Visualization of Nutrient-Related Clinical Practice Guidelines in Childhood

Obesity and diabetes rates have been rising to epidemic levels during the last decade, especially among young populations. Recommendations for clinicians and primary healthcare providers concerning the improvement of childhood nutrition and the healthcare of childhood nutrition-related diseases are of major interest. Clinical Practice Guidelines (CPGs) of the most updated evidence-based recommendations are useful tools that help clinicians in their practice. However, a gap has been observed between the suggested CPGs and their implementation in the context of everyday clinical practice. This could be merely attributed to the text format that is usually presented. In this review article, all the CPGs about the best dietary advice regarding energy and macronutrient intake in childhood and the most common chronic nutrition-related childhood diseases, i.e., obesity, dyslipidemia, and diabetes mellitus type 1 and 2, are summarized and visualized in an algorithmic format and practical examples are given. This could help healthcare providers to achieve a higher adoption rate of CPGs in clinical practice, thus, resulting in better management of children’s health and improved clinical outcomes

Dietary habits and lifestyle of older people (≥65 years old)

Aim: Decline of cognitive functions has been identified as one of the major problems of older people, affecting their quality of life. Lifestyle, including diet, sleep, physical activity and sociability, is a modifiable factor that may affect this process. There is limited evidence examining lifestyle factors and their potential synergistic role in the health of older adults ≥65 years old. Thus, the aim of the current study was: a) to assess diet, sleep, physical activity and social life in older people and to examine the sex- and age-specific associations as well as to examine the differences in people with dementia. b) to examine the associations of diet with sleep, physical activity and social factors and c) to evaluate the synergistic role of lifestyle factors on cognition, through an a priori score. Materials and Methods: 1,943 participants ≥65 years old (59% females) from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included. Dietary intake was assessed by a semi-quantitative food frequency questionnaire, through which energy intake, macro-nutrient intake and food groups consumption were evaluated. Adherence to the Mediterranean diet was evaluated by an a priori score, the MedDietScore, which ranges from 0-55, with higher values indicating greater adherence to the Mediterranean dietary pattern. Sleep habits were assessed through Sleep scale (the score for sleep quality ranges from 1-55, with higher values indicating worse sleep quality), physical activity habits through Athens Physical Activity Questionnaire and social factors were assessed through a relevant questionnaire. Results: Energy intake was calculated at 1,975 ± 532 kcal/day (27 ± 8 kcal/Kg/day), protein intake covered 15.4 ± 2.8% of total energy intake (or 1.0 ± 0.3 grams/kg/day), carbohydrate intake 38.0 ± 6.0% and lipid intake 44.7 ± 5.8% of total energy intake. The mean value for MedDietScore was 33.3 ± 4.6 units. Sleep duration was 6.6 ± 1.5 hours/night and the mean value for sleep quality was 17.7 ± 7.7 units. MET-min per week were 12.378 ± 1.582 MET-min and social contacts per month were 15.1 ± 18.2 contacts. The results were different depending on the sex, age and the diagnosis of dementia. In specific, women, older elderly people and patients with dementia were found to have a less healthy lifestyle. Mediterranean diet was positively associated with sleep quality, number of social contacts per month as well as with the frequency of engagement in intellectual, social and physical activities. A total Lifestyle Index was constructed by the individual lifestyle factors (adherence to the Mediterranean diet, sleep quality, physical activity and engagement in activities of daily living). Participants with dementia and mild cognitive impairment had lower values of the index compared with those with normal cognitive function. Higher values of the Lifestyle Index were associated with 80% reduced odds for dementia, 55% reduced odds for mild cognitive impairment (when participants with dementia were excluded) and with 43% reduced odds for low global cognition (when participants with dementia and mild cognitive impairment were excluded). Conclusions: The present study showed that some diet characteristics, sleep duration and physical activity are lifestyle habits that are not optimal, based on the recommendations for older people. A complex index including various lifestyle factors was significantly associated with lower odds for dementia and mild cognitive decline as well as with cognitive health. More longitudinal studies are needed in order to further elucidate the etiologic relationships between lifestyle factors and cognitive functions and to clarify the potential biological mechanisms.Εισαγωγή και Σκοπός: Η έκπτωση των νοητικών λειτουργιών αποτελεί ένα από τα σημαντικότερα προβλήματα που σχετίζονται με τη γήρανση, επηρεάζοντας πολλές πτυχές της καθημερινότητας των ηλικιωμένων ατόμων και υποβαθμίζοντας την ποιότητα ζωής τους. Παράγοντες του τρόπου ζωής, όπως η δίαιτα, ο ύπνος, η σωματική δραστηριότητα και η κοινωνικότητα, μπορούν να επιδράσουν στα παραπάνω. Ωστόσο, δεν υπάρχουν αρκετές μελέτες που να έχουν αξιολογήσει ταυτόχρονα περισσότερους από έναν παράγοντες του τρόπου ζωής στα ηλικιωμένα άτομα, ενώ σημαντικό κενό στη βιβλιογραφία προκύπτει από το γεγονός ότι υπάρχουν λίγες μελέτες που να εξετάζουν τη συνδυαστική σχέση των παραγόντων του τρόπου ζωής στη νοητική λειτουργία σε άτομα μεγαλύτερης ηλικίας. Συνεπώς, στόχος της παρούσας διδακτορικής διατριβής ήταν: α) η αξιολόγηση των παραγόντων του τρόπου ζωής σε ενήλικες ≥65 ετών και, συγκεκριμένα, της δίαιτας, του ύπνου, της σωματικής δραστηριότητας και της κοινωνικότητας. Η περιγραφή των παραγόντων αυτών πραγματοποιήθηκε και ανά φύλο, ανά ηλικιακή ομάδα, και ανάλογα με το αν είχε τεθεί ή όχι διάγνωση άνοιας. β) η εξέταση της αλληλεπίδρασης των παραγόντων του τρόπου ζωής και γ) η διερεύνηση της συνδυαστικής επίδρασης παραγόντων του τρόπου ζωής στη νοητική λειτουργία, μέσω του σχεδιασμού ενός a priori σκορ. Υλικό και μέθοδος: Για τους σκοπούς της παρούσας διατριβής αναλύθηκαν δεδομένα από 1.943 άτομα ηλικίας ≥65 ετών (59% γυναίκες) της επιδημιολογικής μελέτης HELIAD (Hellenic Longitudinal Investigation of Aging and Diet), η οποία πραγματοποιήθηκε στη Λάρισα και στο Μαρούσι της Αθήνας. Η διαιτητική πρόσληψη αξιολογήθηκε με ένα ημι-ποσοτικό ερωτηματολόγιο συχνότητας κατανάλωσης τροφίμων, μέσω του οποίου υπολογίστηκε η ενεργειακή πρόσληψη και η πρόσληψη μακρο-θρεπτικών συστατικών καθώς και η κατανάλωση ομάδων τροφίμων. Από τις ομάδες τροφίμων υπολογίστηκε ο βαθμός προσκόλλησης στη Μεσογειακή δίαιτα μέσω του δείκτη MedDietScore, με εύρος τιμών 0-55, με υψηλότερες βαθμολογίες να υποδεικνύουν υψηλότερη προσκόλληση στο Μεσογειακό διαιτητικό πρότυπο. Οι συνήθειες ύπνου, σωματικής δραστηριότητας και κοινωνικότητας αξιολογήθηκαν μέσω του Sleep Scale (το σκορ για την ποιότητα ύπνου λαμβάνει τιμές από 1-54, με υψηλότερες τιμές να υποδεικνύουν χειρότερη ποιότητα ύπνου), του Athens Physical Activity Questionnaire και ενός ειδικού ερωτηματολογίου για την κοινωνικότητα, αντίστοιχα. Αποτελέσματα: Η ενεργειακή πρόσληψη των συμμετεχόντων/συμμετεχουσών στη μελέτη ανερχόταν στις 1.975 ± 532 kcal/ημέρα (27 ± 8 kcal/κιλό Σωματικού Βάρους/ημέρα), με την πρόσληψη πρωτεϊνών να καλύπτει το 15,4 ± 2,8% της συνολικής ενεργειακής πρόσληψης (ή 1,0 ± 0,3 γραμμάρια πρωτεϊνών/κιλό σωματικού βάρους/ημέρα), την πρόσληψη υδατανθράκων το 38,0 ± 6,0% και την πρόσληψη λιπιδίων το 44,7 ± 5,8% της συνολικής ενεργειακής πρόσληψης. Η μέση τιμή του MedDietScore ήταν 33,3 ± 4,6 μονάδες. Αναφορικά με τις συνήθειες ύπνου, ο μέσος όρος διάρκειας ύπνου ήταν 6,6 ± 1,5 ώρες/βράδυ, με τη μέση τιμή του σκορ για την ποιότητα ύπνου να ανέρχεται στις 17,7 ± 7,7 μονάδες. Ο μέσος όρος MET-min ανά εβδομάδα ανερχόταν στα 12.378 ± 1.582 MET-min, ενώ ο αριθμός κοινωνικών επαφών τον τελευταίο μήνα στις 15,1 ± 18,2 επαφές. Τα ευρήματα διαφοροποιήθηκαν ανάλογα με το φύλο, την ηλικία και τη διάγνωση άνοιας. Συγκεκριμένα, οι γυναίκες, οι ηλικιωμένοι/ηλικιωμένες μεγαλύτερης ηλικίας (>75 ετών) και τα άτομα με άνοια βρέθηκε ότι έχουν λιγότερο υγιεινό τρόπο ζωής. Ο βαθμός προσκόλλησης στη Μεσογειακή δίαιτα σχετίστηκε θετικά με την ποιότητα ύπνου, με τον αριθμό κοινωνικών επαφών/μήνα καθώς και με τη συχνότητα συμμετοχής σε νοητικές, κοινωνικές και σωματικές δραστηριότητες ελεύθερου χρόνου. Στη συνέχεια, δημιουργήθηκε ένας a priori Δείκτης Τρόπου Ζωής που συνυπολογίζει την ποιότητα της δίαιτας, ως βαθμό προσκόλλησης στη Μεσογειακή δίαιτα, την ποιότητα ύπνου, τη σωματική δραστηριότητα και την ενασχόληση με δραστηριότητες της καθημερινότητας. Άτομα με άνοια καθώς και με ήπια νοητική διαταραχή είχαν μικρότερες τιμές του Δείκτη Τρόπου Ζωής, σε σχέση με αυτούς/αυτές με φυσιολογική νοητική λειτουργία. Επίσης, άτομα στο υψηλότερο τεταρτημόριο του δείκτη είχαν 80% λιγότερες πιθανότητες για παρουσία άνοιας, 55% λιγότερες πιθανότητες για παρουσία ήπιας νοητικής διαταραχής (αφού εξαιρέθηκαν άτομα με άνοια) και 43% λιγότερες πιθανότητες χαμηλής νοητικής λειτουργίας (αφού εξαιρέθηκαν άτομα με άνοια και ήπια νοητική διαταραχή), μετά από έλεγχο για την ηλικία, το φύλο και τα έτη εκπαίδευσης. Συμπεράσματα: Από την παρούσα διατριβή φάνηκε ότι ορισμένα στοιχεία της δίαιτας (π.χ. η πρόσληψη πρωτεϊνών), η διάρκεια του ύπνου και η σωματική δραστηριότητα είναι παράγοντες του τρόπου ζωής που δεν είναι στο πλαίσιο που προτείνεται για τα άτομα μεγαλύτερης ηλικίας στην Ελλάδα. Τα παραπάνω διαφοροποιήθηκαν ανάλογα με το φύλο, την ηλικία και τη νοητική κατάσταση των ατόμων μεγαλύτερης ηλικίας. Ένα πρότυπο τρόπου ζωής που συνδυάζει την υψηλή προσκόλληση στη Μεσογειακή δίαιτα, τα υψηλά επίπεδα σωματικής δραστηριότητας, την καλή ποιότητα ύπνου και το καλό επίπεδο ενασχόλησης με δραστηριότητες της καθημερινότητας, σχετιζόταν με μειωμένες πιθανότητες παρουσίας άνοιας και ήπιας νοητικής διαταραχής αλλά και με τη νοητική υγεία. Απαιτούνται περισσότερες προοπτικές μελέτες για να αποσαφηνιστεί η αιτιολογική σχέση των παραγόντων του τρόπου ζωής με τις νοητικές λειτουργίες

Dietary and Nutrient Patterns and Brain MRI Biomarkers in Dementia-Free Adults

Cognitive impairment is a rapidly growing public health problem. As there is no curative treatment for dementia, the proactive management of modifiable risk factors and the identification of early biomarkers indicative of the cognitive decline are of great importance. Although nutrition is one of the most extensively studied lifestyle factor in relation to cognitive health, its association with brain magnetic resonance imaging (MRI) biomarkers is not well established. In the present work, we review available studies relating dietary or nutrient patterns with brain MRI biomarkers in dementia-free adults. Greater adherence to the Mediterranean diet has been associated with the preservation of structural connectivity and less brain atrophy in adults without dementia. In addition, specific nutrient patterns, characterized by a high intake of antioxidant vitamins, polyphenols and unsaturated fatty acids, have been related to larger brain volume. Although the results are encouraging regarding the role of dietary and nutrient patterns on imaging biomarkers, more well-designed observational longitudinal studies and clinical trials are needed in order to confirm potentially causal relationships and better understand underlying mechanisms

Digital Health Interventions for Weight Management in Children and Adolescents:Systematic Review and Meta-analysis

BACKGROUND: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. OBJECTIVE: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. METHODS: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. RESULTS: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. CONCLUSIONS: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations

HCV-Induced Immunometabolic Crosstalk in a Triple-Cell Co-Culture Model Capable of Simulating Systemic Iron Homeostasis

Iron is crucial to the regulation of the host innate immune system and the outcome of many infections. Hepatitis C virus (HCV), one of the major viral human pathogens that depends on iron to complete its life cycle, is highly skilled in evading the immune system. This study presents the construction and validation of a physiologically relevant triple-cell co-culture model that was used to investigate the input of iron in HCV infection and the interplay between HCV, iron, and determinants of host innate immunity. We recorded the expression patterns of key proteins of iron homeostasis involved in iron import, export and storage and examined their relation to the iron regulatory hormone hepcidin in hepatocytes, enterocytes and macrophages in the presence and absence of HCV. We then assessed the transcriptional profiles of pro-inflammatory cytokines Interleukin-6 (IL-6) and interleukin-15 (IL-15) and anti-inflammatory interleukin-10 (IL-10) under normal or iron-depleted conditions and determined how these were affected by infection. Our data suggest the presence of a link between iron homeostasis and innate immunity unfolding among liver, intestine, and macrophages, which could participate in the deregulation of innate immune responses observed in early HCV infection. Coupled with iron-assisted enhanced viral propagation, such a mechanism may be important for the establishment of viral persistence and the ensuing chronic liver disease

Objective Physical Function in the Alzheimer’s Disease Continuum: Association with Cerebrospinal Fluid Biomarkers in the ALBION Study

Cognitive and physical decline, both indicators of aging, seem to be associated with each other. The aim of the present study was to investigate whether physical function parameters (walking time and handgrip strength) are related to cerebrospinal fluid (CSF) biomarkers (amyloid-beta Aβ42, Tau, PhTau) in individuals in the Alzheimer’s disease (AD) continuum. The sample was drawn from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration study, comprising 163 individuals aged 40–75 years: 112 cognitively normal (CN) and 51 with mild cognitive impairment (MCI). Physical function parameters were measured at baseline, a lumbar puncture was performed the same day and CSF biomarkers were analyzed using automated methods. The association between walking time, handgrip strength and CSF biomarkers was evaluated by linear correlation, followed by multivariate linear regression models adjusted for age, sex, education and APOEe4 genotype. Walking time was inversely related to CSF Aβ42 (lower CSF values correspond to increased brain deposition) in all participants (p < 0.05). Subgroup analysis showed that this association was stronger in individuals with MCI and participants older than 60 years old, a result which remained statistically significant after adjustment for the aforementioned confounding factors. These findings may open new perspectives regarding the role of mobility in the AD continuum

Joint Microbiota Activity and Dietary Assessment through Urinary Biomarkers by LC-MS/MS

Accurate dietary assessment in nutritional research is a huge challenge, but essential. Due to the subjective nature of self-reporting methods, the development of analytical methods for food intake and microbiota biomarkers determination is needed. This work presents an ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) method for the quantification and semi quantification of 20 and 201 food intake biomarkers (BFIs), respectively, as well as 7 microbiota biomarkers applied to 208 urine samples from lactating mothers (M) (N = 59). Dietary intake was assessed through a 24 h dietary recall (R24h). BFI analysis identified three distinct clusters among samples: samples from clusters 1 and 3 presented higher concentrations of most biomarkers than those from cluster 2, with dairy products and milk biomarkers being more concentrated in cluster 1, and seeds, garlic and onion in cluster 3. Significant correlations were observed between three BFIs (fruits, meat, and fish) and R24h data (r > 0.2, p-values < 0.01, Spearman correlation). Microbiota activity biomarkers were simultaneously evaluated and the subgroup patterns detected were compared to clusters from dietary assessment. These results evidence the feasibility, usefulness, and complementary nature of the determination of BFIs, R24h, and microbiota activity biomarkers in observational nutrition cohort studies

Alterations in the iron homeostasis network: A driving force for macrophage-mediated hepatitis C virus persistency

Mechanisms that favor Hepatitis C virus (HCV) persistence over clearance are unclear, but involve defective innate immunity. Chronic infection is characterized by hepatic iron overload, hyperferraemia and hyperferittinaemia. Hepcidin modulates iron egress via ferroportin and its storage in ferritin. Chronic HCV patients have decreased hepcidin, while HCV replication is modified by HAMP silencing. We aimed to investigate interactions between HCV and hepcidin, during acute and chronic disease, and putative alterations in cellular iron homeostasis that enhance HCV propagation and promote viral persistence. Thus, we used HCV JFH-1-infected co-cultures of Huh7.5 hepatoma and THP-1 macrophage cells, HCV patients&apos; sera and Huh7 hepcidin-expressing cells transfected with HCV replicons. Hepcidin levels were elevated in acutely infected patients, but correlated with viral load in chronic patients. HAMP expression was up-regulated early in HCV infection in vitro, with corresponding changes in ferritin and FPN. Hepcidin overexpression enhanced both viral translation and replication. In HCV-infected co-cultures, we observed increased hepcidin, reduced hepatoma ferritin and a concurrent rise in macrophaghic ferritin over time. Altered iron levels complemented amplified replication in hepatoma cells and one replication round in macrophages. Iron-loading of macrophages led to enhancement of hepatic HCV replication through reversed ferritin flow. Viral transmissibility from infected macrophages to naive hepatoma cells was induced by iron. We propose that HCV control over iron occurs both by intracellular iron sequestration, through hepcidin, and intercellular iron mobilisation via ferritin, as means toward enhanced replication. Persistence could be achieved through HCV-induced changes in macrophagic iron that enhances viral replication in these cells