Category: Nevin Manimala

Clin Nutr ESPEN. 2023 Jun;55:90-96. doi: 10.1016/j.clnesp.2023.02.009. Epub 2023 Feb 11.

ABSTRACT

PURPOSE: To assess the association between the diabetes risk reduction diet score (DRRD) and the odds of breast cancer (BC).

METHODS: During this hospital-based case-control study we included 149 newly diagnosed cases of BC and 150 controls matched by age. All cases were patients with pathologically confirmed BC, with no history of any form of other cancers. The controls were randomly selected from visitors and families of non-cancer patients in other wards of the same hospital who had no health issues including BC. The dietary intakes were evaluated by a validated 147-item semi-quantitative FFQ. DRRD score was calculated from 9 dietary components published before, with a better score resembling a higher adherence to DRRD.

RESULTS: A negative association was found between the chances of BC and DRRD after adjusting for potential confounders, but it was not statistically significant (OR, 0.47; 95%CI, 0.11-2.08; P = 0.531). Also, there were no significant associations between DRRD and therefore the odds of BC in the crude model and also in post-menopausal (OR, 0.45; 95%CI, 0.10-1.99; P = 0.505) and pre-menopausal women (OR, 0.52; 95%CI, 0.18-1.40; P = 0.097) in our study, after adjusting for potential confounders.

CONCLUSION: Adherence to a diet with a high DRRD score was not associated with the reduced risk of BC in Iranian adults.

PMID:37202089 | DOI:10.1016/j.clnesp.2023.02.009

Clin Nutr ESPEN. 2023 Jun;55:357-363. doi: 10.1016/j.clnesp.2023.04.001. Epub 2023 Apr 11.

ABSTRACT

BACKGROUND AND AIMS: This study aimed at evaluating associations between nutritional status and outcomes in patients with Covid-19 and to identify statistical models including nutritional parameters associated with in-hospital mortality and length of stay.

METHODS: Data of 5707 adult patients hospitalized in the University Hospital of Lausanne between March 2020 and March 2021 were screened retrospectively 920 patients (35% female) with confirmed Covid-19 and complete data including nutritional risk score (NRS 2002), were included. This cohort was divided into three subgroups: NRS <3: no risk of malnutrition; NRS ≥3 to <5: moderate risk malnutrition; and NRS ≥5: severe risk of malnutrition. The primary outcome was the percentage of in-hospital deaths in the different NRS subgroups. The secondary outcomes were the length of hospital stay (LOS), the percentage of admissions to intensive care units (ICU), and the length of stay in the ICU (ILOS). Logistic regression was performed to identify risk factors associated with in-hospital mortality and hospital stay. Multivariate clinical-biological models were developed to study predictions of mortality and very long length of stay.

RESULTS: The mean age of the cohort was 69.7 years. The death rate was 4 times higher in the subgroup with a NRS ≥ 5 (44%), and 3 times higher with a NRS ≥ 3 to <5 (33%) compared to the patients with a NRS<3 (10%) (p < 0.001). LOS was significantly higher in the NRS ≥ 5 and NRS ≥ 3 to <5 subgroups (26.0 days; CI [21; 30.9]; and 24.9; CI [22.5; 27.1] respectively) versus 13.4; CI [12; 14.8] for NRS<3 (p < 0.001). The mean ILOS was significantly higher in the NRS ≥ 5 (5.9 days; versus 2.8 for NRS ≥ 3 to <5, and 1.58 for NRS<3 (p < 0.001)). In logistic regression, NRS ≥ 3 was significantly associated with the risk of mortality (OR: 4.8; CI [3.3; 7.1]; p < 0.001) and very long in-hospital stay (>12 days) (OR: 2.5; CI [1.9; 3.3]; p < 0.001). Statistical models that included a NRS ≥ 3 and albumin revealed to be strong predictors for mortality and LOS (area under the curve 0.800 and 0.715).

CONCLUSION: NRS was found to be an independent risk factor for in-hospital death and LOS in hospitalized Covid-19 patients. Patients with a NRS ≥ 5 had a significant increase in ILOS and mortality. Statistical models including NRS are strong predictors for an increased risk of death and LOS.

PMID:37202068 | DOI:10.1016/j.clnesp.2023.04.001

Clin Nutr ESPEN. 2023 Jun;55:314-319. doi: 10.1016/j.clnesp.2023.04.002. Epub 2023 Apr 15.

ABSTRACT

BACKGROUND AND AIMS: Dyslipidemia is one of the most important risk factors of cardiovascular diseases (CVDs). Despite developments in pharmacological treatments for dyslipidemia there are several challenges. Recently some herbs highly considered to control dyslipidemia due to their low toxicity and high potency. In this study we investigated the effects of saffron petals on the lipid profile of dyslipidemia patients as well as several other biochemical blood factors.

METHODS: In this double blind, placebo controlled, clinical trial, we used systematic random sampling to divide 40 patients with at least two abnormalities in the following factors: (high-density lipoproteins (HDL) ≤40, low-density lipoproteins (LDL) ≥130, triglycerides (TG) ≥200, total cholesterol (Cho) ≥200), into 2 groups of 21 ones. At the end of the intervention period, serum lipid factors, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea, creatinin (CR) and fasting blood sugar (FBS) were measured and statistically compared with their values just before the intervention.

RESULTS: We found that the saffron petal pills markedly (P < 0.001) decreased the serum lipid levels of patients (TG, Cho and LDL) in the intervention group (113.81 ± 12.93, 56.52 ± 4.68 and 48.28 ± 3.70) as compared to the placebo group (18.42 ± 15.79, 4.57 ± 4.40 and 7.38 ± 3.54). Also, comparing the mean value of differences in two groups before and after the intervention showed significant reduction in TG (113.81 ± 26), Cho (56.53 ± 0.30) and LDL (48.28 ± 4.30) levels (P < 0.001).

CONCLUSIONS: The saffron petal pills considerably reduced blood serum lipid profile and as well as urea and CR of dyslipidemia patients. So, this plant may be used as a potent phytomedicine for treatment and prevention of dyslipidemia and cardiovascular disorders. However, the results indicated that no statistical change was observed in the level of other biochemical blood factors such as ALT, AST, ALP and FBS.

PMID:37202063 | DOI:10.1016/j.clnesp.2023.04.002

Clin Nutr ESPEN. 2023 Jun;55:277-284. doi: 10.1016/j.clnesp.2023.03.018. Epub 2023 Mar 29.

ABSTRACT

BACKGROUND: The mainstay of modern medical therapy for intestinal failure (IF) is parenteral nutrition (PN). The Intestinal Rehabilitation Program (IRP) goal is enhancing nutritional outcomes for patients receiving total parenteral nutrition (TPN), optimizing/transitioning patients from TPN to enteral nutrition (EN), achieving enteral autonomy, monitoring growth and development. The objective of this study is to describe nutritional and clinical outcomes for children undergoing intestinal rehabilitation during 5 years of the program.

METHODS: Retrospective chart review for children from birth to <18 years old with IF who were on TPN from July 2015 to Dec 2020 or to the endpoint of the study when they either weaned from TPN during the 5 year period or continued TPN by Dec 2020 and participated at our IRP.

RESULTS: The mean age of the cohort was 2.4 years (±4.22), 53% male. The 3 most common diagnosis were necrotizing enterocolitis (28%), gastroschisis (14%) and intestinal atresia (14%). Nutritional data including days/hours per week on TPN, glucose infusion rate, amino acids, total EN calories, % of total nutrition received from TPN and EN per day all showed statistically significant differences. Our program showed 0% intestinal failure associated liver disease (IFALD), 0% mortality, 100% survival, 41% patients were weaned from TPN (13/32) with mean of 39 months (±32).

CONCLUSION: Early referral to a center that can offer IRP, such as ours can lead to tremendous positive clinical outcomes and help patients with intestinal failure avoid transplant as shown in our study.

PMID:37202057 | DOI:10.1016/j.clnesp.2023.03.018

Clin Nutr ESPEN. 2023 Jun;55:238-243. doi: 10.1016/j.clnesp.2023.03.020. Epub 2023 Mar 28.

ABSTRACT

OBJECTIVE: Metabolic syndrome (MetS) has become a major health problem across the globe. Various investigations have been conducted to find the underlying lifestyle-related causes of MetS. Modifiable dietary factors are specifically the center of interest, including the macronutrient composition of the regimen. We aimed to study the association between a low-carbohydrate diet score (LCDS) with MetS and its components in a Kavarian population, located in the center of Iran.

METHODS: The present study is a cross-sectional investigation conducted on a healthy sub-sample of PERSIAN Kavar cohort meeting our inclusion criteria (n = 2225). General, dietary, anthropometric, and laboratory data were obtained for each individual using validated questionnaires and measurements. Possible associations between LCDS and MetS and its components were verified using relevant statistical analyses, including analysis of variance and covariance (ANOVA and ANCOVA) and logistic regression. P-values <0.05 were considered as significant.

RESULTS: Compared with the lowest LCDS tertiles, those who were assigned to the upper tertiles had lower chance of MetS, after adjusting for potential confounders (OR: 0.66; 95% CI: 0.51-0.85). Moreover, those who assigned to the top LCDS tertile had 23% (OR: 0.77; 95% CI: 0.60-0.98) and 24% (OR: 0.76; 95% CI: 0.60-0.98) lower odds of abdominal adiposity and abnormal glucose homeostasis, respectively.

CONCLUSION: We observed a protective effect of low-carbohydrate diet against metabolic syndrome and its components, including abdominal obesity and abnormal glucose homeostasis. However, these initial findings need to be confirmed, especially in the format of clinical trials to ensure causality.

PMID:37202052 | DOI:10.1016/j.clnesp.2023.03.020

Clin Nutr ESPEN. 2023 Jun;55:230-237. doi: 10.1016/j.clnesp.2023.03.016. Epub 2023 Mar 28.

ABSTRACT

BACKGROUND: The absorption of vitamin D occurs via two main pathways: first, through the biosynthesis in the skin under the exposure of UV from sunlight; and second, through the intake of certain foods. However, its levels can be influenced by both genetic and environmental factors, which can generate changes such as vitamin D deficiency (hypovitaminosis D), a condition that black adults have a high potential to suffer from.

OBJECTIVE: The aim of this work is to study the association of skin color (self-reported: black, brown and white), food consumption, and the BsmI polymorphism in the vitamin D receptor gene (VDR) on serum levels of vitamin D in a group of adults.

METHODS: This was a cross-sectional analytical study. Individuals in the community were invited to participate in the research and, After signing the informed consent, a structured questionnaire was applied containing identification data, self-declaration of race/color, and nutritional data (Food frequency questionnaire (FFQ) and 24 h); afterwards, blood was collected for biochemical analysis, vitamin D was measured by Chemiluminescence and RT-PCR was used to evaluate the BsmI polymorphism of the VDR gene. Data was analyzed using a statistical program (SPSS 20.0) and differences between groups using p < 0.05.

RESULTS: A total of 114 persons was evaluated between black, brown and white individuals. It was found that a large part of the sample presents hypovitaminosis D, and blacks stand out with an average serum vitamin D level of 15.9 ng/dL. The group demonstrated that dietary intake of vitamin D is low, with the present study is a pioneer in associating the polymorphism of the VDR gene (BsmI) with the consumption of foods that are considered to have a higher content of vitamin D in their composition.

CONCLUSION: The VDR gene does not represent a risk factor for the consumption of vitamin D in this sample, and it was found that the self-declaration of “black” skin color was an independent risk factor for low serum levels of vitamin D.

PMID:37202051 | DOI:10.1016/j.clnesp.2023.03.016

Clin Nutr ESPEN. 2023 Jun;55:109-115. doi: 10.1016/j.clnesp.2023.03.001. Epub 2023 Mar 11.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures. Compared with standard care before ERAS, we investigated whether compliance to ERAS guidelines for nutritional care, preoperative oral carbohydrate loading and postoperative oral nutrition, was associated with a decrease in hospital length of stay (LOS) after pancreaticoduodenectomy, distal pancreatectomy, hepatectomy, radical cystectomy, and head and neck tumor resection with reconstruction.

METHODS: Compliance to ERAS nutrition recommendations was evaluated. Post-ERAS cohort was retrospectively analyzed. Pre-ERAS cohort consisted of case matched patients one year before ERAS: age more than or less than 65 years, body mass index (BMI) more than greater than or less than 30 kg/m², diabetes mellitus, sex, and procedure. Each cohort consisted of 297 patients. Binary linear regressions evaluated the incremental effect of postoperative nutrition timing and preoperative carbohydrate loading on LOS. Multivariate regressions adjusted for postoperative complications.

RESULTS: Compliance with preoperative carbohydrate loading for the post-ERAS cohort was 81.7%. Mean hospital LOS was significantly shorter for the post-ERAS cohort compared with pre-ERAS cohort (8.3 vs 10.0 days, p < 0.001). By procedure, LOS was significantly shorter for patients undergoing pancreaticoduodenectomy (p = 0.003), distal pancreatectomy (p = 0.014), and head and neck procedures (p = 0.024). Early postoperative oral nutrition was associated with a 3.75-day shorter LOS (p < 0.001); no nutrition was associated with a 3.29-day longer LOS (p < 0.001).

CONCLUSION: Compliance with ERAS protocols for specific nutritional care practices was associated with a statistically significant decrease in LOS without subsequent increases in 30-day readmission rates and positive financial impact. These findings suggest that ERAS guidelines for perioperative nutrition are a strategic pathway to improved patient recovery and value-based care in surgery.

PMID:37202034 | DOI:10.1016/j.clnesp.2023.03.001

Psychiatry Res Neuroimaging. 2023 May 9;333:111655. doi: 10.1016/j.pscychresns.2023.111655. Online ahead of print.

ABSTRACT

Clinicians often face a dilemma in diagnosing bipolar disorder patients with complex symptoms who spend more time in a depressive state than a manic state. The current gold standard for such diagnosis, the Diagnostic and Statistical Manual (DSM), is not objectively grounded in pathophysiology. In such complex cases, relying solely on the DSM may result in misdiagnosis as major depressive disorder (MDD). A biologically-based classification algorithm that can accurately predict treatment response may help patients suffering from mood disorders. Here we used an algorithm to do so using neuroimaging data. We used the neuromark framework to learn a kernel function for support vector machine (SVM) on multiple feature subspaces. The neuromark framework achieves up to 95.45% accuracy, 0.90 sensitivity, and 0.92 specificity in predicting antidepressant (AD) vs. mood stabilizer (MS) response in patients. We incorporated two additional datasets to evaluate the generalizability of our approach. The trained algorithm achieved up to 89% accuracy, 0.88 sensitivity, and 0.89 specificity in predicting the DSM-based diagnosis on these datasets. We also translated the model to distinguish responders to treatment from nonresponders with up to 70% accuracy. This approach reveals multiple salient biomarkers of medication-class of response within mood disorders.

PMID:37201216 | DOI:10.1016/j.pscychresns.2023.111655

Semin Arthritis Rheum. 2023 May 4;61:152211. doi: 10.1016/j.semarthrit.2023.152211. Online ahead of print.

ABSTRACT

OBJECTIVE: Interleukin-1 (IL-1) inhibitors are approved for treating familial Mediterranean fever (FMF) that is resistant to colchicine. However, continued concomitant treatment with colchicine is imperative, as it is the only drug proven to prevent secondary amyloidosis. We aimed to compare the adherence to colchicine between patients with colchicine-resistant FMF (crFMF) who were treated with IL-1 inhibitors and patients with colchicine-sensitive FMF (csFMF) who were treated only with colchicine.

METHODS: The databases of Maccabi Health Services, a 2.6-million-member state-mandated health provider in Israel were searched for patients with FMF diagnosis. The medication possession ratio (MPR), calculated from the day of the first colchicine purchase (index date) until the last colchicine purchase was the main outcome measure. Patients with crFMF were matched in a 1:4 ratio to patients with csFMF.

RESULTS: The final cohort included 4526 patients. Of them, 108 (2.4%) were with crFMF, and were matched to 432 with csFMF. The total mean MPR in each of the matched groups was similar (78.9 ± 41.4 and 82.5 ± 80.6, respectively, P = 0.5). Statistically significant differences in MPR were not found between the groups according to age or duration of colchicine use. However, adherence to colchicine was insufficient (MPR<80%) among more than 50% of the patients in both groups.

CONCLUSION: In contrast to initial concerns, adherence to colchicine was similar between patients with crFMF and csFMF. However, in both groups, adherence to colchicine was poor. Education of both caregivers and patients is essential to increase adherence.

PMID:37201215 | DOI:10.1016/j.semarthrit.2023.152211

Drug Metab Pers Ther. 2023 May 19. doi: 10.1515/dmpt-2023-0008. Online ahead of print.

ABSTRACT

OBJECTIVES: Development of the secondary to ACEI cough leads to discontinuation of the drugs of this group. Assessing the safety of the ACEIs with further development of customized approaches for their administration is a major scientific and practical problem. The objective of this study was to assess the association of the genetic markers with the development of the adverse drug reaction in the form of secondary to enalapril dry cough in the patients with essential arterial hypertension.

METHODS: Study involved 113 patients with the secondary to enalapril cough and 104 patients without development of the secondary to enalapril adverse drug reaction.

RESULTS: The patients carriers of the genotype AA rs2306283 of gene SLCO1B1 had 2-fold higher odds of developing the dry cough than those with the genotypes AG and GG (ОR=2.01, 95%CI=1.10-3.66, р=0.023). Similarly, the patients heterozygous for rs8176746 of gene АВО had 2.3-fold higher odds of developing the ADR in the form of dry cough than the carriers of the genotypes GG and TT (ОR=2.30, 95%CI=1.24-4.29, р=0.008).

CONCLUSIONS: Statistically significant association between the development of the ADR in the form of secondary to enalapril dry cough and polymorphisms rs2306283 of gene SLCO1B1 and rs8176746 of gene ABO was revealed.

PMID:37201212 | DOI:10.1515/dmpt-2023-0008