THE ROLE OF DIET FOR THE PRIMARY AND SECONDARY PREVENTION OF CAR-DIOVASCULAR DISEASE – TRADITIONAL DIETARY PATTERNS

Aterosklerotska kardiovaskularna bolest (CVD) ostaje vodeći uzročnik smrti za većinu rasnih/etničkih skupina. Dokle god stope pretilosti i dijabetesa tipa 2 nastave rasti, rasti će i teret CVD. Idealno CV zdravlje se promatra kroz sedam dimenzija: krvni tlak, fizička aktivnost, razina kolesterola i glukoze u krvi, prehrane, tjelesne mase i pušenja. Drugim riječima, CVD bi se trebale promatrati kao kompleksan entitet koji zahtijeva timski pristup primarnoj i sekundarnoj prevenciji. Prehrana je osnova svih oblika brige za CV zdravlje. Pacijenti s čimbenicima rizika imaju bolji ishod ako primaju njegu orijentiranu na pacijenta od strane multidisciplinarnog tima u odnosu na standardnu njegu. Ovaj je pristup posebice učinkovit u kontroli hipertenzije. Sve tehnike usmjerene na prehranu kako bi se snizila razina glukoze (restrikcija ener-getskog unosa, usvajanje redovitih obrazaca konzumacije obroka, promocija konzumacije hrane visoke nutritivne gustoće i dr.), uz promjenu životnih navika poglavito fokusiranih na fizičku aktivnost su posebice učinkoviti u pacijenata s dijabetesom tipa 2. Dok istraživanja konstantno potvrđuju superiornost mediteranske prehrane, sve više dokaza, posebice na djeci govori kako je mediteranska prehrana na rubu izumiranja. Pozitivni učinci polinezasićenim masnih kiselina (posebice iz ekstra djevičanskog maslinovog ulja i ribe), mliječnih proizvoda smanjenog udjela masti, tamno zelenog lisnatog povrća i cjelovitih žitarica na CV zdravlje su dobro poznati. Ipak, učinci idu daleko iznad prehrane pa se često ističe kako je mediteranski stil života ono što ustvari daje rezultate. Ipak, pitanje je možemo li mi kopirati taj stil života, možda ga malo adaptirati našim po-trebama? Ili, u okrilju globalnog pokreta samoodrživosti, možda bismo trebali početi tražiti imaju li naši tradicionalni načini prehrane osobine koje imaju pozitivan učinak na CV zdravlje.Atherosclerotic cardiovascular disease (CVD) remains the leading cause of death for people of most racial/ethnic groups. As long as obesity and type 2 diabetes rates continue to grow, so will the burden of CVDs. The ideal CV health is observed through seven domains: blood pressure, physical activity, cholesterol, diet, weight, smoking, and blood glucose. In other words, CVDs should be observed as a complex entity that requires a team-based approach for primary as well as secondary prevention. Diet represents pillar for every treatment focused on CV health. Patients with risk factors have better outcomes when they receive patient-centered care by a multidis-ciplinary team vs usual care. This approach is especially effective for the control of hypertension. All diet-centered techniques related to glucose-lowering effect (energy restrictions, establishing regular meal patterns, promoting nutrient-dense foods, etc.), along with lifestyle modifications focused on physical activity are especially effective in type 2 diabetics. While research evidence continuously emphasize superiority of the Mediterranean diet, more evidence, especially in children show that the Mediterranean diet is at the verge of existence. Benefits of polyun-saturated fatty acids (especially from extra virgin olive oil and fish), low-fat dairy, green leafy vegeta-bles and wholegrains on CV health are well documented. Still, the effect goes well beyond the diet and we underline that it is the Mediterranean lifestyle that works. But the question is whether we can copy this lifestyle, adapt it slightly to our way of life? Or, in the light of the global sustainability movement, maybe we should start looking whether our own, traditional dietary patterns have benefi-cial traits for CV health too

NUTRITION DURING PREGNANCY

The health of the new-born is largely a function of the mother\u27s nutritional, general and reproductive health status. Therefore, pregnancy is considered as a critical window in child’s growth and development. Several characteristics of a woman prior or in early pregnancy, as well as external, environmental factors affect pregnancy outcomes. External factors account for 30% of the pregnancy outcome and infant\u27s birth weight, and mother’s diet during pregnancy is one of the most important ones. General opinion is that pregnant women tend to change their dietary and lifestyle habits for better during pregnancy, and that they have diet of better quality which is more in relation with the recommendations, but the result from Croatia do not support these statements. Besides nutrition, advanced maternal age (35 years and older), pre-pregnancy body mass index (BMI), and excessive weight gain during pregnancy are all considered as important risk factors for pregnancy complications and adverse outcomes. Today pre-pregnancy overweight/obesity is considered as one of the most common high-risk obstetric situations, and Croatia is not an exception. Also, year after year the average age of pregnant woman in Croatia increases, as well as the number of pregnant women older than 35 years. Diet during pregnancy should complement pregnancy, especially since studies found that for example, a diet with 50% carbohydrate, together with the increase in energy intake during pregnancy will reduce their risk of both impaired glucose tolerance and gestational diabetes mellitus. More intensive educations of women of reproductive age are needed to reverse the current negative trends in demographic indicators, reproductive health, and in order to prevent the second generation obesity cases and obesity-related complications later in life

Iron Deficiency Anemia and Pregnancy

Iron deficiency is the most common nutritional deficiency in the world with immense public health consequences. It has a complex etiology and prolonged imbalance between dietary intake, absorption, and body needs which leads to iron deficiency anemia. If developed during pregnancy, it significantly alters pregnancy outcomes. Low birth weight is one of the main features, and those infants are at increased risk of developing anemia later in life. Along with widely recommended and practiced supplementation during pregnancy, proper combination of foods remain the best way for an optimal absorption of iron. Dietary iron is directly related to the total dietary energy intake, but depending on the type of its dietary source, maximum absorption is up to 40% of the total intake. Plant foods, the basis of everyday diet, contain significant number of dietary factors that inhibit iron absorption in the gut. Therefore, planning a well-balanced diet in order to achieve maximum absorption of iron from foods can be challenging. Pregnancy, especially its earliest period, is considered as the critical window in fetal programing, an ideal time frame to reduce risk factors for a number of health conditions in a newborn. Healthy pregnancy should be observed as a prerequisite for a healthier society

Magnezij iz perspektive javnog zdravstva

Magnesium is a cofactor in more than 300 enzymes, it plays a vital role in energy metabolism, homeostasis of electrolites, and bone metabolism, and regulates a number of fundamental functions such as muscle contraction, neuromuscular conduction, glycemic control, and blood pressure. Magnesium deficiency has been associated with a wide range of diseases, from cardiovascular diseases, hypertension, diabetes, to anxiety and other mental disorders, migraine and osteoporosis, and especially worrying is subclinical form which is estimated to affect up to 30% of the population. Recommended dietary intake of magnesium is 300 mg and 350 mg per day for adult males and females, respectively. While highly abundant in a variety of foods, especially green leafy vegetables, nuts and seeds, water is the main contributor to magnesium daily intake. Water has been the focus of a number of public health interventions aiming to improve magnesium status of populations, especially in Israel and Australia. Supplements are becoming a more important contributor to the total magnesium intake, especially among physically active individuals. Public awareness of the health benefits gained from physical activity is improving, and more individuals decide to engage in (recreational) physical activity. Even though physical activity increases the risk of magnesium deficiency, misuse of supplements due to lack of knowledge and misinformation shared on social networks can have a detrimental effect on individual’s health and physical performance.Magnezij je kofaktor za više od 300 enzima koji ima ključnu ulogu u energetskom metabolizmu, homeostazi elektrolita, metabolizmu kostiju te regulira brojne fiziološke procese kao što su kontrakcija mišića, neuromuskulatorne funkcije, kontrola glikemije i krvnog tlaka. Deficit magnezija predstavlja čimbenik rizika za cijeli niz zdravstvenih problema, od kardiovaskularnih bolesti, hipertenzije, dijabetesa, do anksioznosti i drugih mentalnih poremećaja, migrena i osteoporoze. Posebice zabrinjava subklinički oblik deficita magnezija za koji se procjenjuje kako pogađa do 30% populacije. Preporučeni unos magnezija za odrasle osobe je 300 mg za žene i 350 mg za muškarce. Iako je široko rasprostranjen u hrani, posebice tamno zelenom lisnatom povrću, orašastim plodovima i sjemenkama, najveći doprinos dnevnom unosu magnezija dolazi iz vode. Upravo je voda u fokusu javnozdravstvenih intervencija koje imaju za cilj poboljšati status magnezija u populaciji, posebice u Izraelu i Australiji. Dodaci prehrani postaju sve važniji izvor magnezija, posebice među tjelesno aktivim osobama. S porastom svijest javnosti o zdravstvenim dobrobitima fizičke aktivnosti raste i broj (rekreativno) tjelesno aktivnih osoba. Iako rizik od deficita magnezija raste s fizičkom aktivnošću, pogrešno uzimanje dodataka prehrani uslijed nedostatnog znanja i dezinformacija koje se dijele na društvenim mrežama, povećava se mogućnost za negativne posljedice na zdravlje i tjelesnu sposobnost

Students' attitudes on the quality of university teaching

The quality of university education is in focus recent years. It becomes not only the subject of research in areas closely related to education, but also becomes the topic of taught, writing and research interdisciplinary around the globe. Ensuring the quality of university education becomes global trend and a priority of modern society. On track of these settings our research has grown. The aim was to explore students’ attitudes on quality of university teaching via its criteria, to look at elements that affect quality, and to observe differences in attitudes between students from different faculties. The results based on a sample of 173 students from five faculties show that for creating conditions to ensure and raise quality of university teaching the biggest importance have: that the faculty was student’s first choice, the way contents would be presented, regular student’s participation in courses, and the positive social and emotional climate

COLORECTAL CARCINOMA AND NUTRITION – WHAT DOES THE EVIDENCE SAY?

Kolorektalni karcinom (CRC) ostaje treći najčešći karcinom globalno. Izdvaja se po svojoj iznimno visokoj povezanosti s prehranom. Istraživanja pokazuju kako životne i prehrambene navike nadilaze genetsku predispoziciju i dijagnozu upalne bolesti crijeva. Do sada je najjača pozitivna povezanost s CRC rizikom utvrđena za konzumaciju crvenog i procesiranog mesa te konzumaciju alkohola. Pretilost (udio masnog tkiva ukupno i abdominalno) također pokazuje jaku pozitivnu povezanost s rizikom za CRC, a povezana je i s agresivnijim tipom CRC-a kao i većom smrtnosti uslijed CRC. Iako visok unos voća i povrća pokazuju inverznu povezanost s CRC-om, u pušača ustvari povećavaju rizik od CRC-a. S druge strane, samo 30 minuta svakodnevne fizičke aktivnosti smanjuje rizik za CRC za 11%. Konzumacija cjelovith žitarica i prehrambenih vlakana općenito su najznačajniji zaštitni čimbenici povezani s prehranom. Za svakih 10 g prehrambenih vlakana na dan, rizik za CRC se smanjuje za 10% a učinak je nešto izraženiji u muškaraca. Rezultati istraživanja pokazuju značajan protektivan učinak unosa kalcija, iz mliječnih proizvoda i suplemenata, a čini se i kako bi vitamini D i C također mogli imati protektivnu ulogu. Nedavno je vitamin B12 predložen kao citoprotektor. Interesantno je što su neki od njegovih izvora u prehrani ujedno i najbolji izvori željeza, sugerirajući njegovu upletenost u bioraspoloživost željeza, najvažnijeg pro-kancerogenog nutrijenta. Trenutni dokazi o utjecaju prehrane i specifičnih nutrijenata na etiologiju i patogenezu CRC-a sugeriraju kako se radi o kompleksnoj interakciji između vremena prolaska hrane kroz probavni trakt, pH stolice, učestalosti konstipacije i intraluminalnoj izloženosti željezu.Colorectal cancer (CRC) remains the third most common cancer around the globe. It is distinctive for its strikingly high correlation with the diet. The evidence show that lifestyle and dietary habits overcome genetic predisposition and diagnosis of inflammatory bowel disease. So far, the strongest positive association with CRC risk has been found for intake of red and processed meat, and alcohol consumption. Body fatness, and abdominal fatness also show convincing evidence with increased risk for CRC and are associated with a more-aggressive CRC and higher risk of CRC mortality. While high intake of fruits and vegetables shows inverse association with CRC risk, in smokers it actually increases the risk of CRC. On the other hand, only 30 min of physical activity per day decreases the risk of CRC by 11%. Dietary factors that show the strongest positive effect are wholegrains and dietary fibers in general. Per every 10 g of fibers a day, the risk of CRC lowers by 10%, and the effect is stronger in men than women. Evidence support intake of calcium, from both dairy and supplements as highly protective, while intake of vitamin D and C may also act protectively. Recently, vitamin B12 has been proposed as cytoprotector. Interestingly, some of its dietary sources are also the best dietary sources of iron, suggesting its implications in iron’s bioavailability, the most important pro-carcinogenic nutrient. Current evidence regarding the role of diet and specific nutrients in etiology and pathogenesis of CRC suggest a complex interaction between the bowel transit time, pH of the stool, prevalence of constipation and intraluminal exposure to iron

POLYCYSTIC OVARY SYNDROME (PCOS) – PILOT STUDY ON DIET QUALITY

Introduction: Polycystic Ovary Syndrome (PCOS) is a complex gynecological and endocrinological disorder affecting 6% to 21% of reproductive age women. The main characteristics of PCOS include hyperandrogenism, irregular menstrual cycles, lack of ovulation, enlarged ovaries with numerous cysts and infertility. Symptoms vary widely between women, but most commonly include obesity, hyperinsulinemia and insulin resistance (approximately 65% to 70% of women with PCOS). Therefore, uniform therapy and dietary recommendations fail. Objective: The objective of this study was to analyze the quality of diet and dietary patterns of women with PCOS. Actual lifestyle habits and the diet of the women with PCOS have not been extensively researched internationally and never in Croatia. Methods: The study included women of reproductive age diagnosed with PCOS (N=12), recruited at the Gynecological Office Lončar, Karlovac, Croatia. Study participants completed a general questionnaire on socio-economic characteristics and two questionnaires regarding their gynecological health and PCOS symptoms. Anthropometry was measured (Seca) while biochemical data was provided by the gynecologist. Diet quality was assessed with a 24-hour dietary recall and quality of diet and exercise habits were assessed with a questionnaire developed specifically for this study. Results: Women with PCOS had an average daily energy intake of 82.3% of the RDA, i.e. 2333 kcal/day. When analyzing the contribution of separate macronutrients to that daily energy intake, discrepancies from the recommendations were found. The main discrepancies are high contribution of fats (40.1%) and increased intake of proteins (17.7%). Total fat intake showed a statistically significant positive correlation with waist circumference and waist to hips ratio. In addition, a statistically significant correlation was found between age and intake of total carbohydrates and plant proteins. Conclusion: Study findings show the potential for a larger-scale study on Croatian women with PCOS

THE USE OF VITAMIN D IN ASSISTED REPRODUCTIVE TECHNOLOGY PROCEDURES (ART) - CAN THE OCCURRENCE OF BREAST CANCER BE REDUCED?

Introduction: Vitamin D has crucial biological activity and antioxidative function involved in human reproduction. Lots of infertility patients worldwide have their children through assisted reproductive technology. Beside endogenous synthesis, it is possible and important to supplement vitamin D with diet. Vitamin D insufficiency is strongly connected with severe diseases, cancers, infertility. Studies have reported vitamin D insufficiency in up to 75% of women with diagnosed breast cancer and improvements in survival after diagnosis in women with higher level of vitamin D. Aim: The purpose of this narrative review was to elucidate the role of vitamin D in assisted reproductive technology (ART) procedures, prevention and reduction of breast cancer incidence providing current evidence from human studies. Materials and methods: The Medline database was searched using keywords vitamin D, breast cancer, fertility, supplementation, in vitro fertilization. The search was made as of April 10, 2023. Results and discussion: Majority of papers analysed show that vitamin D is important in achieving good quality embryos in procedures of medically assisted reproduction and through effects that are noticeable in endometrium vitamin D supplementation facilitates successful implantation of embryos. Research also shows that there is some elevated risk in developing breast cancer after those procedures, but some papers also show that there is no notable risk, so the results are inconclusive. We found that there is a general agreement that normal serum concentrations of vitamin D acts oncoprotective against breast cancer and may facilitate treatment on already developed cancer. Conclusion: For women with elevated risk for breast cancer, supplementation with vitamin D after medically assisted reproduction seem to have protective effect

IRRITABLE BOWEL SYNDROME PREVALENCE AND THE ROLE OF DIET IN ADULT POPULATION

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with a very strong psychosomatic component in the etiology. The prevalence is higher in women and many IBS patients say that food triggers their symptoms. The aim of this study was to determine the prevalence of IBS symptoms (GSRS-IBS questionnaire) and the role of diet and dietary habits on IBS symptoms in adults. An observational online study with the study-specific questionnaire was completed by 109 adults (84.4% women, 15.6% men), average age 26 years (21-63 years). 12.8% of study participants had high IBS score (44-75 points). Participants with high IBS score tend to overeat (93.0% sometimes, 7.0% always) and skip meals (36.0%) which was proven to worsen IBS symptoms. Coffee consumption also worsens IBS symptoms, as well as the consumption of all drinks (without water) and sweets. IBS score was higher in participants who said that some food provokes symptoms. Beans (lentil, pea, bean) were proven to increase the risk for high IBS score, while strong spices (soup cube, chilli, curry) increase the risk of high IBS only in women (univariate logistic regression)