Effects of Fetal Programming on Osteoporosis

This chapter deals with the bone metabolic syndrome programmed by fetal nutritional deprivation, and the effect of compensatory growth from over-feeding in early life. The prophylaxis and treatment of the resulting conditions of osteoporosis and osteopenia are complex processes and depend on multi-professional cooperation. Aspects of nutrition-dependant embryogenesis are discussed, together with the need for hormonal, vitamin and mineral supplementation in cases of pathological osteogenesis. Clinical examples are presented of nutritionally-deprived pregnant women during World War Two and the late effects of intrauterine malnutrition on the bone quality of their offspring. In addition, one case suggestive of transgenerational transfer is presented, with a woman who had been nutritionally deprived as a fetus later having a son who in early middle age began showing typical signs of fetal nutritional deprivation even though his own intrauterine nutrition had been normal. The public health issue of fetal nutrition and bone quality in peoples migrating from famine-affected backgrounds to developed countries is also raised

Plant-based diets to manage the risks and complications of chronic kidney disease

International audienceTraditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3-5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis