Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome

Metabolic syndrome (MS) is a cluster of metabolic alteration associated with a higher risk of cardiovascular disease and overall mortality than the single alterations alone. The Italian Mediterranean Diet (IMD) can exert a positive effect on cardiovascular risk and related morbidity and mortality. The aim was to evaluate the benefits of dietary intervention based on a typical IMD on body composition, cardiometabolic changes and reduction in cardiovascular disease in patients with MS. Eighty White Italian subjects with MS were prescribed a balanced hypocaloric IMD. We investigated dietary habits and impact of the diet on health status, blood biochemical markers, anthropometric measurements and body composition during a 6-month follow-up period. Body composition, fat mass and distribution were assessed by Dual X-ray absorptiometry. Adherence to the IMD led to a decrease in body weight (102.59 ± 16.82 to 92.39 ± 15.94 kg, p < 0.001), body mass index (BMI) (38.57 ± 6.94 to 35.10 ± 6.76, <0.001) and waist circumference (112.23 ± 12.55 vs 92.42 ± 18.17 cm, p < 0.001). A significant loss of total body fat especially in waist region was observed. The MS was resolved in 52 % of the patients. Significant improvements in systolic and diastolic blood pressure and fasting glucose occurred. Low-density lipoprotein cholesterol was reduced from 128.74 ± 33.18 to 108.76 ± 38.61 mg/dl (p < 0.001), triglycerides from 169.81 ± 80.80 to 131.02 ± 63.88 mg/dl (p < 0.001). The present results suggest that a dietary intervention based on a typical IMD effectively promotes weight loss and reduces the growing burden of cardiovascular risk factors that typifies patients with MS

Clinical problems caused by obesity

Over the past few decades the incidence of obesity has doubled worldwide and current estimates classify more than 1.5 billion adults as overweight and at least 500 million of them as clinically obese, with body mass index (BMI) over 25 kg/m2 and 30 kg/m2, respectively. Obesity prevalence rates are steadily rising in the majority of the modern Western societies, as well as in the developing world. Moreover, alarming trends of weight gain are reported for children and adolescents, undermining the present and future health status of the pediatric population. To highlight the related threat to public health, the World Health Organization has declared obesity a global epidemic, also stressing that it remains an under-recognized problem of the public health agenda

Congenital Adrenal Hyperplasia in Adults

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder affecting adrenal steroid synthesis. More than 95% of CAH cases are caused by reduced 21-hydroxylase function leading to variable extent of cortisol and aldosterone deficiency in addition to androgen excess. The foundation of CAH treatment is the use of glucocorticoids. However, overtreatment leads to Cushing s syndrome and undertreatment to hyperandrogenism and Addisonian crisis. The aims of this thesis has been to evaluate the impact of CAH and its treatment on some factors that could lead to a reduced quality of life and increased morbidity or mortality during adult life. In total 93 patients (32 males) with CAH and 93 (32 males) age- and sex-matched controls were studied. Subgroups of different ages (<30 years or older), phenotypes and the three most common genotype groups (null, I2 splice and I172N) were studied. Focus was on cardiovascular and metabolic risk, bone health in females and fertility in males. Cardiovascular and metabolic risk: Younger female and male patients and controls had similar waist/hip ratio, lean and fat mass and insulin values. Older females had higher waist/hip ratio, lean mass and insulin values than controls. Fat mass was similar to controls but higher than in younger patients. Lipid profiles were slightly more favourable in older patients than in controls. Gestational diabetes was more common in patients. Few older female patients had hypertension, cardiovascular disease or diabetes. Despite moderate glucocorticoid doses, most patients had suppressed androgens. Serum liver enzymes were elevated in patients compared to controls. In patients, liver enzymes were correlated with waist circumference and with total body and trunk fat. Liver enzymes were increased even in non-obese patients mainly attributed to the patients ≥30 years who also demonstrated elevated insulin levels and HOMA-indices. In older males, waist/hip ratio, fat mass, and gamma-glutamyl transpeptidase were higher and heart rate faster than in controls. Insulin levels were increased during oral glucose tolerance test in all and older patients. Homocysteine was lower in all and in younger male patients which may be cardioprotective. Adverse cardiovascular profiles were mainly found in the mild genotype I172N. This group had normal urinary epinephrine concentrations whereas the more severe genotypes null and I2 splice had low levels. Few old male patients had cardiovascular disease and no patient had diabetes. Bone health in females: Patients had lower bone mineral density (BMD) than controls at all measured sites. In patients ≥30 years old 73% were osteopenic or osteoporotic vs 21% in controls. BMD was similar in the two classic forms and had no obvious relationship to genotypes. More fractures were reported in patients than controls. Fertility in males: Compared to national data the fertility was impaired in CAH males. The lifetime number of partners was smaller in all patients, in older patients and in the null group. Testicular tumours (TARTs) were found in 86% and 47% had pathological semen. Those with pathological semen had increased total and truncal fat mass, fat/lean mass ratio and heart rate. FSH was elevated and correlated negatively with sperm count and concentration. Conclusions: Adult CAH females and males have a number of issues due to the disease and to corticoid supplementation. However, the findings in this thesis are more positive than many of the previous reports on CAH. Many parameters studied in our CAH individuals <30 years were not different from age- and sex-matched controls. This is likely to reflect improvements in management

Epidemiological and clinical studies: Lipo-metabolic ultrasonography and prevention

Over the last few decades, obesity has become a severe medical condition worldwide, and a risk factor for many cardio-metabolic diseases. It is described as an excessive accumulation of fat in the body leading to other complications such as type 2 diabetes mellitus (T2DM), hypertension, dyslipidaemia, liver steatosis, and cardiovascular diseases [1]. In other cases, obesity may lead to many types of cancer (i.e. breast, ovary, liver, gallbladder, colon and kidney cancer) [2]. The journey from obesity to metabolic dysfunction-associated steatotic liver disease (MASLD) and ultimately to cardiovascular disease (CVD) highlights a critical and interconnected health pathway. Obesity, a central feature of metabolic syndrome, significantly increases the risk of developing MASLD, a condition characterized by excessive fat accumulation in the liver. The presence of MASLD is strongly associated with an elevated risk of cardiovascular disease, which remains the leading cause of mortality among individuals with this liver condition. Shared pathophysiological mechanisms, including insulin resistance, chronic inflammation, and oxidative stress, underpin the link between MASLD and CVD. Addressing obesity is therefore crucial not only for preventing liver-related complications but also for mitigating the risk of cardiovascular events. Many approaches were studied to find a healthy way to lose weight and prevent and/or cure obesity-related metabolic diseases. Since the timing of meals during the day plays a critical role in losing weight besides the calorie deficit, physical activity, medical interventions, and surgeries, intermittent fasting, especially Ramadan intermittent fasting has been gaining popularity as a healthy strategy to improve weight and metabolic diseases

Cardiovascular health, muscular strength and body composition in Colombian university students

La actual disertación doctoral gira en torno a como los componentes de la composición corporal y la condición física, como el porcentaje de tejido graso (BF%- Siglas en inglés body fat percentage), el índice de masa grasa (FMI- Siglas en inglés fat mass index) y la fuerza muscular (fuerza prensil ajustada- NGS- Siglas en ingles normalized grip strength) respectivamente, pueden utilizarse para detectar síndrome metabólico (MetS- Siglas en inglés metabolic syndrome) en estudiantes universitarios de Colombia. Además, estos componentes están relacionados con el índice de salud cardiovascular (CVH- siglas en inglés cardiovascular health) en estudiantes universitarios colombianos. Por estas razones, la presente tesis doctoral se basa en 3 estudios científicos. El primer estudio (capítulo 2) tuvo como objetivo explorar los valores de referencia del BF% y el FMI para la predicción de MetS en los estudiantes universitarios de Colombia. El objetivo del segundo estudio (capítulo 3) fue determinar los puntos de referencia de la NGS para la detección de MetS en una gran muestra no representativa de una población de estudiantes universitarios de Colombia. El último estudio (capítulo4) tuvo el propósito de investigar la relación entre la fuerza prensil, masa muscular y el índice de CVH en estudiantes universitarios de Colombia.The current Ph.D. dissertation revolves around the components of the body composition and physical condition like body fat percentage (BF%), fat mass index (FMI) and muscular strength (normalized grip strength [NGS]) respectively, can be used to detect metabolic syndrome (MetS) in collegiate students from Colombia. Besides these components are related with the ideal cardiovascular health (CVH) in Colombian University Students. For these reasons, the current doctoral thesis is based on 3 scientific studies. The first study (chapter 2) has the aim to explore thresholds of body fat percentage (BF%) and fat mass index (FMI) for the prediction of MetS among Colombian University students. The second study (chapter 3) to determine cut-off of normalized grip strength (NGS) for the detection of MetS in a large nonrepresentative sample of a collegiate student population from Colombia. The lastly study (chapter 4) has the purpose to investigate the relationship between handgrip strength, muscle mass, and ideal cardiovascular health (CVH) among Colombian college students.FUPRECOL has been partially supported by the Universidad del Rosario (Code N° FIUR DN-BG001), Institución Universitaria Antonio José Camacho (Code N° 111-02.01.48/16). Universidad Santo Tomás (Code N°2013004), Universidad Manuela Beltrán (Code N° FT201204), and Universidad de Boyacá (Code N° RECT60).Programa de Doctorado en Ciencias de la Salud (RD 99/2011)Osasun Zientzietako Doktoretza Programa (ED 99/2011

Pika-ajaline toitumise uuring: antropomeetriliste ja kliinilis-laboratoorsete näitajate hindamine neeruasendusravi patsientidel intensiivse toitumisalase nõustamise järgselt

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Sissejuhatus: Krooniline neeruhaigus (KNH) on vaikselt ja algstaadiumis oluliste kaebusteta kulgev haigus, mis progresseerub lõpp-staadiumi neerupuudulikkuseni aastate ja sageli aastakümnete jooksul. KNH peamisteks tekkepõhjusteks Eestis on glomerulonefriit, suhkur- ja kõrgvererõhktõbi ning harvem muud kroonilised neeruhaigused. KNH lõpp-staadiumi haigete arvu suurenemine Eestis ja globaalselt on seotud eelkõige KNH progresseerumist põhjustavate riskitegurite laialdase esinemisega elanikkonna hulgas (hüpertensioon, suitsetamine, ülekaal, rasvtõbi, jm.), diagnostika- ja ravivõimaluste paranemisega ning dialüüsiaparatuuri täiustumisega. KNH-ga kaasnevalt areneb südame- ja veresoonkonna kahjustus ning KNH-ga patsientide kardiovaskulaarne suremus on üldrahvastikuga võrreldes oluliselt suurem. Lõpp-staadiumi neerupuudulikkuse kõige efektiivsemaks ravimeetodiks on neerusiirdamine hemo- ja peritoneaaldialüüsi kõrval. Neeru siirdamise järgselt patsiendi üldseisund ja söögiisu paraneb ning sageli kehakaal suureneb. Teaduskirjanduses ilmub üha uusi andmeid siirdatud neeruga patsientide antropomeetriliste, densitomeetriliste ja biokeemiliste näitajate, toitumisharjumuste ja toiduvaliku kohta, kuid kehakaalu suurenemise ärahoidmise efektiivsete meetodite kohta on läbi viidud väga vähe uuringuid. Käesoleva uurimustöö üldine eesmärk oli analüüsida lõpp-staadiumi kroonilise neeruhaige kehakoostist ja toitumisharjumusi. Me püstitasime hüpoteesi, et intensiivne toitumisalane nõustamine võimaldab muuta patsientide toitumisharjumusi nii, et peale neerusiirdamist ei teki olulist kehakaalu suurenemist. Uuringu eesmärgid: 1. Analüüsida antropomeetriliste mõõtmiste tulemusi lõpp-staadiumi neerupuudulikkuse haigetel ning võrrelda dialüüsi ja transplanteeritud haigete kehakoostise andmeid. 2. Testida, kas intensiivsel toitumisalasel nõustamisel on efekti neerutransplantatsiooni mees- ja naishaigete kehakoostisele. 3. Hinnata intensiivse toitumis-alase nõustamise mõju antropomeetriliste, biokeemiliste ja toitumuse parameetrite muutustele peale jälgimisperioodi ning analüüsida nimetatud parameetrite omavahelisi seoseid eraldi siirdatud mees- ja naishaigetel. 4. Hinnata intensiivse toitumisalase nõustamise pika-aegset efekti kehakaalu suurenemisele neerutransplantatsiooni haigetel. 5. Hinnata makro- ja mikrotoitainete kasutust neerutransplantatsiooni haigetel 3-päeva menüü alusel dünaamikas. Uuritavad ja uurimismeetodid: Uuring viidi läbi Tartu Ülikooli Kliinikumi Sisekliiniku nefroloogia osakonnas aastatel 2003–2005 ja 2015. Uuringul on Tartu Ülikooli inimuuringute eetikakomitee luba. Esimesse uuringugruppi kaasati kliiniliselt stabiilses seisundis järjestikulised neeruasendusravi patsiendid (dialüüsravil ja siirdatud neeruga), kes andsid nõusoleku uuringus osalemiseks: 37 mees- ja 38 naispatsienti. Teise uuringugrupi moodustasid stabiilses seisundis järjestikulised neerusiirikuga patsiendid, kes andsid nõusoleku uuringus osalemiseks: 12 meespatsienti (keskmine vanus 42,8 ± 16,1 aastat) ja 16 naispatsienti (keskmine vanus 47,0 ± 14,9 aastat). Uuringud viidi läbi kahe visiidi käigus: esimene visiit poolteist aastat ja teine visiit kolm aastat peale neerusiirdamist. Uurimismeetodid olid järgmised: antropomeetrilised mõõtmised, kehakoostise hindamine bioimpedansi ja densitomeetria abil, laboratoorsete näitajate kogumine ning toitumise uurimine 3-päeva menüüde alusel. Lisaks koostati spetsiaalne ankeet-sagedusküsimustik toitumise uurimise kohta (Food Frequency Questionnare, FFQ). Antropomeetrilisi mõõtmisi teostati vastavalt klassikalise Martini (1928) ja Knussmann (1988) metoodika järgi. Mõõdeti 36 antropomeetrilist näitajat: kehakaal, pikkus, 2 keha sügavusmõõtu, 8 keha laiusmõõtu, 13 ümbermõõtu ja 11 nahavolti. Kõik mõõtmised teostati litsentseeritud antropometristi poolt. Nende mõõtmiste alusel arvutati indeksid ja kehakoostise näitajad: keharasvamass (kg; %), kehamassiindeks (BMI, kg/m2), kehapindala (m2), kehatihedus (g/cm3), Siri indeks (%), keskmine nahavoldi paksus (mm), nahaaluse rasvkoe mass (kg), suhteline rasvkoe mass kehakaalu suhtes. Kehakoostise tähtsamad komponendid on kehatihedus (Db) ja keharasvamass (FM), mida arvutati kahe regressioni võrrandi (Jack H. Wilmore ja Albert R. Behnke, Durnin ja Rahaman) alusel. Densitomeetriline uuring teostati uuringu teisel visiidil. Osteopeenia ja osteoporoosi hindamiseks teostati regionaalne luutiheduse mõõtmine lülisamba lumbaalpiirkonnas. Mõõtmised teostati aparaadil GE LUNAR DPX-IQ densitomeeter (Madison, WI, US, software version 4.7e) sertifitseeritud tehniku poolt. Laboratoorsed andmed koguti peale neeru siirdamist uuringu esimesel ja teisel visiidil. Vereseerumis määrati 18 olulist laboratoorset parameetrit, sealhulgas verelipiidide, parathormooni, homotsüsteiini ja tsüstatiin C tase. Toitumise uurimine viidi läbi kasutades kahte meetodit: esimene meetod käsitles ühekordset ankeet-sagedusküsimustikku (FFQ), mida uuritav täitis ainult uuringu esimesel visiidil. Teine meetod käsitles 3-päeva menüüde kogumist mõlemal visiidil. Individuaalset toitumisalast nõustamist alustati kohe peale ankeet-küsitluslehe täitmist ja 3-päeva menüüde analüüsimist. Kroonilise neeruhaige toitumisalase nõustamise aluseks on antropomeetrilised ja kehakoostise näitajad ning laboratoorsed testid. Lisaks eelnevale arvestati ka haige toitumisharjumusi, kuid soovituslikul toiduvalikul lähtuti Eestis kehtivast ja autori poolt välja töötatud haiguspuhusest dieetide nomenklatuurist. Statistiline analüüs: Meie uuritavatel viidi läbi klassikalised antropomeetrilised mõõtmised ja mõõtmisandmete statistiline analüüs (statistikaprogramm SAS), mille alusel on toodud kirjeldava statistika näitajad antropomeetriliste tunnuste kohta (keskväärtused, standardhälbed) eraldi mees- ja naispatsientidel. Korrelatsioonianalüüsil uuriti seoseid antropomeetriliste ja kliinilis-laboratoorsete tunnuste ning toitainete kasutuse vahel, kasutades Pearsoni korrelatsiooni- analüüsi. Regressioonianalüüsiga arvutati parimad prognostilised mudelid siirdatud neeruga patsientide toitumise hindamiseks. Erinevate uuritavate gruppide tunnuste keskväärtuste hindamisel ja varasemate andmetega võrdlemiseks on kasutatud t-testi. Lubatud statistilise vea piiriks valiti 5% (p < 0.05). Tulemused: 1. Esimese uuringugrupi neeruasendusravil olnud haigete antropomeetriliste mõõtmiste tulemused näitasid, et uuritud dialüüsi ja neerusiirikuga haigete gruppide keskväärtusete näitajad olid sarnased. Neerutransplantatsiooni järgselt tavaliselt haigete ureemiline seisund taandub, üldseisund paraneb ja isu suureneb, mis omakorda avaldub kehakaalu suurenemises, kuid meie esimesse uuringugruppi kaasatud neerusiirikuga haigetel ei esinenud veel olulist kehakaalu suurenemist. 2. Teise uuringugrupi moodustasid neerusiirikuga haiged, kellel viidi läbi antropomeetrilised mõõtmised ja dietoloogi poolt toitumisalane intensiivne nõustamine 1,5 aastat peale neerusiirdamist (1. visiit) ja 3 aastat peale neerusiirdamist (2. visiit). Transplanteeritud haigete kehakoostist hinnati eraldi meestel ja naistel. Peale intensiivset toitumisalast nõustamist olid uuritavatel paljude antropomeetriliste näitajate muutused kooskõlas kehakaalu suurenemisega. Samas, meeste kehakaalu suurenemine oli peale jälgimisaega statistiliselt oluline, kuid naistel mitte. See võib olla seletatav sellega, et naised järgisid dietoloogi-poolseid soovitusi ja kehakaalu hoolsamalt võrreldes meestega. 3. Intensiivse toitumisalase nõustamise järgselt kliinilisest aspektist lähtudes, esinesid olulised biokeemiliste näitajate muutused, põletikulise staatuse (CRV) normaliseerumine ja lipiidide taseme normi piirides püsimine nii meestel kui naistel. 4. Antropomeetriliste ja biokeemiliste näitajate vahelised seosed olid meestel ja naistel erinevad. Meestel esinesid antropomeetriliste mõõtmiste seosed põletikunäitajatega ja naistel lipiididega. Vaatamata intensiivsele toitumisalasele nõustamisele jäid need seosed püsima ka korduval mõõtmisel (3 aastat peale neerusiirdamist). Need seosed väärivad tähelepanu, sest põletikuline staatus ja hüperlipideemia on üldtuntud kardiovaskulaarsed riskitegurid. On teada, et lõpp-staadiumi neerupuudulikkuse haigetel, sealhulgas neerutransplantatsiooni järgselt, on peamised surmapõhjused neeruhaigetel just kardiovaskulaarsed tüsistused. 5. Antropomeetriliste näitajate usaldusväärseid seoseid mikro- ja makrotoitainete kasutusega 3-päeva menüüde andmete alusel ei esinenud. Järelikult nimetatud seosed ei oma kliinilist tähtsust. 6. Intensiivse toitumisalase nõustamise efektiivsus avaldus ka kaugtulemusi uurides: 10 aastat peale neerusiirdamist ei esinenud statistiliselt usaldusväärset kehakaalu suurenemist nõustamist saanud transplanteeritud meeste ega naiste seas erinevalt neerusiirikuga kontrollhaigetest. 7. Peamiste toitainete kasutamisel leidsime valkude ja süsivesikute tarbimise suurenemist jälgimisperioodi ajal naistel, kuid mitte meestel ning rasvade kasutus jäi normi piiresse nii naistel kui meestel. Nii naiste kui ka meeste osas on nende makro- ja mikrotoitainete kasutamine kooskõlas Eesti toitumis- ja toidusoovitustega. Järelikult, intensiivne toitumisalane nõustamine oli efektiivne, patsientide toitumisharjumused paranesid niivõrd, et kehakaal ei suurenenud, kuigi mõnede toitainete osas esines suurenenud tarbimise tendents, ei ületanud nende tarbimine kaasaegsete Eesti vabariigi toitumissoovituste referentsväärtusi. Kehakaalu suurenemine leiab aset neerusiirdamise järgsetel esimestel aastatel ning seetõttu on oluline õigeaegne ja asjakohane patsientide teavitamine ning antropomeetriliste mõõtmiste regulaarne läbiviimine. Kliinilises tavapraktikas teeb seda patsiendi raviarst ja dietoloog annab oma soovitused vajadusel neerusiirdamise järgselt haiglast lahkudes. Edaspidine dietoloogi-poolne monitoorimine ei tarvitse alati olla enam järjepidev, kuna haigete üldseisund paraneb ja nad külastavad neerukeskust harvem. Transplanteeritud patsientide toitumisalane nõustamine peab olema individuaalne ja regulaarne, mis eeldab kõikide kliiniliselt oluliste andmete järjepidevat kogumist ja analüüsimist dünaamikas.Optimal nutritional evaluation, the use of biochemistry together with anthropometry in clinical practice is of great importance in all chronic kidney disease phases, including the post-transplant period. The gain of body weight often develops after kidney transplantation and influences the long-term outcome. Much research has been carried out in the world studying the body composition of healthy people but there are limited data about the research where these methods together with other clinical parameters have been used for investigating patients with a transplanted kidney. The assessment of body composition in a complex manner, including the anthropometrical, blood biological and nutritional peculiarities of the patients with a transplanted kidney, have not been previously studied in Estonia. According to literature, the main problem after kidney transplantation is the gain of body weight, therefore, we planned to test if intensive nutritional counselling has an effect on a patient’s nutritional habits in preventing the gain of body weight. The general aim of the present study was to analyse the body build and nutritional habits of end-stage chronic kidney disease (CKD) patients. We hypothesised that intense nutritional counselling significantly improves nutritional habits, and, ultimately, the gain of body weight after kidney transplantation will be prevented. The specific aims of the present study were as follows: 1. To analyse anthropometric measurements data of the end-stage CKD patients and to compare the body composition of the dialysis and transplant patients. 2. To test if intensive nutritional counselling has an effect on body composition of kidney transplant male and female patients. 3. To evaluate the effect of intensive nutritional counselling on the changes of anthropometric, biochemical and nutritional parameters of kidney transplant patients after the follow-up and to describe gender-specific associations between the studied parameters. 4. To estimate the long-term effect of intensive nutritional counselling on anthropometrical measures of kidney transplant patients. 5. To evaluate the follow-up changes of the intake of nutrients of kidney transplant patients on the basis of a 3-day menu. Subjects of study and methods: The prospective long-term study was carried out during the years 2003–2005 and 2015 at the Department of Internal Medicine of the University of Tartu. In total, 150 chronic kidney disease patients were studied. The kidney transplant patients had their transplantation at the Transplant Center of the Tartu University Hospital. The first anthropometric study population consisted of 75 consecutive non-diabetic CKD patients (37 males and 38 females) of renal replacement therapy who had agreed to participate in the study and who were treated at the Nephrology Division of the Tartu University Hospital. The participation was voluntary and all patients signed a written informed consent. The transplanted patients’ population was formed from consecutive stable ambulatory non-diabetic kidney transplant patients (12 males at the age of 42.8 ± 16.1 years and 16 females at the age of 47.0 ± 14.9 years) who had agreed to participate in the study and who were monitored by the nephrologists at the Tartu University Hospital. The participation was voluntary and all patients signed a written informed consent. The transplanted patients’ control population was formed from 47 clinically consecutive stable ambulatory non-diabetic kidney transplant patients who had agreed to participate in the study and who were monitored by the nephrologists at the Tartu University Hospital or at the West-Tallinn Central Hospital. The participation was voluntary and all patients signed a written informed consent. All the measurements of 28 kidney transplant patients, including anthropometry, densitometry, biochemistry, the food frequency questionnaire (FFQ) and the 3-days dietary records, were analysed. The data of anthropometry, biochemistry and the 3-days dietary records analyses were performed in patients twice: one and a half years after the first cadaveric kidney transplantation and afterwards, three years after the kidney transplantation during the follow-up. Densitometry was performed in patients once after three years of the transplantation. The preventive nutritional counselling and dietary consultation by a dietitian were carried out for all the kidney transplant patients during one and a half years after the kidney transplantation. The initial data were compared with the results obtained at the end of the study. The last anthropometric measurements ten years after the kidney transplantation were carried out both in the counselled kidney transplant patients and in the control kidney transplant patients. Conclusions: 1. The anthropometrical profile in the studied dialysis and transplant patients was almost similar. No significant differences were found in the studied anthropometrical parameters of the dialysis and kidney transplant patients either in male or female patients’ groups which evidently can be explained by the fact that the transplanted patients were studied shortly after the transplantation. 2. The body composition characteristics indicated the systematic differences between the male and female patients of renal transplantation. After the intense nutritional counselling, the anthropometric measurement changes were in accordance with the increase of body weight after the follow-up which was statistically significant in the studied males but not in females. 3. The effect of intensive nutritional counselling on the changes of biochemical indices revealed the normalization of inflammatory status in most patients, and the studied lipids levels remained within normal reference values. 4. The associations between anthropometric and biochemical parameters were found to be different in male and female patients. In male patients, several anthropometrical parameters were associated with inflammatory parameters but in females with lipids. These associations deserve attention because inflammation and hyperlipidaemia are well-known cardiovascular risk factors. 5. The amount of consumed food (3-day menu indices of macro- and micronutrients) was not associated with the anthropometrical variables of the studied transplant patients which shows that there is no clinical significance of these correlations. 6. Intensive nutritional counselling was effective in the long term: ten years after the kidney transplantation, statistically significant body weight gain was not seen either in males or in females, but on the contrary, it was present in the kidney transplant patients with standard care control. 7. The increased consumption of proteins and carbohydrates after kidney transplantation was found in females but not in males. The consumption of fats was within the normal range. After intensive nutritional counselling, all the values of macronutrients remained within the normal range in accordance with the Estonian nutritional recommendations. We conclude that nutritional counselling and guidance is important and should be offered early and regularly after kidney transplantation to maintain body weight and appropriate nutritional state longitudinally. Post-transplant outcomes will be optimized by a team approach for the comprehensive management of the kidney transplantation recipient combined with vigilant surveillance to detect body weight gain in a timely fashion. However, long-term body weight gain data clearly showed that in our kidney transplant patient population, the patients who received intensive individual dietary counselling had much more educated behaviour in the long-term, thereby preventing body weight gain which is a really well-known risk factor for long-term graft failure as well as for cardiovascular complications and mortality

To assess the effectiveness of tailored food recipe in attenuating the progression of cancer cachexia to refractory cachexia in adult female patients undergoing palliative care in India

Cancer cachexia negatively impacts patients’ capability to undergo chemotherapy and fight infection. Increased energy expenditure and anorexia are key clinical features among cachexia patients leading to body weight loss. Therefore, it is imperative to assess all cancer patients for early signs of undernourishment. Nutrition intervention with counseling may ameliorate undernutrition and metabolic alterations. The aim of this study was to attenuate the progression to refractory cachexia, improve nutritional status and quality of life of female palliative care patients by providing nutrient rich natural food along with counseling. Female cancer patients with symptoms of cachexia were randomly distributed into control and intervention group. Patients were recruited from the Palliative clinic, Oncology department in AIIMS, New Delhi, India; control/placebo groups (for pilot n= 30 and scale-up n=75) and intervention groups (for pilot n= 33 and scale-up n=75). In addition to nutritional and physical activity counseling, intervention patients were instructed to consume 100g nutritional supplement (IAtta) on a daily basis with their normal dietary intake for a six month period, during the pilot study. Moreover, during the scale-up study, the intervention group received 100g of IAtta while the placebo group received 100g of whole wheat flour for daily consumption. Anthropometric measurements, physical activity level (PAL), dietary intake, quality of life (QoL) and biochemical indices were assessed at baseline, three-month and after six-month period. Study variables were analysed using repeated-measures ANOVA and the Friedman test for multi–comparisons to determine the changes within the groups at different time points (i.e. baseline, mid-intervention and post-intervention). Student t-test/ Wilcoxon ranksum tests were performed on the variables to assess the difference between the intervention and control/placebo groups at baseline (P- value ≤0.05; 95% confidence interval). After six months, patients in intervention group (IAtta group) had significant improvement in PAL (p<0.001) and QoL domain (global health status, p<0.001 and fatigue, p=0.001). Conversely, the QoL in the placebo group did not improve (global health status, p=0.74) nor did PAL (p=0.49). Body mass index was maintained in both groups (IAtta, p-value 0.121; Placebo, p-value 0.35). Serum albumin levels were significantly reduced (p = 0.005) in placebo group patients after six months of intervention. Nutrition sensitive intervention (IAtta meal) along with counseling (tailored nutrition and physical activity) improves quality of life and nutritional status as well as delays progression of cachexia among female palliative care patients. These findings highlight the need to ascertain the nutritional status of cancer patients and underpin the pivotal role of IAtta as intervention tool to compensate for deficient nutrients. It is therefore suggested to embed IAtta into the Indian palliative care framework to modulate cancer progression