwide. We suggest, therefore, that future Sustainable Development Goals should include alongside “zero hunger”–“reduce obesity”.

2-Arachidonoylglycerol as a possible treatment for anorexia nervosa in animal model in mice

We have investigated the effects of 0.001mg/kg 2-arachidonoylglycerol (2-AG) administered in combination with compounds present in the body alongside 2-AG like 2-palmitoylglycerol and 2-linoleylglycerol (also termed "entourage"), on cognitive function,food intake, and neurotransmitter levels in the hippocampus and hypothalamus of mice under diet restriction. Young female Sabra mice were treated with vehicle, 2-AG, 2-AG+entourage, 2-AG+entourage+5-(4-Chlorophenyl)-1-(2,4-dichloro-phenyl)- 4-methyl-N-(piperidin-1-yl)-1H-pyrazole-3-carboxamide (SR141716A, a CB₁ antagonist) and SR141716A. The mice were fed for 2.5h a day for 14days. Cognitive function was evaluated by the eight arm maze test, and neurotransmitter (norepinephrine, dopamine, L-DOPA and serotonin) levels were measured in the hippocampus and hypothalamus by high-performance liquid chromatography-electrochemical detection. Food intake was increased by 2-AG and, to an even greater extent, by 2-AG+entourage. SR141716A reversed the effect of 2-AG+entourage. The administration of 2-AG+entourage improved cognitive function compared to the vehicle mice, and this improvement was blocked by SR141716A. 2-AG+entourage-treated mice showed an increase in norepinephrine (NE), dopamine and L-DOPA levels in the hippocampus. SR141716A normalized NE and L-DOPA levels. There were no significant changes in hypothalamic neurotransmitter levels. The use of very low doses of the endocannabinoid 2-AG+entourage can improve cognitive function by elevating norepinephrine and L-DOPA levels in the hippocampus, without cannabinomimetic side effects. These findings may have implications for cognitive enhancement in anorexia nervosa.

The Impact of Δ9-THC on the Psychological Symptoms of Anorexia Nervosa: A Pilot Study

BACKGROUND

Δ9-Tetrahydrocannabinol (Δ9-THC) is the active compound of Cannabis sativa with appetitestimulating properties. This study evaluated the effect of low doses of oral Δ9-THC on self-reported symptoms of patients suffering from chronic anorexia nervosa (AN).

METHODS

Nine female subjects over 18 years of age participated in the study. Six were diagnosed according to DSM-IV criteria with AN restrictive type and three with active AN binge-purge type. Their mean age was 45.0±3.2 years and their BMI was 16.1±1.6 kg/M2. They completed questionnaires before and after treatment with Δ9-THC (1 mg/day for one week and 2 mg/day for three weeks). The primary outcome was improvement in the way patients perceived their eating behavior.

RESULTS

Significant improvements were found in selfreported body care, sense of ineffectiveness, asceticism and depression. There were no significant changes in BMI.

CONCLUSIONS

Δ9-THC may be an effective component in treating the psychological symptoms of AN.

A Double Blind, Randomized Cross-Over Trial of Tyrosine Treatment on Cognitive Function and Psychological Parameters in Severe Hospitalized Anorexia Nervosa Patients

BACKGROUND

Anorexia nervosa (AN) is characterized by self-induced malnutrition, affecting body image, mood, cognition and survival. Tyrosine, an essential amino acid is the precursor of catecholamines. The use of tyrosine to treat AN is based on experiments on diet restricted mice, in which it increased food consumption, improved cognitive function and elevated brain catecholamines. We evaluated the effect of oral tyrosine administration on the cognition and emotional state of patients with AN. We hypothesized that tyrosine may improve cognitive function without changing body weight, thus "kick-start" nutritional rehabilitation.

METHODS

19 female hospitalized patients with chronic AN were supplemented with L-tyrosine (100 mg/kg/day)/ placebo capsules for a three-week period in a double blind, randomized, cross-over study. Participants were evaluated cognitively and psychologically.

RESULTS

Tyrosine shortened reaction time and test duration in memory tasks and improved depressive mood. No side effects were noted with the use of tyrosine.

CONCLUSIONS

Tyrosine may improve cognitive function and psychological traits associated with AN.

A Consensus Proposal for Nutritional Indicators to Assess the Sustainability of a Healthy Diet: The Mediterranean Diet as a Case Study

BACKGROUND

There is increasing evidence of the multiple effects of diets on public health nutrition, society, and environment. Sustainability and food security are closely interrelated. The traditional Mediterranean Diet (MD) is recognized as a healthier dietary pattern with a lower environmental impact. As a case study, the MD may guide innovative inter-sectorial efforts to counteract the degradation of ecosystems, loss of biodiversity, and homogeneity of diets due to globalization through the improvement of sustainable healthy dietary patterns. This consensus position paper defines a suite of the most appropriate nutrition and health indicators for assessing the sustainability of diets based on the MD.

METHODS

In 2011, an informal International Working Group from different national and international institutions was convened. Through online and face-to-face brainstorming meetings over 4 years, a set of nutrition and health indicators for sustainability was identified and refined.

RESULTS

Thirteen nutrition indicators of sustainability relating were identified in five areas. Biochemical characteristics of food (A1. Vegetable/animal protein consumption ratios; A2. Average dietary energy adequacy; A3. Dietary Energy Density Score; A4. Nutrient density of diet), Food Quality (A5. Fruit and vegetable consumption/intakes; A6. Dietary Diversity Score), Environment (A7. Food biodiversity composition and consumption; A8. Rate of Local/regional foods and seasonality; A9. Rate of eco-friendly food production and/or consumption), Lifestyle (A10. Physical activity/physical inactivity prevalence; A11. Adherence to the Mediterranean dietary pattern), Clinical Aspects (A12. Diet-related morbidity/mortality statistics; A13. Nutritional Anthropometry). A standardized set of information was provided for each indicator: definition, methodology, background, data sources, limitations of the indicator, and references.

CONCLUSION

The selection and analysis of these indicators has been performed (where possible) with specific reference to the MD. Sustainability of food systems is an urgent priority for governments and international organizations to address the serious socioeconomic and environmental implications of short-sighted and short-term practices for agricultural land and rural communities. These proposed nutrition indicators will be a useful methodological framework for designing health, education, and agricultural policies in order, not only to conserve the traditional diets of the Mediterranean area as a common cultural heritage and lifestyle but also to enhance the sustainability of diets in general.

Mediterranean Diet: From a Healthy Diet to a Sustainable Dietary Pattern

The notion of the Mediterranean diet has undergone a progressive evolution over the past 60 years, from a healthy dietary pattern to a sustainable dietary pattern, in which nutrition, food, cultures, people, environment, and sustainability all interact into a new model of a sustainable diet. An overview of the historical antecedents and recent increased interest in the Mediterranean diet is presented and challenges related to how to improve the sustainability of the Mediterranean diet are identified. Despite its increasing popularity worldwide, adherence to the Mediterranean diet model is decreasing for multifactorial influences - life styles changes, food globalization, economic, and socio-cultural factors. These changes pose serious threats to the preservation and transmission of the Mediterranean diet heritage to present and future generations. Today's challenge is to reverse such trends. A greater focus on the Mediterranean diet's potential as a sustainable dietary pattern, instead than just on its well-documented healthy benefits, can contribute to its enhancement. More cross-disciplinary studies on environmental, economic and socio-cultural, and sustainability dimensions of the Mediterranean diet are foreseen as a critical need.

Temporal concentrations of cortisol and LH in virgin ewes acutely exposed to rams during the transition into the breeding season

The objectives of this study were to determine if exposing seasonally anovular ewes to rams would alter patterns of cortisol concentrations, and if these changes are associated with changes in characteristics of LH concentrations. Seasonally anestrous ewes were assigned to be exposed to rams (RE; n=11) or wethers (NE; n=12). Blood samples were collected at 15-min intervals beginning 120 min before introduction of males (time=0 min), and continued for 360 min after male exposure. Characteristics of cortisol and LH concentrations included: mean and baseline concentrations, pulse amplitude, duration, frequency, and time to first pulse. Mean and baseline cortisol concentrations, and cortisol pulse amplitude, frequency, and time to first pulse after male exposure did not differ between RE and NE ewes. Cortisol pulse duration was longer (P<0.05) in RE ewes than in NE ewes. Mean LH and LH pulse amplitude, duration, and time to first pulse after male exposure did not differ between RE and NE ewes. Baseline LH concentrations and LH pulse frequency were greater (P<0.05) in RE than in NE ewes. In RE ewes, but not NE ewes, LH pulse frequency tended to increase (P=0.06) as pulse frequency of cortisol decreased. In conclusion, exposing ewes to mature rams during the transition into the breeding season increased LH pulse frequency which hastened ovulatory activity. However, the results do not support the hypothesis that changes in cortisol concentrations plays a significant role in the 'ram effect'.

Laugh Away the Fat? Therapeutic Humor in the Control of Stress-induced Emotional Eating

This review explores the potential overlap between the fields of nutrition and therapeutic humor, together with the role of humor as a possible tool for aiding those in whom emotions, particularly negative ones, trigger eating as a means to improve mood. We review emotional eating, obesity, and the hypothesized mechanisms of emotional eating. We then review the field of therapeutic humor and its ability to de-stress individuals, possibly through endorphin and opioid systems, both of which are also involved in eating behavior. Finally, we present a novel hypothesis that people may be trained to use humor as a "food substitute" at best, or to blunt hunger stimuli, to achieve similar advantages, without the side effect of weight gain.

Health-related quality of life changes and weight reduction after bariatric surgery vs. a weight-loss program

BACKGROUND

The present study compared the outcome of bariatric surgery against a uniform high-level weightloss program which included vigorous physical exercises, behavior modification and nutritional advice.

METHOD

44 subjects who underwent bariatric surgery and 47 subjects participating in a weight-loss program completed the Medical Outcomes Study Short Form- 36 (SF-36), the Mental Health Inventory (MHI) and the Rosenberg Self-Esteem scale, prior to surgery/diet and one year afterwards.

RESULTS

Post-surgery subjects had a greater mean weight loss (34.70% ± 11.94) than subjects in the weight-loss program, even though their weight reduction was also clinically significant (9.23% ± 8.31). Post-surgery subjects showed significant improvements in SF-36, MHI, and selfesteem. The diet group improved in SF-36 total score, physical functioning, health perceptions, and vitality scales.

LIMITATIONS

Differences in background variables and short follow-up.

CONCLUSIONS

Surgery outcomes were significantly better in terms of both weight reduction and psychological adjustment compared to highly motivated participants in a prestigious, cutting edge weight-loss program.

The direct profibrotic and indirect immune antifibrotic balance of blocking the cannabinoid 2 receptor

Cannabinoid 2 (CB2) receptors expressed on immune cells are considered to be antifibrogenic. Hepatic stellate cells (HSCs) directly interact with phagocytosis lymphocytes, but the nature of this interaction is obscure. We aimed to study the effects of CB2 receptors on hepatic fibrosis via their role in mediating immunity. Hepatic fibrosis was induced by carbon-tetrachloride (CCl(4)) administration in C57BL/6 wild-type (WT) and CB2 knockout (CB2(-/-)) mice. Irradiated animals were reconstituted with WT or CB2(-/-) lymphocytes. Lymphocytes from naïve/fibrotic WT animals and healthy/cirrhotic hepatitis C virus were preincubated in vitro with or without CB2 antagonist, evaluated for proliferation and apoptosis, and then cocultured with primary mouse HSCs or a human HSC line (LX2), respectively. Lymphocyte phagocytosis was then evaluated. Following CCl(4)-administration, CB2(-/-) mice developed significant hepatic fibrosis but less necroinflammation. WT mice harbored decreased liver CD4(+) and NK(+) cells but increased CD8(+) subsets. Naïve CB2(-/-) mice had significantly decreased T cell subsets. Adoptive transfer of CB2(-/-) lymphocytes led to decreased fibrosis in the irradiated WT recipient compared with animals receiving WT lymphocytes. Moreover, necroinflammation also tended to decrease. In vitro, a CB2-antagonist directly increased human HSC activation and increased apoptosis and decreased proliferation of mice/human T cells (healthy/fibrotic) and their phagocytosis. We concluded that CB2(-/-) lymphocytes exert an antifibrotic activity, whereas lack of CB2 receptor in HSCs promotes fibrosis. These findings broaden our understanding of cannabinoid signaling in hepatic fibrosis beyond their activity solely in HSCs.

Tell me what you eat and I will tell you your sociotype: coping with diabesity

The term sociotype has been introduced to describe the dynamic relationship of an individual with his/her social environment throughout life. The sociotype is a conceptual framework to highlight, in addition to bio-medical pathways, the psycho-social and environmental factors necessary to understand responses to life stresses and patient self-management for chronic illness. The sociotype interacts with genotype expression through mate selection and metabolic programming, and with the phenotype to determine adaptation throughout life from birth to old age. Following on the work of Antonovsky, Engel, and McEwen, and others in the life and social sciences, the sociotype details and expands the many factors generally included in the environmental influences on a person's life identified here as the domains of health, relationships, and environment. Physiological mediators for sociotypic influences include: adrenal steroids and the sympathetic nervous system (allostatic load), and oxytocin (social neuroscience). The biological pathways are multiple through nutrition (essential dietary-derived amino- and fatty acids for neurotransmitter synthesis, caloric restriction, and diet-gene interactions), epigenesis, and metabolic programming. Nutrition influences growth and development, fertility and longevity, and also determines susceptibility to non-communicable diseases such as cardiovascular disease and cancer, and particularly diabetes and obesity, through in-utero effects, the development of intestinal flora (microbiome), and chronic stress. Thus the sociotype and nutrition are reciprocally related in both health and disease.

The dietary treatment of obesity

In no sector of therapeutics is the theory so simple as in weight control. The major gap lies in translating this theory into practice. In the final analysis, the answer lies in personal choice, because many diets seem to work, but not universally in all studies. A reduced calorie diet is obviously essential, although the composition remains to be individually tailored. For this, health care professionals must become “personal trainers” and realize the importance of lifestyle prescriptions with regard to diet and exercise in all consultations, fitting them to the needs of patient. It may be argued that medical practitioners do not have the necessary time or behavioral skills for these long-term interventions, which might be better handled by a team of other health professionals. Prevention is, of course, better than treatment, and therefore a major effort must be made to target children, from breast feeding to education throughout schooling. No more surveys are needed; “we know the enemy and it is us.” In the words of the Lancet editorial concerning obesity: “Our public health leaders must replace prevarication with imagination.”

The role of the sociotype in managing chronic disease: integrating bio-psycho-sociology with systems biology

THE PROBLEM

Attempts have been made to replace the bio-medical approach with that of systems biology, which considers dynamic human behavior (internal factors) for chronic (rather than acute) disease management. They have not yet incorporated the Bio-psycho-social (BPS) model of Engel which adds patients' background and cultural beliefs (external factors) contributing to their susceptibility to, and coping strategies for, non-communicable diseases (NCDs) the increasing domain of global Public Health. The problem is how to include the social determinants of disease in a comprehensive model of care, especially in the management of chronic disease.

THE SOLUTION HYPOTHESIS

The concept of "sociotype" is proposed as a framework for understanding the interactions between the social, cultural and environmental inputs that influence the growth, development and life-long behavior of a person, including relationships, lifestyle and coping strategies. Pre-/peri-natal influences on development and subsequent susceptibility to chronic disease are examples of interactions between the sociotype, genotype and phenotype. Disorders of the sociotype, encompassing social determinants (e.g. poverty, education, networking), of disease are major contributors to the increase in NCDs, as well as for mental illness and absenteeism. Thus, people are the product of a threefold cord--genotype, phenotype and sociotype. WHAT NEXT?: Holistic management of patients through the BPS model have to be aligned with the relevant elements of systems biology--context, space, time and robustness--that pertain to the sociotype. Medical curricula should balance basic sciences with disciplines such as psychology, sociology, anthropology and public health that attempt to explain human behavior and the social determinants of disease. This requires methodologies combining qualitative and quantitative research to study simultaneous interactions (and their possible mechanisms) between systems biology and the BPS model. The neologism "sociotype" highlights the importance of the social dimension of the BPS model in a novel and useful way. The sociotype, with its effects on genotype and phenotype, will bring psychosocial variables into a paradigm of medical practice to promote health and improve the management of chronic illness.

[Who will take care of the caretaker? Lifestyle recommendations for physicians]

A healthy lifestyle is the mainstay of preventive medicine. HeaLthcare personnel might disregard keeping a healthy diet and exercise habits, perhaps due to feeling protected by their own knowledge. Physicians might under-diagnose their own overweight status, and have been shown in some studies to display lower rates of healthy behaviors compared with the general population. This review presents the availabLe data on physicians' own lifestyle habits, and discusses the importance of these for both their own health, and for the benefit of their patients. We supply several healthy lifestyle recommendations based on national and international guidelines, and adapt them to the clinic and hospital settings. Eating a healthy diet, and performing at least 150 minutes of aerobic exercise a week, with additional resistance exercises 2-3 times a week, will benefit all caretakers--both personally and professionally.

The effect of vitamin C on upper respiratory infections in adolescent swimmers: a randomized trial

The risk of upper respiratory infections (URIs) is increased in people who are under heavy physical stress, including recreational and competitive swimmers. Additional treatment options are needed, especially in the younger age group. The aim of this study was to determine whether 1 g/day vitamin C supplementation affects the rate, length, or severity of URIs in adolescent swimmers. We carried out a randomized, double-blind, placebo-controlled trial during three winter months, among 39 competitive young swimmers (mean age 13.8 ± 1.6 years) in Jerusalem, Israel. Vitamin C had no effect on the incidence of URIs (rate ratio = 1.01; 95% confidence interval (CI) = 0.70-1.46). The duration of respiratory infections was 22% shorter in vitamin C group, but the difference was not statistically significant. However, we found a significant interaction between vitamin C effect and sex, so that vitamin C shortened the duration of infections in male swimmers by 47% (95% CI: -80% to -14%), but had no effect on female swimmers (difference in duration: +17%; 95% CI: -38% to +71%). The effect of vitamin C on the severity of URIs was also different between male and female swimmers, so that vitamin C was beneficial for males, but not for females. Our study indicates that vitamin C does not affect the rate of respiratory infections in competitive swimmers. Nevertheless, we found that vitamin C decreased the duration and severity of respiratory infections in male swimmers, but not in females. This finding warrants further research.

Fish oil promotes survival and protects against cognitive decline in severely undernourished mice by normalizing satiety signals

Severe malnutrition resulting from anorexia nervosa or involuntary starvation leads to low weight, cognitive deficits and increased mortality rates. In the present study, we examined whether fish oil supplementation, compared with that of canola oil, would ameliorate the morbidity and mortality associated with these conditions by normalizing endocannabinoid and monoaminergic systems as well as other systems involved in satiety and cognitive function within the hypothalamus and hippocampus. Female Sabra mice restricted to 40% of their daily food intake exhibited decreased body weight, were sickly in appearance, displayed cognitive deficits and had increased mortality rates. Strikingly, fish oil supplementation that contains high omega-3 fatty acids levels decreased mortality and morbidity, and normalized the expression of genes and neurotransmitters in the hippocampus and hypothalamus. Fish oil supplementation, but not canola oil, increased survival rates, improved general appearance and prevented cognitive decline, despite the facts that both diets contained an equivalent number of calories and that there were no differences in weight between mice maintained on the two diets in 100% but decrease in the 40%. In the hypothalamus, the beneficial effects of fish oil supplementation were related to normalization of the endocannabinoid 2-arachidonylglycerol, serotonin (5-HT) (P<.056), dopamine, neuropeptide Y (NPY) and Ca(2+)/calmodulin (CaM)-dependent protein kinase (Camkk2). In the hippocampus, fish oil supplementation normalized 5-HT, Camkk2, silent mating type information regulation 1 and brain-derived neurotrophic factor. In conclusion, dietary supplements of fish oil, as source of omega-3 fatty acids, may alleviate cognitive impairments associated with severe diet restriction and prolong survival independently of weight gain by normalizing neurochemical systems.

Leptin reduces infarct size in association with enhanced expression of CB2, TRPV1, SIRT-1 and leptin receptor

Brain ischemia is associated with detrimental changes in energy production and utilization. Therefore, we hypothesized that leptin, an adipokynin hormone protecting against severe energy depletion, would reduce infarct volume and improve functional outcome after stroke. Male Sabra mice underwent permanent middle cerebral artery occlusion (PMCAO) by photothrombosis. Following initial dose-response and time-window experiments animals were treated with vehicle or leptin, were examined daily by a neurological severity score (NSS) and were sacrificed 72 hours after stroke. Infarct volume was determined and the expression of key genes involved in neuroprotection and survival including the cannabinoid receptors CB1, CB2 and TRPV1, SIRT-1, leptin receptor and Bcl-2 was quantified in the cortex. A separate group of mice were examined with the neurological severity scale 1, 24 and 48 hours and 1, 2 and 3 weeks after stroke, and were killed 3 weeks post stroke to examine metabolic status in the peri-infarct area. Leptin given at a dose of 1mg/kg intra-peritoneally 30 minutes after PMCAO significantly improved neurological disability and reduced infarct volume. Leptin treatment led to increased expression of CB2 receptor, TRPV1, SIRT-1 and leptin receptor and reduced expression of CB1 receptor. There was also a non-significant increase in Bcl-2 gene expression following leptin administration. These results suggest that leptin may be used for attenuating ischemic injury after stroke via induction of an anti-apoptotic state.

Cannabidiol ameliorates cognitive and motor impairments in bile-duct ligated mice via 5-HT1A receptor activation

BACKGROUND AND PURPOSE

We aimed to demonstrate the involvement of 5-HT(1A) receptors in the therapeutic effect of cannabidiol, a non-psychoactive constituent of Cannabis sativa, in a model of hepatic encephalopathy induced by bile-duct ligation (BDL) in mice.

EXPERIMENTAL APPROACH

Cannabidiol (5 mg x kg(-1); i.p.) was administered over 4 weeks to BDL mice. Cognition and locomotion were evaluated using the eight-arm maze and the open field tests respectively. Hippocampi were analysed by RT-PCR for expression of the genes for tumour necrosis factor-alpha receptor 1, brain-derived neurotrophic factor (BDNF) and 5-HT(1A) receptor. N-(2-(4-(2-methoxy-phenyl)-1-piperazin-1-yl)ethyl)-N-(2-pyridyl) cyclohexanecarboxamide (WAY-100635), a 5-HT(1A) receptor antagonist (0.5 mg x kg(-1)), was co-administered with cannabidiol. Liver function was evaluated by measuring plasma liver enzymes and bilirubin.

KEY RESULTS

Cannabidiol improved cognition and locomotion, which were impaired by BDL, and restored hippocampal expression of the tumour necrosis factor-alpha receptor 1 and the BDNF genes, which increased and decreased, respectively, following BDL. It did not affect reduced 5-HT(1A) expression in BDL mice. All the effects of cannabidiol, except for that on BDNF expression, were blocked by WAY-100635, indicating 5-HT(1A) receptor involvement in cannabidiol's effects. Cannabidiol did not affect the impaired liver function in BDL.

CONCLUSIONS AND IMPLICATIONS

The behavioural outcomes of BDL result from both 5-HT(1A) receptor down-regulation and neuroinflammation. Cannabidiol reverses these effects through a combination of anti-inflammatory activity and activation of this receptor, leading to improvement of the neurological deficits without affecting 5-HT(1A) receptor expression or liver function. BDNF up-regulation by cannabidiol does not seem to account for the cognitive improvement.

[Childhood obesity--assessment, prevention and treatment]

As in other parts of the western world, the rates of pediatric overweight and obesity are also rising in Israel. This fact warrants immediate action by several government offices and health care providers, and also by the trinity of physician, parent(s) and child. An overweight child is likely to remain undiagnosed if relying on observation alone, unless height and weight are objectively measured by the caring medical staff. This review is based on recommendations on the assessment, prevention, and treatment of children and youth who are overweight and obese, recently published on behalf of the American Medical Association and additional health organizations. In general, preventing and treating pediatric obesity is fairly similar: adhering to a healthy lifestyle which emphasizes healthy food choices and habits, regular physical activity, and limiting screen time. Treating and preventing obesity is a timely, but extremely difficult task. Medical personnel and parents should be continuously educated in this field, while supplied with practical tools for childhood lifestyle modification.

Limited English proficiency is a barrier to receipt of advice about physical activity and diet among Hispanics with chronic diseases in the United States

The prevalence of obesity, diabetes, and cardiovascular disease is reaching epidemic proportions among Hispanics in the United States. Health care providers play an important role in motivating patients to make healthful lifestyle changes to reduce the burden of such conditions. Data from the US 2000 National Health Interview Survey was analyzed to determine differences in report of physician-provided physical activity and/or dietary advice by level of English proficiency among obese Hispanics or those who reported having diabetes or cardiovascular disease and who contacted a physician during the past year (n=1,186). Only one third of the sample reported receiving advice to increase their physical activity or to improve their dietary habits; one fifth reported receipt of advice about both. English-proficient Hispanics were about 50% more likely to report receiving advice on physical activity (adjusted odd ratio [AOR]=1.5; 95% confidence interval [CI]: 1.1 to 2.1), diet (AOR=1.5; 95% CI: 1.1 to 2.2) or both (AOR=1.6; 95% CI: 1.1 to 2.3), as compared with limited English-proficient Hispanics, after controlling for health insurance coverage and number of visits to a physician during the last year. Sex, age, region of residence, level of education, annual family income, and smoking status were not significantly associated with receiving physical activity and/or dietary advice. In order to address racial health disparities, and lower the burden of chronic illness, culturally sensitive strategies must be implemented to enhance delivery of effective health-promotion messages by physicians, particularly among at-risk communities.