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

Ghrelin and its potential in the treatment of eating/wasting disorders and cachexia

The gastrointestinal “hunger” hormone ghrelin is the only known circulating peripheral molecule with the ability to decrease body fat utilization and to increase body weight gain. Accordingly, due to ghrelin’s effects to promote food intake while decreasing energy expenditure ghrelin may offer potential as a drug for treatment of eating/wasting disorders and cachexia. Therapeutic potential of ghrelin and ghrelin analogues to promote food intake and body weight gain was recently indicated in several clinical studies. The recent discovery of the ghrelin O-acyltransferase as the key enzyme responsible for ghrelin acylation has further deepened our understanding of ghrelin activation, thereby paving the way for more efficient targeting of the ghrelin pathway. Here, we summarize the current knowledge pertaining to the potential of the endogenous ghrelin system as a drug target for the treatment of eating/wasting disorders and cachexia

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders

A Quantitative Analysis of Social Capital in Mexico

Social capital has been related to efiiciency in markets (Arrow, 1972), contract reinforcement (Durlauf and Fafchamps, 2004) and in general to development and welfare (Keefer and Knack 1997; Putnam 2000; Knack and Zak 2003). In this paper we empirically investigate the determinants of social capital, focusing on three common approximate measures of it: two related to trust, and one related to social organisation memberships. Using data for urban areas in Mexico for the year 2006, we find that social capital measured as trust and membership increases with age, and with the perception of higher levels of social capital in the environment; it also tends to be higher in smaller communities, and is different across regions of the country. On the other hand, social capital measured as trust decreases with segregation, while social capital measured as membership increases with education and income, but decreases with the lack of social security

Trust and social capital: evidence for Mexico

Desde la perspectiva económica la confianza entre los miembros de una sociedad está asociada al funcionamiento eficiente de los mercados, al reforzamiento de contratos y, en general, a la capacidad para generar desarrollo y bienestar. En este artículo exploramos empíricamente los determinantes de la confianza en México, en particular, aislamos la relación entre dos medidas de capital social, una para el individuo y otra para su entorno. Nuestros resultados muestran que la confianza aumenta con estas medidas de capital social y con ausencia de segregación es mayor en comunidades pequeñas, a mayor edad y para habitantes del centro-occidente, entre otras.</jats:p

La succession de los bienes vinculados, es uno de los assuntos mas comunes ... no son muy antiguos los mayorazgos en España ... La defensa de esta Causa ... no puede tocar muy de lleno à Don Manuel Maria Gaytan de Ayala, num.21. y quando la padezca ... no ha de ser tan infeliz, que alcance à Don Manuel Joseph su padre ... todos los defensores hemos reducido la dificultad à dos puntos: el de Don Manuel Joseph pretende persuadir, que entre el Mayorazgo litigioso, y el de Villafranca, no hay incompatibilidad alguna ... Los demás solicitan ... se reconozca la incompatibilidad ...

Tít. tomado do comenzo do textoTexto asinado polo "Doct. Pedro Manuel de Soldevilla y Saz"A data que figura no v. da f. 1 e 1642, pero outros imp. asinados polo mismo licenciado están datados aproximadamente entre 1766 e 1790Sign.: A\p8\

Health Benefits of Mango By-products

Nearly half of all tropical fruits produced worldwide are mangoes (Mangifera indica L.) and their net production is expected to grow steadily in the next two decades; this is a result of improved agro-industrial methods, the marketing of new varieties, and their demand by health-conscious consumers. However, during their agronomic-to-industrial processing, vast amounts of nonedible wastes (e.g. leaves and barks) and by-products (e.g. peels, seeds, and bagasse) are generated, not only causing significant environmental impact but also economic losses. Conventional recovery methods offer eco-friendly solutions (e.g. soil bioremediation and livestock feeding) but novel technologies are more profitable, sustaining their continuous growth on the fact that many mango phytochemicals can be recovered from these industrial residues for the cosmetic, food, and nutraceutical industries. For instance, mango peel and bagasse are rich sources of dietary fiber (pectin/cellulose), carotenoids, and phenolic compounds with proven benefits for cardiovascular, type 2 diabetes, metabolic syndrome, and cancer, while mango seed is a rich source of vegetable oil (stearic/oleic), proteins, and macromolecular antioxidants with antibiotic potential. In this chapter, we review the nutritional and functional value of mango by-products, their bio-efficacy, and related nutraceutical mechanisms