Sleep Quality After Intradialytic Oral Nutrition: A New Benefit of This Anabolic Strategy? A Pilot Study

BackgroundSince disturbances of appetite and sleep are closely related and both affect metabolic disorders, it would be expected that a renal specific oral nutritional supplement (RS-ONS) that covers the energy the patient does not consume on the HD day, could contribute to improve the nutritional status and body composition, as well as sleep quality. There is still scarce information related to this topic.AimTo evaluate the effect of the use of intra-dialytic RS-ONS vs. RS-ONS at home on sleep quality, nutritional status, and body composition in patients on HD.MethodsAdult patients < 65 years, with ≥3 months on HD were invited to participate in an open randomized pilot study (ISRCTN 33897). Patients were randomized to a dialysis-specific high-protein supplement provided during the HD session (Intradialytic oral nutrition [ION]) or at home (control), during non-HD days (thrice weekly, for both) 12 weeks. The primary outcome was sleep quality defined by the Pittsburgh Sleep Quality Index (PSQI) score. Nutritional assessment included Malnutrition Inflammation Score (MIS), bioelectrical impedance analysis, anthropometry, 3-day food records, and routine blood chemistries.ResultsA total of 23 patients completed the study. Age was median 35 (range 24–48 years), 42% were women. At baseline, the PSQI score was median 4 (range 2–7), and MIS showed a median of 6 (range 5–8); there were no baseline differences between groups. After intervention, both groups improved their MIS scores and similarly when we analyzed the whole cohort (pre- vs. post-intervention P < 0.01). Patients in the ION group improved the overall PSQI score to median 3 (2–5), and assessment of sleep duration and sleep disturbances (pre- vs. post-intervention P < 0.05), with a trend toward an effect difference compared to patients consuming the supplement at home (P for treatment-effect across arms 0.07 for PSQI score and 0.05 for sleep latency).ConclusionOral supplementation improved nutritional status in the whole cohort, but only ION improved the PSQI score. More studies are needed to explore the nutritional strategies that influence the relationship between sleep and nutritional status in HD patients

Evaluation of the Biological Activity of Soil in a Gradient Concentration of Arsenic and Lead in Villa de la Paz, San Luis Potosi, Mexico

The mining industry has generated different sources of pollution and effects in human and ecosystem health. The objective of this study was to evaluate the effect in gradient of the biological activity of the soil derived from the contamination by lead and arsenic. A linear transect was conducted from the tailings in Villa de la Paz to a reference site 10 km away against wind direction and runoff. The parameters that were analyzed in the soil samples included As, Pb, pH, organic matter, electrical conductivity, soil respiration, and soil enzymes. As concentrations ranged from 4.7 to 463.2 mg/kg, while those of lead ranged from 171.7 to 2319.0 mg/kg. The changes in the physicochemical parameters and in the biological activity of the soil were stronger within the first 100 m of distance from the tailings. The pattern of inhibition of biological activity was: urease>β-glucosidase>arylsulfatase> dehydrogenase>phosphatase>respiration. Strong negative relationships were observed among biological activities and arsenic (from 86.5 to 96%). Metals and covariables jointly explain the 89.2% of variability of the effect in the biological activities. This study provides a field baseline that could be part of a long-term monitoring and remediation program

<i>Dieta de la Milpa:</i> A Culturally-Concordant Plant-Based Dietary Pattern for Hispanic/Latine People with Chronic Kidney Disease

Chronic kidney disease (CKD) disproportionately affects minorities in the United States, including the Hispanic/Latine population, and is a public health concern in Latin American countries. An emphasis on healthy dietary patterns, including the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets, has been suggested as they are associated with a lower incidence of CKD, slower CKD progression, and lower mortality in kidney failure. However, their applicability may be limited in people from Latin America. The Dieta de la Milpa (Diet of the Cornfield) was recently described as the dietary pattern of choice for people from Mesoamerica (Central Mexico and Central America). This dietary pattern highlights the intake of four plant-based staple foods from this geographical region, corn/maize, common beans, pumpkins/squashes, and chilies, complemented with seasonal and local intake of plant-based foods and a lower intake of animal-based foods, collectively classified into ten food groups. Limited preclinical and clinical studies suggest several health benefits, including cardiometabolic health, but there is currently no data concerning CKD. In this narrative review, we describe and highlight the potential benefits of the Dieta de la Milpa in CKD, including acid-base balance, protein source, potassium and phosphorus management, impact on the gut microbiota, inflammation, and cultural appropriateness. Despite these potential benefits, this dietary pattern has not been tested in people with CKD. Therefore, we suggest key research questions targeting measurement of adherence, feasibility, and effectiveness of the Dieta de la Milpa in people with CKD

Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis

Gastrointestinal symptoms (GIS) are common in patients with end-stage renal disease (ESRD) and are associated with nutritional risks resulting from low food intake. Little is known about the relationship between GIS and malnutrition in geriatric patients with ESRD. The main objective of this study was to determine the relationship between nutritional status and severity of GIS in geriatric patients on dialysis therapy. Clinically-stable geriatric patients (older than 60 years old) who were dialysis outpatients were included in this cross-sectional study. The severity of GIS was assessed using the Gastrointestinal Symptoms Questionnaire (GSQ, short version), with patients classified into three groups: mild, moderate, and severe. Nutritional status was evaluated with the Malnutrition Inflammation Score (MIS), anthropometric assessment, biochemical parameters, and bioelectrical impedance. Descriptive statistics were used and differences between groups were analyzed with ANOVA and Kruskal Wallis, with a p &lt; 0.05 considered to indicate significance. Fifty patients completed the study; the median age was 67 years old. Twenty-three patients were on hemodialysis (HD) and 27 were on peritoneal dialysis (PD). No significant differences were found according to dialysis modality, presence of diabetes, or gender. Ninety percent of patients had at least one GIS. Poorer nutritional status (evaluated by MIS) was related to a higher severity of GIS. There were no significant differences with other nutritional parameters. Our study showed a high prevalence of GIS in geriatric patients. There were no differences in observed GIS values that were attributed to dialysis modality, gender, or presence of type 2 diabetes mellitus (DM2). Severe GIS values were associated with poorer nutritional status determined by MIS, however, there was no association with anthropometry, biochemical values, or bioimpedance vector analysis

Food Sources of Sodium Intake in an Adult Mexican Population: A Sub-Analysis of the SALMEX Study

Excessive dietary sodium intake increases blood pressure and cardiovascular risk. In Western diets, the majority of dietary sodium comes from packaged and prepared foods (≈75%); however, in Mexico there is no available data on the main food sources of dietary sodium. The main objective of this study was to identify and characterize the major food sources of dietary sodium in a sample of the Mexican Salt and Mexico (SALMEX) cohort. Adult male and female participants of the SALMEX study who provided a complete and valid three-day food record during the baseline visit were included. Overall, 950 participants (mean age 38.6 ± 10.7 years) were analyzed to determine the total sodium contributed by the main food sources of sodium identified. Mean daily sodium intake estimated by three-day food records and 24-h urinary sodium excretion was 2647.2 ± 976.9 mg/day and 3497.2 ± 1393.0, in the overall population, respectively. Processed meat was the main contributor to daily sodium intake, representing 8% of total sodium intake per capita as measured by three-day food records. When savory bread (8%) and sweet bakery goods (8%) were considered together as bread products, these were the major contributor to daily sodium intake, accounting for the 16% of total sodium intake, followed by processed meat (8%), natural cheeses (5%), and tacos (5%). These results highlight the need for public health policies focused on reducing the sodium content of processed food in Mexico

In vitro validation of Quantitative Light-induced Fluorescence (QLF) for the diagnosis of enamel fluorosis in permanent teeth

The use of Quantitative Light-induced Fluorescence (QLF) for the diagnosis of enamel fluorosis has not been validated. This study aimed to validate QLF as a diagnostic tool for mild and moderate fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n=17), mild (TFI 1-2; n=69) and moderate (TFI 3-4; n=43) fluorosis. Fluorosis was then assessed with QLF using the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A ROC curve was conducted to determine QLF’s diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining a ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.Departamento Administrativo de Ciencia, Tecnología e Innovación [CO] Colciencias1308-569-34427Modelo de caracterización ambiental, epidemológica, clínico-histológica e inorgánica de la fluorosis dental en niñosn

Quantitative light fluorescence (QLF) assessment of mild and moderate enamel fluorosis in primary teeth

Enamel fluorosis affects both permanent and primary teeth; however, there are few studies on primary teeth. Fluorosis in primary teeth is difficult to diagnose for mild and moderate cases. Quantitative light-induced fluorescence (QLF) has been used for enamel fluorosis on the permanent dentition, but there are no current studies on primary fluorotic teeth. The purpose of this study was to assess mild to moderate enamel fluorosis in primary teeth using QLF. The buccal surfaces of exfolicated and extracted primary teeth (n=113) were visually examined and classified using the Thylstrup & Fejerskov Index (TFI) for fluorosis into categories TFI-0 to TFI-4. Fluorescence images were acquired. Image analysis was performed using the complete tooth surface (S) and through the selection of a Region of Interest (ROI), which was determined as the region where the fluorosis lesions were more representative and with at least a minimum of adjacent sound area. Area (mm2), fluorescence loss (%) and ΔQ (mm2×%) values were obtained. The correlation between QLF variables and visual diagnosis was determined using the Kendall-tau coefficient. Sencitivity, specificity, and Receiver Operating Characteristic analysis was performed for QLF versus visual diagnosis. Moderate to strong positive correlation was found between QLF and visual diagnosis using the ROI. QLF showed greater sensitivity and specificity for the diagnosis of mild fluorosis than moderate fluorosis and with the ROI analysis than with S. QLF was a useful tool for the assessment of mild and moderate fluorosis in primary teeth using a ROI analysis technique.Departamento Administrativo de Ciencia, Tecnología e Innovación [CO] Colciencias1308-569-34427Modelo de caracterización ambiental, epidemológica, clínico-histológica e inorgánica de la fluorosis dental en niñosn