A Dietary Assessment of Mid-Spectrum Chronic Kidney Disease

Diets of adult individuals with mid-spectrum (stages III and IV) Chronic Kidney Disease (CKD) remain understudied. The 2015-2020 Dietary Guidelines for Americans food patterns based on the Recommended Dietary Allowances (RDA) in concert with the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines are advised to individuals with CKD. Estimated glomerular filtration rate (eGFR) remains the best method for tracking CKD progression, yet relationships between self-reported dietary intake and eGFR are understudied. PURPOSE: To assess the self-reported dietary pattern in patients with stage III or IV CKD in contrast to the RDA and NKF KDOQI dietary guidelines and to identify correlates of eGFR. METHODS: Twenty participants with stage III or IV CKD [n = 6 male (M); n = 14 female (F)]; age 62.0 ± 9.9 years; weight 80.9 ± 16.2 kg; body fat 37.3 ± 8.5% of weight; eGFR 51.5 ± 6.82 mL/min/1.73m2) completed self-reported dietary assessments for an average of 5 days. Diet was assessed using the ESHA Food Processor Software, Version 11.1. Micro- and macronutrient analyses for males and females were compared to the RDA and NKF KDOQI guidelines to identify malnutrition. T-tests were used to test the difference in eGFR between genders and bivariate correlation analyses were used to identify correlates of eGFR, p-values were considered significant at the α = 0.05 level. RESULTS: On average, all subjects met the RDA and NKF KDOQI guidelines for caloric intake. Average consumption of saturated fat (F = 24.3 ± 10.8g, M = 34.1 ± 6.0g), sodium (F = 3780 ± 2510mg, M = 4210 ± 386mg) and protein (F = 65.0 ± 23.5g, M = 107.3 ± 27.3g) was higher than the recommendations while the average consumption of fiber (F = 13.6 ± 4.1g, M = 14.8 ± 7.3g), calcium (F = 573 ± 325mg, M = 720 ± 224mg), potassium (F = 240 ± 1800mg, M = 940 ± 492mg) and phosphorous (F = 628 ± 1320mg, M = 425 ± 314mg) was low. On average, males had a higher eGFR than females (t = -2.40, p = 0.03). Age, body fat percentage, weight, cholesterol, calcium intake, protein intake, and daily caloric intake were not found to be significantly correlated with eGFR. CONCLUSION: When compared to the RDA and NKF KDOQI guidelines, individuals with mid-spectrum CKD had poor nutritional quality. Female gender was correlated with reduced eGFR. Future interventions in individuals with mid-spectrum CKD should look to improve diet quality to align with clinical guidelines and prevent progression to end-stage renal disease

Impact of Acute Dietary Manipulations on Dual-Energy X-ray Absorptiometry Estimates of Visceral Adipose Tissue

Dual-energy x-ray absorptiometry (DXA) is viewed as a superior method of body composition assessment, but whole-body DXA scans are impacted by variation in pre-assessment activities, such as eating and drinking. DXA software now allows for estimation of visceral adipose tissue (VAT), which has been implicated in a number of diseases. It is unknown to what extent food and fluid intake affect VAT estimates. PURPOSE: determine the effects of acute high-carbohydrate (HC) and very low-carbohydrate (VLC) diets on DXA estimates of VAT. METHODS: Male and female adults completed two one-day dietary conditions in random order: a VLC diet (1 – 1.5 g CHO/kg) and a HC diet (9 g CHO/kg). The diets were isocaloric to each other, and all food items were provided to participants. DXA scans were conducted in the morning after an overnight fast and in the afternoon soon after the third standardized meal. VAT volume, mass, and area were obtained, and paired samples t-tests were performed to compare the changes in VAT measures between diets. RESULTS: Fifteen males (age 22 ± 3, BF% 21 ± 5%) and eighteen females (age 21 ± 2, BF% 31 ± 5%) were included in the analysis. The change in VAT volume between the fasted and fed visits was different between diets (HC: +1.6%; VLC: -9.2%, p= 0.047). There were also trends for differences in VAT mass (p= 0.089) and area (p= 0.096) changes between diets. CONCLUSIONS: Within a single day, VAT estimates are differentially affected by isocaloric HC and VLC diets, with VLC consumption leading to reductions in VAT estimates. The content of the diet on the day of a DXA scan can affect estimates of VAT, which could spuriously influence the categorization of an individual’s health risk by DXA VAT estimates. Standardization of food intake prior to scans, preferably in the form of an overnight fast, should be employed to eliminate this important source of error

Renal Function Responses to Steady-State Moderate-Intensity and High-Intensity Interval Exercise in Mid-Spectrum Chronic Kidney Disease

Efficacy of exercise to improve renal function remains understudied in adults with mid-spectrum chronic kidney disease (CKD). In addition, a comparison of steady-state exercise (SSE) and high-intensity interval exercise (HIIE) may contribute clinically-relevant information for exercise-related augmentation of renal function in mid-spectrum CKD. PURPOSE: To determine the influence of SSE and a comparable amount of HIIE on indicators of post-exercise renal function in patients diagnosed with secondary Stage 3 or 4 CKD. METHODS: Twenty participants (n = 6 men; n = 14 women; age 62.0 + 9.9 yr; weight 80.9 + 16.2 kg; body fat 37.3 + 8.5% of weight; VO2max 19.4 + 4.7 ml/kg/min) completed 30 min of SSE at 65% VO2reserve or HIIE by treadmill walking (90% and 20% of VO2reserve in 3:2 min ratio) in a randomized crossover design. Both exercise conditions averaged ~ 65% VO2reserve. Blood and urine samples were obtained by the same technician under standardized conditions just before, 1hr and 24hrs after exercise. Serum creatinine (sCR), urine epidermal growth factor ratio (uEGFr), cystatin C and estimates of glomerular filtration rate - modification of diet in renal disease (MDRD) and the CKD-EPI - responses were analyzed using 2 (condition) by 3 (sample point) repeated measures ANOVAs. RESULTS: sCR decreased from 1.45 + 0.05 pre-exercise to 1.26 + 0.05 mg/dl (-13%) 1hr after exercise and returned to pre-exercise levels by 24hr (p = 0.009). Both MDRD and CKD-EPI estimates of glomerular filtration rate were 16 to 19% higher at 1hr, returning to pre-exercise values by 24hrs after exercise. The MDRD estimate increased from 43.1 + 1.9 pre-exercise to 50.3 + 2.1 ml/min/1.73m2 1hr after exercise (p = 0.007) and CKD-EPI from 45.2 + 2.1 to 53.8 + 2.4 ml/min/1.73m2 at 1hr post-exercise (p = 0.009). Relative to pre-exercise measures, uEGFr remained stable with SSE but was 5.4% greater 24hr after HIIE (p = 0.052). Cystatin C remained stable in the hours after exercise (p \u3e 0.05). CONCLUSION: By clinical estimates, renal function was not normalized but transiently improved with SSE and HIIE in mid-spectrum CKD

The Influence of Age and Cardiorespiratory Fitness on Cardiac Autonomic Modulation. A Pilot Study.

Maximal rate of oxygen consumption (VO2max) is traditionally viewed as the gold standard of determining cardiorespiratory fitness (CF) in healthy and diseased populations. CF has a significant influence on the improvement of cardiac autonomic modulation (CAM) and the risk of morbidity and mortality rates. Heart rate variability (HRV) is a non-invasive way to assess CAM. Age is another factor that influences CAM and CF in healthy and diseased populations. However, what is not fully elucidated, is if CF is maintained at a high level throughout adulthood, will CAM remain relatively unchanged. PURPOSE: To determine if age and CF are significantly correlated to variables of HRV to determine CAM in healthy fit individuals. METHODS: Twenty-two healthy individuals (n = 14 male; n = 8 female, Age 33.2 ± 11.8 years, %BF 18.3 ± 6.0, VO2max 42.0 ± 6.2 ml/ /kg/min) completed a single health assessment to quantify CF and HRV. HRV was measured for 5 mins in the supine position and during a standard VO2max test using an elastic belt and Bluetooth monitor (Polar H7). CardioMood software was used to process HRV variables high frequency (HF), low frequency (LF), total power (TP) were assessed for frequency domain, and standard deviation of all NN intervals (SDNN) and the square root of the mean of the squares of successive R-R interval differences (RMSSD) for the time domain. Pearson correlation was used to check associations between age and CF, and CAM. Multiple regression was implemented to determine if there were any differences in HRV variables in relation to age and VO2max. A paired sample t-test was used to determine changes in HRV variables from rest to VO2max. All analyses were performed using SAS (v.9.3). RESULTS: HRV variables were significantly altered from rest to VO2max (p \u3c 0.05). HRV time and frequency domain variables were not significantly correlated to age and CF level (p \u3e 0.05). The multiple regression analysis indicated that the only significance was max heart rate is 0.642 bpm lower during exercise for each 1-year increase in age (p = 0.035). CONCLUSION: The analysis of pilot data focused on determining the impact of CF and age on CAM appears not to be significantly correlated when utilizing HRV. However, due to the project\u27s continuation and further data collection, significant outcomes may still be observed

Influence of Acute Turkesterone Dosing on Serum Insulin-like Growth Factor 1 (IGF-1) and Subjective Digestibility Scores in Recreationally-active Males

Turkesterone is a relatively novel phytoecdysteroid compound that has become increasingly popular amongst recreationally active demographics. Despite prior in vitro data suggesting that this compound may support enhanced body composition via both insulin-like growth factor 1 (IGF-1)-mediated protein synthesis, no human evidence exists in this regard nor how well its digestibility is tolerated. PURPOSE: To determine the effect of multiple turkesterone doses on serum IGF-1 and to report any gastrointestinal (GI) distress symptoms in a healthy human sample. METHODS: Eleven recreationally active males (23.3±2.2y) visited the laboratory on three occasions separated by at least seven days and were randomized in single-blind, placebo-controlled, and counter-balanced crossover fashion to either 2000mg cellulose placebo (PLA), 1000mg turkesterone + 1000mg placebo, (1000T) or 2000mg (2000T) turkesterone. Venous blood was sampled to determine serum IGF-1 concentrations and a GI distress questionnaire was (nausea, vomiting, heartburn symptoms, etc.) administered both at baseline (PRE), as well as 3-hours (POST3H) and 24-hours (POST24H) post-acute supplementation at each visit. Serum IGF-1 was analyzed using a two-way (condition [PLA, 1000T, 2000T] x time [PRE, POST3H, POST24H]) ANOVA with repeated measures at a significance level of pRESULTS: Analyses failed to reveal any significant condition (p=.180; ηp2=0.228), time (p=0.227; ηp2=.390), nor interaction effects (p=0.547; ηp2=0.211) for serum IGF-1. Moreover, no participants reported any GI distress symptoms across any condition and/or time permutation. CONCLUSION: Although the current study did not find any significant IGF-1-associated serum alterations to multiple acute turkesterone doses in the times assessed, there were fortunately no adverse GI symptoms experienced by the participants across any dose throughout the investigation. Nevertheless, these data support turkesterone supplementation is well tolerated and thus future research should build upon our analysis by employing a longitudinal supplementation regimen alongside an exercise intervention to elucidate the potential long-term and anabolism-permissive impacts of this compound on the presently-explored and additional associated parameters

Acute Responses in Agonists of uEGF to Moderate-Intensity and High-Intensity Interval Exercise in Mid-Spectrum CKD

Urine epidermal growth factor (uEGF) is a novel biomarker utilized in assessing renal health in various renal diseases, specifically chronic kidney disease (CKD). uEGF promotes multiple intracellular pathways, stimulating renal cell growth, survival, and replication. uEGF production is activated by multiple agonists that bind to the uEGF receptor. Aerobic exercise initiates the upregulation of several of these agonists to increase the production of uEGF. Depending on the mode and intensity of aerobic exercise, uEGF agonists may activate differently in CKD populations. PURPOSE: To determine the influence of an acute bout of steady-state exercise (SSE) and high-intensity interval exercise (HIIE) on concentrations of uEGF agonists (serum insulin-like growth factor 1 (IGF-1), angiotensin II receptor type 1 (AGTR-1), and transforming growth factor beta 1 (TGF-β1)) in mid-spectrum CKD. METHODS: Twenty participants (n = 6 men; n = 14 women; age 62.0 + 9.9 yr; weight 80.9 + 16.2 kg; body fat 37.3 + 8.5% of weight; VO2max 19.4 + 4.7 ml/kg/min) completed 30 min of SSE at 65% VO2reserve or HIIE by treadmill walking (90% and 20% of VO2reserve in 3:2 min ratio) in a randomized crossover design. Both exercise conditions averaged ~ 65% VO2reserve. Blood and urine samples were obtained under standardized conditions just before, 1hr, and 24hrs after exercise. uEGF (ng/mL), serum IGF-1 (ng/mL), AGTR-1 (ng/mL), and TGF-β1 (pg/mL) responses were analyzed using 2 (condition) by 3 (sample point) repeated measures ANOVAs and Pearson Correlations. RESULTS: Serum IGF-1 and AGTR-1 increased 1hr and 24hr post-exercise in both exercise conditions; however, statistical significance was not achieved (p = 0.28 and p = 0.09). Similarly, serum TGF-β1 decreased at 24hrs in both exercise conditions but statistically remained unaltered (p = 0.42). IGF-1 was significantly correlated to uEGF in both conditions at all three-time points (p = 0.03), while AGTR-1 was significantly correlated to uEGF at 1hr in HIIE. uEGF findings were previously reported in ACSM abstract (DOI: 10.1249/01.mss.0000560710.72569.11). CONCLUSION: Agonists of uEGF remained unaltered following an acute bout of SSE and HIIE in mid-spectrum CKD. Further research is needed to understand better uEGF response activation to aerobic exercise in mid-spectrum CKD

Cardiorespiratory and Biomechanical Changes with Hippotherapy in Children with and without Cerebral Palsy

Hippotherapy utilizes the rhythmic movement of the horse to improve functional abilities and quality of life of individuals with neurological impairments. Little is known regarding the changes in body segment kinematics and cardiovascular responses of the rider due to the therapy. A change in the magnitude of pelvic displacement (PD) may allow those who use the therapy to more easily perform activities of daily living. Also, reduced cardiovascular stress to similar physical activities may be an important, but overlooked, therapeutic benefit of hippotherapy. The purpose of this study was to characterize PD and cardiorespiratory (CR) responses to simulated horseback riding (SHR) and walking in children with minimal-to-moderate spastic cerebral palsy (CP) before and after eight weeks of hippotherapy. These results were compared to healthy children undergoing the same protocol. Our hypothesis was that eight weeks of hippotherapy would elicit an increase in PD and reduced CR response during SHR and treadmill walking in children with CP. Eight children with CP (1 female, 7 males; 10 + 4 years of age; height 54 + 10 in; weight 70.2 + 34.3 lb) and eight healthy children (5 females, 3 males; 11 + 2 years of age; height 59 + 6 in; weight 104.6 + 33.4 lb) underwent similar hippotherapy training. Before and after the intervention, both groups completed simulated horseback riding (SHR) at an intensity approximating a fast walk (0.65 Hz) and walked on a treadmill (1 mph, 0% grade). PD along the anterior-posterior, superior-inferior and medial-lateral axes and HR, VO2, VE, SBP, and DBP were measured at steady-state exercise. Mean arterial pressure and rate pressure product were calculated. Prior to hippotherapy, PD was increased in healthy children (p = 0.032) but CR responses were similar in both groups during SHR (p \u3e 0.05 for all). Treadmill walking elicited greater PD and CR responses compared to SHR in both groups and significantly greater responses in CP compared to healthy children (p \u3c 0.05 for all). Eight weeks of hippotherapy did not alter acute responses. Our findings demonstrate treadmill walking at 1 mph elicits greater PD and CR responses than SHR. The walking responses are more pronounced in children with CP compared to healthy children. Observable cardiovascular adaptations or kinematic changes in children with CP are unaffected by short-term hippotherapy training

Demography and Dispersal Ability of a Threatened Saproxylic Beetle: A Mark-Recapture Study of the Rosalia Longicorn (Rosalia alpina)

The Rosalia longicorn or Alpine longhorn (Coleoptera: Cerambycidae) is an endangered and strictly protected icon of European saproxylic biodiversity. Despite its popularity, lack of information on its demography and mobility may compromise adoption of suitable conservation strategies. The beetle experienced marked retreat from NW part of its range; its single population survives N of the Alps and W of the Carpathians. The population inhabits several small patches of old beech forest on hill-tops of the Ralska Upland, Czech Republic. We performed mark-recapture study of the population and assessed its distribution pattern. Our results demonstrate the high mobility of the beetle, including dispersal between hills (up to 1.6 km). The system is thus interconnected; it contained ∼2000 adult beetles in 2008. Estimated population densities were high, ranging between 42 and 84 adult beetles/hectare a year. The population survives at a former military-training ground despite long-term isolation and low cover of mature beech forest (∼1%). Its survival could be attributed to lack of forestry activities between the 1950s and 1990s, slow succession preventing canopy closure and undergrowth expansion, and probably also to the distribution of habitat patches on conspicuous hill-tops. In order to increase chances of the population for long term survival, we propose to stop clear-cuts of old beech forests, increase semi-open beech woodlands in areas currently covered by conifer plantations and active habitat management at inhabited sites and their wider environs