A trial to evaluate the effect of the sodium–glucose co‐transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA‐HF)

Background: Sodium–glucose co‐transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. Design and methods: The Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF) is an international, multicentre, parallel group, randomized, double‐blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i.e. an urgent heart failure visit) or cardiovascular death. Patients with and without diabetes are eligible and must have a left ventricular ejection fraction ≤ 40%, a moderately elevated N‐terminal pro B‐type natriuretic peptide level, and an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2. The trial is event‐driven, with a target of 844 primary outcomes. Secondary outcomes include the composite of total heart failure hospitalizations (including repeat episodes), and cardiovascular death and patient‐reported outcomes. A total of 4744 patients have been randomized. Conclusions: DAPA‐HF will determine the efficacy and safety of the SGLT2 inhibitor dapagliflozin, added to conventional therapy, in a broad spectrum of patients with heart failure and reduced ejection fraction

The Effect on HbA1c of intake of Lactobacillus acidophilus & Bifidobacterium lactis in individuals with type 2 diabetes mellitus.

Titel: Effekt på HbA1c vid intag av probiotikastammarna Lactobaciullus acidophilus & Bifidobacterium lactis hos individer med typ 2 diabetes mellitus. Författare: Mathilda Forsby & Petra Sjöholm Handledare: Anna Winkvist Examinator: Frode Slinde Linje: Dietistprogrammet, 180/240 hp Typ av arbete: Självständigt arbete i klinisk nutrition, 15 hp Datum: 2018-03-27 Bakgrund Diabetes är en kronisk sjukdom med utbredning över hela världen, i Sverige är prevalensen 4-5 %. Typ 2 diabetes är den vanligaste formen av diabetes och sjukdomen kan leda till allvarliga komplikationer. HbA1c används som mått för att utvärdera effekten av diabetesbehandling. Probiotika är enligt WHO levande organismer som vid intag kan förbättra hälsan. Tidigare studier indikerar att det kan ha gynnsam effekt på diabeteskontroll. Syfte Syftet med denna systematiska översiktsartikel var att granska tillgänglig vetenskaplig litteratur om huruvida det finns belägg för att probiotika i form av en kombination av Lactobaciullus acidophilus La-5 och Bifidobacterium lactis Bb-12 kan rekommenderas för en förbättrad glukoskontroll hos vuxna personer med diabetes mellitus typ 2. Sökväg Litteratursökningen gjordes i databaserna PubMed, Scopus och Cochrane. Urvalskriterier RCT, humanstudier, studier på svenska och engelska, personer med diabetes typ 2, vuxna mellan 18 och 70 år, probiotikasupplementering med en kombination av stammarna Lactobacillus acidophilus La- 5 och Bifidobacterium lactis Bb-12. Exklusionskriterier var studier gjorda på barn, gravida, personer >70 år, insulinbehandlad diabetes samt andra sjukdomar än diabetes typ 2. Datainsamling och analys Totalt tre studier granskades med hjälp av “Mall för kvalitetsgranskning av randomiserade studier” från SBU. Studierna bedömdes ha medelhög och hög studiekvalitet. Vidare användes mallen “Underlag för sammanvägd bedömning enligt GRADE” från Göteborgs universitet, för att bedöma evidensstyrkan för valt effektmått; HbA1c. Resultat Evidensstyrkan för valt effektmått, HbA1c, bedömdes vara måttlig (+++). Efter sex till åtta veckor med intag av probiotikastammarna Lactobacillus acidophilus La- 5 och Bifidobacterium lactis Bb-12 kunde man se en signifikant förbättring av HbA1c mellan interventionsgrupp och kontrollgrupp. Slutsats Det finns måttlig evidens för att HbA1c minskas vid intag av en kombination av probiotikastammarna Lactobaciulls acidophilus La-5 och Bifidobacterium lactis Bb-12. Nyckelord: Probiotika, diabetes mellitus typ 2, HbA1c, Lactobaciullus acidophilus, Bifidobacterium lactisTitle: The Effect on HbA1c of intake of Lactobacillus acidophilus & Bifidobacterium lactis in individuals with type 2 diabetes mellitus. Author: Mathilda Forsby & Petra Sjöholm Supervisor: Anna Winkvist Examiner: Frode Slinde Programme: Programme in dietetics, 180/240 ECTS Type of paper: Bachelor’s thesis in clinical nutrition, 15 higher education credits Date: May 27, 2018 Background Diabetes is a chronic disease spreading across the world, the prevalence in Sweden is 4- 5%. The most common form is type 2 diabetes, which can have serious complications. HbA1c is a marker used to evaluate the long-term effect of diabetes treatment. According to WHO, probiotics are living organisms which, when consumed, can improve health. Prior research indicate that probiotics may have beneficial effects on controlling diabetes. Objective The aim of this systematic review was to evaluate available scientific evidence of whether a combination of Lactobacillus acidophilus La-5 and Bifidobacterium lactis Bb-12 could improve glucose control in individuals with type 2 diabetes and thus be recommended. Search strategy Literature searches were performed in PubMed, Scopus and Cochrane. Selection criteria RCT, human studies, in Swedish and English, individuals with type 2 diabetes, adults between 18 and 70 y/o, probiotic supplementation of the combination Lactobacillus acidophilus La-5 and Bifidobacterium Bb-12. Exclusion criteria were research performed on children, pregnant, individuals > 70 y/o, diabetes currently treated with insulin and additional diseases other than type 2 diabetes. Data collection and analysis Three articles were examined using the template for quality assessment of randomized trials provided by SBU, which were deemed moderately high or high quality. Further, the GRADE template designed to estimate the collective study quality provided by Gothenburg university was used to evaluate the strength of evidence for the endpoint measurement, HbA1c. Main results Evidence for lowering HbA1c was considered moderate (+++). An intake of Lactobacillus acidophilus La-5 and Bifidobacterium lactis Bb-12 resulted in a significant improvement of HbA1c between intervention groups and control groups after an intake for six to eight weeks. Conclusions There is moderate evidence suggesting a reduction in HbA1c with intake of a combination of Lactobacillus acidophilus La-5 and Bifidobacterium Bb-12. Keywords: Probiotika, diabetes mellitus typ 2, HbA1c, Lactobaciullus acidophilus, Bifidobacterium lacti

Nutritional intake and determinants of nutritional quality changes from pregnancy to postpartum—a longitudinal study

Nutrient requirements vary across the reproductive cycle, but research on changes in nutritional intake and quality from pregnancy to beyond the lactation period is limited. Thus, we aimed to study nutritional intake and quality changes, among Swedish pregnant participants from late pregnancy to 18 months postpartum and to study the determinants of nutritional quality changes. Participants (n = 72) were studied longitudinally from the third trimester of pregnancy and postpartum (2 weeks 4, 12, and 18 months postpartum). At each visit, participant characteristics and 4-day food diaries were collected. Nutritional quality was assessed by energy adjusted Nutrient Rich Food Index 11.3. Linear mixed models were used to analyze the determinants of change in nutritional quality. Intakes of carbohydrate energy percentage (E%), fiber, vitamin A, vitamin C, and potassium were higher in the third trimester compared to postpartum, whereas intakes of E% protein and monounsaturated fat were lower. Adherence to recommended intakes was low at all study visits for saturated fat (4%–11%), fiber (15%–39%), vitamin D (8%–14%), folate (0%–2%), and iron (6%–21%). Overall, nutritional quality did not differ significantly from third trimester to postpartum. Shorter duration (<4 months) of lactation was negatively related to nutritional quality changes, whereas higher age was positively related to changes. In conclusion, nutritional intake from pregnancy to postpartum changed, whereas quality remained relatively stable, with age and lactation duration as determinants. Identification of people at risk of adverse dietary changes from pregnancy to the postpartum period should be further addressed in future larger and more diverse study populations

Does the food processing contaminant acrylamide cause developmental neurotoxicity? A review and identification of knowledge gaps

There is a worldwide concern on adverse health effects of dietary exposure to acrylamide (AA) due to its presence in commonly consumed foods. AA is formed when carbohydrate rich foods containing asparagine and reducing sugars are prepared at high temperatures and low moisture conditions. Upon oral intake, AA is rapidly absorbed and distributed to all organs. AA is a known human neurotoxicant that can reach the developing foetus via placental transfer and breast milk. Although adverse neurodevelopmental effects have been observed after prenatal AA exposure in rodents, adverse effects of AA on the developing brain has so far not been studied in humans. However, epidemiological studies indicate that gestational exposure to AA impair foetal growth and AA exposure has been associated with reduced head circumference of the neonate. Thus, there is an urgent need for further research to elucidate whether pre- and perinatal AA exposure in humans might impair neurodevelopment and adversely affect neuronal function postnatally. Here, we review the literature with emphasis on the iden-tification of critical knowledge gaps in relation to neurodevelopmental toxicity of AA and its mode of action and we suggest research strategies to close these gaps to better protect the unborn child

Does the food processing contaminant acrylamide cause developmental neurotoxicity? A review and identification of knowledge gaps

There is a worldwide concern on adverse health effects of dietary exposure to acrylamide (AA) due to its presence in commonly consumed foods. AA is formed when carbohydrate rich foods containing asparagine and reducing sugars are prepared at high temperatures and low moisture conditions. Upon oral intake, AA is rapidly absorbed and distributed to all organs. AA is a known human neurotoxicant that can reach the developing foetus via placental transfer and breast milk. Although adverse neurodevelopmental effects have been observed after prenatal AA exposure in rodents, adverse effects of AA on the developing brain has so far not been studied in humans. However, epidemiological studies indicate that gestational exposure to AA impair foetal growth and AA exposure has been associated with reduced head circumference of the neonate. Thus, there is an urgent need for further research to elucidate whether pre- and perinatal AA exposure in humans might impair neurodevelopment and adversely affect neuronal function postnatally. Here, we review the literature with emphasis on the iden-tification of critical knowledge gaps in relation to neurodevelopmental toxicity of AA and its mode of action and we suggest research strategies to close these gaps to better protect the unborn child