Search Results (17)

The aim of this study was to assess bone health in individuals over 60 years of age in Kazakhstan, focusing on the relationship between osteoporosis, body mass index (BMI), body composition, and nutritional factors. This study included 1961 participants, consisting of 1620 women and 341 men, aged 60 to 89. Bone strength was assessed using quantitative ultrasound of the calcaneus, while fracture risk was assessed with the FRAX tool. Osteoporosis was detected in 20.2% of women and 15.2% of men, and osteopenia affected 59.8% of women and 58.4% of men. A total of 73.7% of the participants were overweight, 38.2% were pre-obese, and 35.5% were obese. The results of the study emphasise that, in addition to classic nutrients (calcium, vitamin D, protein), a number of trace elements and vitamins (selenium, iodine, zinc, vitamin B6, phytosterols) also play a significant, possibly indirect, role in bone metabolism. An inverse correlation was observed between BMI and osteoporosis prevalence; with a decrease in BMI, the incidence of osteoporosis increased (women: χ² = 26.0, df = 2, p < 0.001; men: χ² = 4.29, df = 2, p < 0.014; total sample: χ² = 32.3, df = 2, p < 0.001), thus confirming that excess body fat exerts a protective effect on bone health. Significant risk factors for osteoporosis included age, height, and weight. A link was found between the age of first osteoporosis onset and BMI (from 65 to 72.14 years). This confirms the value of FRAX for accurately assessing fracture risk and developing personalised recommendations based on anthropometric and dietary characteristics. Future longitudinal research is warranted to validate these results and further elucidate the underlying mechanisms, including the predictive power of novel anthropometric parameters such as the Body Roundness Index and Body Shape Index. Full article

Metabolic acidosis is a common complication of chronic kidney disease (CKD). The kidneys play a crucial role in acid–base balance, maintaining pH within the normal range (isohydria) by following mechanisms: bicarbonate reabsorption, ammogenesis, and titratable acidity. The anion gap describes the amount of unmeasured anions and is classically evaluated as the difference between the major cation (sodium) and the sum of the two major anions (chloride and bicarbonate). Metabolic acidosis can be divided into two types: normal anion gap metabolic acidosis and high anion gap metabolic acidosis. A high anion gap level is considered unfavorable in terms of prognosis as it is associated with increased mortality. Treatment of metabolic acidosis in patients with chronic kidney disease, despite available therapeutic options, is a challenge. Supplementation with bicarbonates does not improve prognosis on the one hand, and on the other hand, it may be harmful. The new KDIGO guidelines for 2024 have been significantly modified compared to 2012 after negative results of studies on bicarbonate supplementation. Bicarbonate supplementation is currently recommended only when levels are less than 18 mmol/L. This review provides an overview of the current knowledge on the pathophysiology, classification, and therapeutic options, including dietary recommendations and new pharmacology agents. Full article

Introduction: Protein substitutes (PSs) free of phenylalanine (Phe) represent the primary source of proteins and micronutrients in dietary management of classical Phenylketonuria (PKU). Over the last few years, the composition of PSs has undergone rapid and significant improvements, including the development of slow-release amino acid technologies, the introduction of glycomacropeptide-based products, as well as enhancements in taste and the variety of available formulations. However, their micronutrient content has received limited attention. This work aims to analyse the micronutrient composition of all PS formulations available in Italy for paediatric PKU patients and compare their micronutrient contribution to the recommended dietary allowance (RDA) and assess variability among products and age groups. Materials and Methods: The content of 28 micronutrients was analysed in 63 PSs, grouped according to the age ranges defined by the RDA guidelines: 0–6 months, 6–12 months, 1–3 years, 3–8 years, 8–14 years. The micronutrient content was standardised for 10 g of protein equivalent (PE). Results: Compared to the RDA, many micronutrients were found to be over-supplemented across all age groups, particularly in the 0–6 month group, where peak levels were observed for vitamin K, chromium, and manganese. The 1–3 age group showed the lowest levels of supplementation, with most micronutrients falling within the sub-supplementation range. The variability in supplementation among PSs was broad and showed the highest values in the latter age ranges, reaching maximum levels for biotin and copper. Among different ages, the variability was higher in the first two age ranges, particularly for vitamin A. Choline is not supplemented in many PSs across different age ranges. Conclusions: Many micronutrients supplemented in the PSs exceed the RDA for all age groups, with high variability among different PSs and age groups. When prescribing a PS, the daily amount of synthetic proteins of the diet should be considered in order to evaluate the real daily intake of micronutrients in a PKU diet. Full article

Background/Objectives: Phenylketonuria is a hereditary metabolic disorder characterized by a deficiency of phenylalanine hydroxylase. The main treatment for PKU is a phenylalanine-restricted diet. The exclusion of protein rich natural foods and inclusion of low-Phe substitutes may give rise to an imbalanced diet, and the increased risk of overweight and obesity in PKU is a cause for concern. We aimed to evaluate the body composition and nutritional biochemical biomarkers in adult PKU patients who are on Phe-restricted and essential amino acid-supplemented nutrition therapy and to investigate the relationships between these parameters and patient gender, adherence to dietary therapy, and disease type, defined as mild or classic PKU. Methods: The study group comprised 37 PKU patients and 26 healthy siblings as controls. The participants were assessed based on an analysis of anthropometric parameters, body composition, and biochemical test results. Results: PKU patients do not have a higher incidence of overweight and obesity than healthy controls, the proportion of energy derived from carbohydrates in their diets was below the recommended level, and their total energy intake was below the recommended daily allowance. It was remarkable that patients with a treatment adherence ratio of <50% displayed a higher prevalence of overweight and abdominal obesity in comparison to those with a more favorable treatment adherence ratio. Conclusions: In view of the growing prevalence of overweight in the general population, PKU patients should be kept under close long-term follow-up. Particularly in the group with low treatment compliance, more caution should be taken in terms of adverse outcomes. Full article

The treatment for Maple Syrup Urine Disease (MSUD) consists of a hypoproteic diet with integration therapy to limit leucine intake, ensuring adequate energy, macronutrients, and micronutrients to prevent catabolism and promote anabolism. We conducted a retrospective cross-sectional study at the Metabolic Rare Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. Patients with MSUD who were over 3 years old, not treated with liver transplantation, and who provided written consent, were included. The study aimed to describe the dietary treatment of patients with MSUD, evaluate growth data, and analyze the effect of a low-protein and semi-synthetic diet on body composition. Data on height, weight, BMI, waist circumference, food intake, physical activity, and DEXA scans were collected. Thirteen subjects (11 classic MSUD, 2 intermediate MSUD) were included, of which 5 < 18 years old. Results indicated that patients with MSUD follow a balanced diet and have body compositions like healthy subjects in terms of fat and lean mass. A high incidence of osteopenia was observed from a young age, with a positive correlation between protein intake and lean mass and a negative correlation between BCAA-free mixture consumption and bone mineral density z-score. The study highlights the positive effects and potential consequences of the semi-synthetic diet on the body composition of patients with MSUD. A similar study involving all Italian metabolic centers treating MSUD is recommended. Full article

Coffee is part of our daily lives since it is a drink with a symbolic value, both in our social relationships and as a stimulating drink. The main objective of this paper is to conduct a risk characterization of fluoride overexposure from the consumption of these beverages; for this purpose, in the present study, the fluoride concentration was determined in 80 samples of different brands of coffee commonly consumed in the Canary Islands, and the risk derived from their intake was then evaluated. Significant differences (p < 0.05) were found between the coffee brands soluble Nescafé Classic^®, Saimaza^®, Auchan^®, Tirma^® soft blend, and Hacendado^® and the other analyzed brands. The brand that recorded the highest mean fluoride levels is “Hacendado descafeinado^®” (0.308 mg/L). The problem with coffee is not the fluoride it contains but the fact that, according to the survey results, most coffee drinkers brew their coffee with tap water (over 51% of respondents use tap water). The results of the fluoride content in coffee prepared with tap water from the different areas of Tenerife in the Canary Islands (metropolitan, northern, and southern areas) have reported higher concentrations of fluoride: north (max. concentration found of 16.68 mg/L), south (max. concentration found of 8.47 mg/L) and metropolitan (max. concentration found of 4.73 mg/L). Coffee has not been identified as a risk of dietary overexposure to fluoride; however, the use of tap water for its brewing has been identified as a factor that considerably increases its concentration. Therefore, the use of bottled water is recommended, especially in regions such as the Canary Islands, which have high concentrations of fluoride in their water. Full article

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in childhood. Skin barrier impairment exposes infants to food allergens, potentially causing sensitization followed by IgE-mediated food allergy. We describe the case of an infant with severe AD in whom several sensitizations to foods are detected, with consequently difficult weaning, and a history of anaphylaxis to cashew nut. Foods for which skin tests were negative were introduced into the infant’s diet. Then, when AD control was managed, oral food challenges (OFCs) for foods to which the patient was sensitized, with the exception of cashew nut, were performed. The simultaneous presence of sensitization toward multiple foods made it difficult to introduce them using classic OFC. Therefore, it was decided to perform the low-dose, gradual controlled OFC. This led to an introduction of sensitized foods into the infant’s diet, with the exception of cashew nut, avoiding allergic reactions. Absolute recommendations on how, when, and where to perform OFCs with allergenic food to which the child with AD is sensitized are lacking so far. In our opinion, OFCs and the subsequent ntroduction of allergenic foods should be individualized, evaluating some factors such as their social and nutritional importance, the patient’s age and clinical phenotype (including the history of anaphylaxis), and the sensitization profile. There is agreement on the fact that the dietary approach in children with moderate-severe AD should no longer include a strict elimination diet. We believe that an early, gradual controlled introduction of all allergenics to identify the amount of food tolerated in the absence of reactions, even if low dose, may improve patients’ and families’ quality of life. However, even if discussing a vast relevant literature, the limitation of our work is that we describe the management of a single patient. Extensive and high-quality research is needed in this field to improve the available evidence in the area. Full article

Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations. Full article

Background: Classical homocystinuria (HCU) is an inborn defect of methionine metabolism caused by a deficiency of the enzyme cystathionine β-synthase (CBS). The main symptoms of classical homocystinuria are lens subluxation, bone lesions, vascular disease and developmental delay/intellectual disability. The treatment method for HCU is a methionine-poor diet supplemented with amino acid preparations. The aim of the study was to examine the relationship of dietary factors, metabolic compensation and selected skeletal parameters in patients with HCU. Methods: Bone mineral density measurements (DXA) were performed in pediatric patients with HCU, and blood levels of selected amino acids, minerals and vitamins, as well as dietary nutritional value, were analyzed. Results: A total of 11 patients with HCU whose median age was 9.3 years were enrolled in the study. The median DXA total body less head of HCU patients was −0.4 z-score, and the lumbar spine was −1.4 z-score. Despite supplementation, calcium intake was below the age norm. Average vitamin D3 intake was in line with recommendations, but 36% of patients had reduced blood levels. Bone mineral density depended on blood levels of 25-hydroxyvitamin D, homocysteine and methionine, as well as on BMI, age and intake of natural protein (R² = 98.5%, p = 0.015; R² = 86.7%, p = 0.0049) and protein from an amino acid preparation (r = 0.69, p = 0.026). Conclusion: The results of the study indicate the need for regular densitometry in patients with HCU and also the use of additional calcium and vitamin D3 supplementation. It is also necessary to perform a comprehensive analysis of the diet and metabolic controls. Full article

Iodine is an essential mineral required for the synthesis of thyroid hormones. Iodine plays a critical role in growth and neurocognitive development. Classical galactosaemia is a disorder resulting from an inborn error in galactose metabolism. Its current management consists of life-long lactose and galactose dietary restriction. This study estimated dietary intakes of iodine in infants and children with classical galactosaemia in the Republic of Ireland. The diets of 43 participants (aged 7 months–18 years) with classical galactosaemia were assessed for iodine intake using an iodine-specific food frequency questionnaire. Intakes were compared to the European Food Safety Authority (EFSA) dietary recommendations for iodine intake. The potential role of iodine fortification of dairy alternative products was also examined. There were no significant differences observed between sex, ethnicity and parental education and meeting dietary iodine recommendations. Differences, however, were seen between age groups, causing the p value to approach statistical significance (p = 0.06). Infants consuming infant formula were likely to meet iodine recommendations. However, over half (53%) of children aged 1–18 years had average intakes below the recommendations for age. For these children, consumption of iodine-fortified dairy alternative milk was the leading source of iodine in the diets, followed by fish/shellfish and eggs. An assessment of iodine intake should be undertaken during dietetic reviews for those with classical galactosaemia. Mandatory iodine fortification of all dairy alternative products would result in 92% of the total population cohort meeting iodine recommendations based on their current consumption. Full article

Chemical risk assessment in the context of the risk analysis framework was initially designed to evaluate the impact of hazardous substances or xenobiotics on human health. As the need of multiple stressors assessment was revealed to be more reliable regarding the occurrence and severity of the adverse effects in the exposed organisms, the cumulative risk assessment started to be the recommended approach. As toxicant mixtures and their “cocktail effects” are considered to be main hazards, the most important exposure for these xenobiotics would be of dietary and environmental origin. In fact, even a more holistic prism should currently be considered. In this sense, the definition of One Health refers to simultaneous actions for improving human, animal, and environmental health through transdisciplinary cooperation. Global policies necessitate going beyond the classical risk assessment for guaranteeing human health through actions and implementation of the One Health approach. In this context, a new perspective is proposed for the integration of microbiome biomarkers and next generation probiotics potentially impacting and modulating not only human health, but plant, animal health, and the environment. Full article

Irritable bowel syndrome (IBS) is a chronic disease with recurrent abdominal pain, disturbed bowel emptying, and changes in stool consistency. We compared the effectiveness of three different dietary treatment plans (G1-FM-low FODMAP diet, G2-IP IgG based elimination-rotation-diet, and as control group, the G3-K control diet recommended by an attending gastroenterologist) in treating patients diagnosed with mixed irritable bowel syndrome. A total of seventy-three female patients diagnosed with a mixed form of irritable bowel syndrome (IBS-M) were enrolled in the study. The diet of each patient in Group 1 (G1-FM) and 2 (G2-IP) was determined individually during a meeting with a dietitian. Patients from Group 3 (G3-K) received nutrition advice from a gastroenterologist. Significant differences in the reduction of IBS symptoms were found between the groups. IBS symptoms as well as comorbid symptoms significantly improved or disappeared completely in the G2-IP group (idiopathic abdominal pain, p < 0.001; abdominal pain after a meal, p < 0.001; abdominal pain during defecation, p = 0.008), while in the G1-FM group, some of the IBS symptoms significantly improved (mucus in stool, p = 0.031; bloating, p < 0.001). In group G3-K no significant improvement was seen. Based on the results of this open-label study, it was concluded that various dietary interventions in the treatment of IBS-M patients do not uniformly affect the course and outcomes of disease management. Rotation diets based on IgG show significantly better results compared to other diets. Full article

Lower urinary tract symptoms (LUTS) are classically characterized as being related to storage (e.g., frequency, urgency, and nocturia) or flow (e.g., weak stream, intermittency, straining, and incomplete emptying). Conventional prescription medications such as α1-blockers and 5α-reductase inhibitors are used to treat progressive LUTS in men. Due to the adverse events associated with these prescription drugs, many patients with mild-to-moderate LUTS may decide to initiate treatment with non-prescription medications and/or dietary supplements. The lipidosterolic extract of Serenoa repens (LSESr), at a recommended daily dose of 320 mg/day, has been the focus of numerous peer-reviewed studies and review articles concerning the treatment of LUTS, from the first publication in 1983 by Boccafoschi to the most recent publication in 2021 by Russo. Although it seems improbable that the beneficial effect of LSESr reflects a placebo effect given the consistent degree of efficacy comparing various studies published in different countries over a span of almost 40 years, this has been the prevailing impression stemming from essentially three publications in the Western medical literature. In addition, despite publications reporting findings of almost identical efficacy using LUTS endpoints such as the International Prostate Symptom Score (IPSS), the quality of life score (QoL), and the peak urinary flow (Qmax) in comparing LSESr with the α-blocker tamsulosin or the 5α-reductase inhibitor finasteride, and despite the recognized acceptance of the hexane lipidosterolic extract product (Permixon^®) as an herbal medicine in Europe showing value in the treatment of LUTS, the use of LSESr remains controversial in the US. Contributing to such an opposing view in the US are the wide variability in quality, composition, and dosage of Serenoa products, the commercial prevalence of dried berry powder supplements, and the lack of awareness of a standardized Serenoa phytotherapy lipidosterolic profile. Can the controversy over the efficacy of LSESr in the context of LUTS be resolved? By understanding the main literature that has led to clinical practice guidelines for Serenoa repens for LUTS in Europe and the US, and by an in-depth analysis of the totality of the clinical literature concerning dose, extraction method, and quality of the Serenoa product used, it should be possible to answer this question. Given the extent of this global analysis, this report is presented in three sections. Part I introduces LUTS. What are the demographics of LUTS? What symptoms are assessed by LUTS, and how do we quantify LUTS? Why would a non-prescription item be a valuable consideration in LUTS treatment versus other treatment options? What is basic information about Serenoa repens, and what defines a standardized LSESr product? What are the published trials that have affected the acceptability of Serenoa repens in the treatment of LUTS? Finally, a major portion of Part I discusses the four major reviews of Serenoa repens versus LUTS that have influenced how it is accepted in the USA, in Europe, and in other parts of the world. Part I, therefore, lays the groundwork and is foundational for the important findings relating to LUTS and Serenoa repens that will be presented as Parts II and III in subsequent review articles. Full article

The current protein requirement estimates in children were largely determined from studies using the nitrogen balance technique, which has been criticized for potentially underestimating protein needs. Indeed, recent advances in stable isotope techniques suggests protein requirement as much as 60% higher than current recommendations. Furthermore, there is not a separate recommendation for children who engage in higher levels of physical activity. The current evidence suggests that physical activity increases protein requirements to support accretion of lean body masses from adaptations to exercise. The indicator amino acid oxidation and the ¹⁵N-end product methods represent alternatives to the nitrogen balance technique for estimating protein requirements. Several newer methods, such as the virtual biopsy approach and ²H₃-creatine dilution method could also be deployed to inform about pediatric protein requirements, although their validity and reproducibility is still under investigation. Based on the current evidence, the Dietary Reference Intakes for protein indicate that children 4–13 years and 14–18 years require 0.95 and 0.85 g·kg⁻¹·day⁻¹, respectively, based on the classic nitrogen balance technique. There are not enough published data to overturn these estimates; however, this is a much-needed area of research. Full article

Several by-products, such as whole cull dates, date stones (also called pits, seeds, kernels), sugar-extracted date pulp, are produced from date fruit processing industries. These by-products, particularly date stone meal represent 10 to 20% of the whole dates are wasted, causing environmental issues. However, the date stone is rich in various nutrients, such as nitrogen-free extract, fiber, fat, and minerals, which could be used as an alternative feed source in poultry nutrition. However, the high fiber content in date stone meal restricts its use in poultry diets. Whole date wastes and date pulp have lower protein, fiber and fat content than those in date stone meal. Several studies have investigated the use of date stone meal and other by-products as a replacement of dietary corn and barley on feed intake, growth, feed efficiency, and nutrient utilization in poultry. The compilation of results obtained from different studies indicates that date fruit by-products, particularly date stone meal, could be incorporated up to 10% levels, replacing corn or barley grains without hampering production performance, and this could reduce the production cost. Moreover, the use of date stone meal at lower levels (5–10%) sometimes shows better growth performance, probably due to the presence of bioactive principles such as antioxidants and phenolic compounds. The use of date stone meal in poultry diets may be practically important under certain circumstances not only under the COVID-19 crisis due to the lockdown of airports, dry ports, ports and traffic restrictions, but also in countries with a limited supply of classical feed resources and which depend on imported ones. Finally, it can recommend that using date stone meal (DSM) up to 5–10% in poultry diets positively affect the productive performance. Due to the variability in the nutritive value of the DSM, developing a formula for metabolizable energy (ME) of DSM = a (intercept) − b (slope) × crude fiber (CF) content should be considered to improve the precision of feed formula for poultry. However, the nutritional value of DSM might not only depend on crude fiber but also on other compounds. Full article