Drug/Xenobiotic-Metabolism, Disposition and Toxicity in Malnutrition

The role of malnutrition and diet in general on bioprocess, which govern the fate of drug/xenobiotic in the body only just beginning to be understood. Absorption, protein binding distribution, bio-transformation and renal elimination of xenobiotics/drugs are all affected by altered states of nutrition. As such, evaluation of nutritional status is highly relevant prior to prolonged drug thereby especially with drugs having narrow safety margin

Traditional Indian spices and their health significance

India has been recognized all over the world for spices and medicinal plants. Both exhibit a wide range of physiological and pharmacological properties. Current biomedical efforts are focused on their scientific merits, to provide science-based evidence for the traditional uses and to develop either functional foods or nutraceuticals. The Indian traditional medical systems use turmeric for wound healing, rheumatic disorders, gastrointestinal symptoms, deworming, rhinitis and as a cosmetic. Studies in India have explored its anti-inflammatory, cholekinetic and anti-oxidant potentials with the recent investigations focusing on its preventive effect on precarcinogenic, anti-inflammatory and anti atherosclerotic effects in biological systems both under in vitro and in vivo conditions in animals and humans. Both turmeric and curcumin were found to increase detoxifying enzymes, prevent DNA damage, improve DNA repair, decrease mutations and tumour formation and exhibit antioxidative potential in animals. Limited clinical studies suggest that turmeric can significantly impact excretion of mutagens in urine in smokers and regress precancerous palatal lesions. It reduces DNA adducts and micronuclei in oral epithelial cells. It prevents formation of nitroso compounds both in vivo and in vitro. It delays induced cataract in diabetes and reduces hyperlipidemia in obese rats. Recently several molecular targets have been identified for therapeutic/preventive effects of turmeric. Fenugreek seeds, a rich source of soluble fiber used in Indian cuisine reduces blood glucose and lipids and can be used as a food adjuvant in diabetes. Similarly garlic, onions, and ginger have been found to modulate favourably the process of carcinogenesis

Importance of folate in human nutrition

From a public health perspective, some of the new insights into folic acid nutrition are of significance. Folate intake recommendations vary under different conditions. Intake of 350 µg is required to maintain plasma homocysteine levels, 650 µg for those with elevated plasma homocysteine, about 400 µg for women planning to become pregnant and 4000 mg for those with history of neural tube defect affected pregnancy. This raises the question whether the folate intake is adequate for the general population, particularly in the vulnerable groups or whether there is a need for scientists to take a fresh view of the requirements, recommended dietary intakes, and consider intervention measures which will have impact on the folate nutritional status. The recommendations should provide a margin of safety to allow for decreased intake, increased requirements, individual variability and bioavailability of natural food folates. The folate intake and nutriture in relation to India and other developing countries needs careful consideration to reduce anemia, neural tube defects and possibly impact on the high incidence of cardiovascular diseases

Development and testing of a quantitative food frequency questionnaire for use in Kerala, India

Objective: To develop and test a food frequency questionnaire (FFQ) for use in rural areas of Kerala, India. Design: Based on food use and market surveys of the study area, a quantitative 81- item interviewer-administered FFQ was developed. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 8 days randomly selected over an entire year and two administrations of the FFQ, one at the beginning of the l-year period and the other at the end. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by examining differences in the nutrient scores. Setting: Rural villages in Ernakulum district, Kerala, South India. Subjecrs: In each of 30 households, the male head of household and female food preparer were enrolled. Results: Pearson (parametric) correlation coefficients (Y,) averaged about 0.50 in comparing nutrient scores derived from the 24HR with those from the first FFQ and about 0.55 in comparing the second FFQ. On average, Spearman correlation coefficients (YJ were slightly lower than the Y, in comparing the scores derived from the first FFQ, but virtually identical for the second FFQ. Regression analyses indicated better agreement in the comparison of the 24HR-derived scores with the first FFQ than the second FFQ. Difference scores, however, tended to be larger in comparing the first FFQ scores with the 24HR. Conclusions: This FFQ produces results broadly comparable to those used in Europe and North America, indicating its suitability for comparing exposures within a study population in reference to health-related endpoints

Drug metabolism and pharmacokinetics in malnutrition

Malnutrition is one of the major public-health problems of the Third World and several million people are underfed and suffer from deficiencies of essential nutrients. Drugs, though not an answer to the problem of malnutrition, do play an essential role in various health projects. However, nutrient-drug interactions, particularly in humans, have attracted very little attention. Only recently have data accumulated to indicate that under-nutrition and malnutrition have great potential for altering drug metabolism and disposition, which may have direct clinical relevance. The pathophysiological changes encountered in both macro- and micro-nutrient deficiencies are such that they can interfere with pharmacokinetic and pharmacodynamic processes in the body which may result in altered drug response. Studies in laboratory animals and in malnourished human subjects indicate that dietary factors and nutritional status considerably influence absorption, plasma protein binding, distribution, biotransformation and excretion of drugs. Therapeutic response and toxicity are therefore likely to be altered. Data obtained show that the doses and dosage regime in the under-nourished or malnourished depend on three factors, namely environment, patient and the drug concerned. A wide variety of environmental factors, operating at different levels, and their interaction with the complex problem of malnutrition, of varying types and severity, need to be considered and evaluated properly in the under-nourished population

Methionine metabolism in pyridoxine deficiency

Methionine metabolism was studied in a group of subjects having clinical signs and symptoms of peripheral neuropathy. Following a load of methionine, these subjects excreted higher amounts of cystathionine, and the ratio of cystathionine/ cysteine sulfinic acid was elevated suggesting a block in the conversion of cystathionine to cysteine sulfinic acid. The load return of methionine as cystathionine was significantly more. These results indicate that the activity of enzyme cystathionase, a pyridoxal-dependant enzyme, is low in pyridoxine deficiency. With pyridoxine therapy, there was a significant improvement in the clinical status, and the biochemical abnormalities were corrected

Nutrition Research : Current Scenario and Future Trends

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Developing and implementing dietary guidelines in India

Single nutrients are no solution to the problem of malnutrition. It is essential that food based dietary guidelines (FBDG) are developed and implemented to overcome the diet related diseases and promote health in the population. A multidisciplinary group was constituted to develop FBDGs in India. A manual with scientific details and an abridged version were prepared with 6 goals and 14 dietary guidelines covering all age groups to overcome the public health nutritional problems. The guidelines are based on dietary patterns and specific outcomes of health and disease. Dietary diversification has been suggested as the practical approach. Diets from locally available and culturally accepted foods in household measures have been suggested to ensure optimal health. For successful implementation of FBDGs, political/bureaucratic commitment are essential. It must become a tool in the developmental plans for food, nutrition, agriculture, rural, educational and biotechnology policies. Workshops and meetings were organized to sensitise the administrative set-up. The intersectoral nature of FBDG for implementation was highlighted. The department of women and child development, which is responsible for implementing the National Nutritional Policy, was recognized as nodal agency. Meetings were organised for secondary target audiences. The press was invited to participate in popularization of the FBDGs. Social marketing strategies were used to match the local dietary and cultural aspects. Interpersonal communication and professional societies were used for better dissemination. Industry and legislative bodies were requested to take active action in this regard. The FBDGs have to be implemented to achieve food and nutrition security and the Millennium Development Goals

Plasma “cortisol” levels in pellagrins

Circulating plasma cortisol levels are essentially normal in pellagrins. The reciprocal relationship between cortisol and serotonin which has been postulated in other psychiatric disorders was not observed in pellagrins, who had varying grades of anxiety, tension, apprehension and insomnia. The response to stimulation with synthetic ACTH (β1–24 corticotrophin) was also similar to normal subjects indicating an intact pituitary-adrenal axis. Studies on the rate of secretion and rate of disappearance of cortisol from plasma are necessary for a proper understanding of the role of altered cortisol metabolism if any, in pellagrins with depressive psychosis

Drug xenobiotic metabolism, disposition and toxicity in malnutrition

The role of malnutrition and diet in general on bioprocess, which govern the fate of drug/xenobiotic in the body only just beginning to be understood. Absorption, protein binding distribution, bio-transformation and renal elimination of xenobiotics/drugs are all affected by altered states of nutrition. As such, evaluation of nutritional status is highly relevant prior to prolonged drug thereby especially with drugs having narrow safety margin