Dietetics

Small-intestinal bacterial overgrowth (SIBO) is defined by an excessive microbial presence in the small intestine and is associated with a range of gastrointestinal symptoms. Its management remains complex due to diagnostic limitations and high recurrence rates following treatment. A narrative review was conducted using MEDLINE (PubMed) and Cochrane databases to identify relevant studies published between 1984 and 2024. Search terms included small intestinal bacterial overgrowth SIBO, FODMAP, probiotics, prebiotics, synbiotics, and low-carbohydrate diets. Reference lists were also screened for additional studies. Antibiotics, particularly rifaximin, are commonly used for SIBO treatment but recurrence is frequent. Dietary strategies, such as low-FODMAP and low-carbohydrate diets, may help reduce symptoms, especially in patients with complications like D-lactic acidosis. Evidence for biotic agents (probiotics, prebiotics, synbiotics) is mixed, with limited high-quality studies and inconsistent outcomes. Some probiotic strains show symptom improvement, but effects on breath-test results are variable. A tailored, multidisciplinary approach combining dietary and medical therapies may offer optimal symptom control in SIBO. However, heterogeneity in study designs and limited evidence highlight the need for further research to inform standardised, evidence-based clinical practice.

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake.

Background: Calcium (Ca) and magnesium (Mg) are essential micronutrients integral to metabolic processes and cardiovascular health. Emerging evidence suggests that the dietary Ca:Mg ratio may influence chronic disease risk, yet variability in this ratio across diverse demographic groups and its relationship to body composition and vitamin D status remain unclear. Methods: Dietary intakes of Ca and Mg were assessed using validated Food Frequency Questionnaires (FFQs) and body composition was quantified via Dual-energy X-ray Absorptiometry (DXA) scans. Relationships between dietary Ca:Mg ratios and demographics, body composition parameters (lean and fat mass), and vitamin D and parathyroid hormone (PTH) levels were examined statistically using SPSS ver. 29.0 and R ver. 4.5.1 (2025) employing Kruskal–Wallis, regression, and moderated mediation analyses. Results: We examined 155 healthy adults with a mean age of 36.6 ± 12.5 years. Only 16.8% had adequate intakes of Mg compared with 45.8% who had adequate dietary Ca intakes. Significant differences in the Ca:Mg ratio were observed across racial groups (p = 0.023) and age groups (p = 0.017). South Asian Indians exhibited the highest median Ca:Mg ratio (4.83), whereas African Americans exhibited the lowest (2.67). Interestingly, our moderated mediation analysis indicated that African Americans were the most sensitive to the impact of PTH changes on the balance of Ca:Mg (indirect effect = −0.762, 95% CI [−1.298, −0.234]), indicating that even slight shifts in their Ca:Mg balances cause significant elevation in the PTH, which, in turn, leads to lowering of their vitamin D levels. Young adults (ages 18–29) had the highest median Ca:Mg ratio (4.73). No statistically significant differences were detected based on Gender (p = 0.425 and BMI (p = 0.744) on Ca:Mg ratios. Additionally, dietary Ca:Mg ratios were positively associated with sPTH in males (r = 0.203, p < 0.05), but not with body composition. Conclusion: Important variations in dietary Ca:Mg ratios exist across racial and age demographics, notably among young adults, and specific ethnic groups exhibited elevated ratios. Tailored nutritional interventions may be necessary for these populations to optimize Ca:Mg balance and support metabolic and cardiovascular health outcomes in these populations.