Triple Adaptation of the Mediterranean Diet: Design of A Meal Plan for Older People with Oropharyngeal Dysphagia Based on Home Cooking

Background: Oropharyngeal dysphagia (OD) and malnutrition are highly prevalent in older patients that are discharged from general hospitals (47% and 30%, respectively). Aims: To develop a nutritional plan for these patients involving a triple adaptation of their traditional diet: (a) rheological adaptation (texture and viscosity) for safe deglutition, (b) nutritional adaptation (water, calories, and proteins), and (c) organoleptic adaptation to improve compliance. Methods: Two fluid viscosities (250 and 800 mPa·s) were selected according to previous studies on optimal viscosities in older patients. The British Dietetic Association food texture classification based on common clinical practice selected two food textures (thick purée and fork-mashable. Two levels of calorie protein enrichment were selected according to previous studies using the Mini Nutritional Assessment (MNA®). Results: The daily caloric-protein and hydric needs were established at 1750 kcal, 70 g protein, and 1750 mL water in patients with MNA® ≥ 17; and, 2037 kcal, 90 g protein, and 2000 mL water/day in malnourished patients. Sixteen weekly menus (296 recipes) were developed while using two textures, two levels of viscosity, two nutritional phenotypes (normal/at-risk vs. malnourished), and two seasons of the year (spring/summer-autumn/winter) based on Mediterranean cuisine. Conclusion: This concept paper demonstrates that traditional Mediterranean cooking can be adapted to meet the rheological, nutritional, and hydration needs of older patients with OD. The recipes that we have developed meet the needs of patients with varying degrees of OD and malnutrition are reproducible in patient’s homes and they could have a major impact on the clinical outcomes of these patients

Multiparameter immune profiling of operational tolerance in liver transplantation

Immunosuppressive drugs can be completely withdrawn in up to 20% of liver transplant recipients, commonly referred to as 'operationally' tolerant. Immune characterization of these patients, however, has not been performed in detail, and we lack tests capable of identifying tolerant patients among recipients receiving maintenance immunosuppression. In the current study we have analyzed a variety of biological traits in peripheral blood of operationally tolerant liver recipients in an attempt to define a multiparameter 'fingerprint' of tolerance. Thus, we have performed peripheral blood gene expression profiling and extensive blood cell immunophenotyping on 16 operationally tolerant liver recipients, 16 recipients requiring on-going immunosuppressive therapy, and 10 healthy individuals. Microarray profiling identified a gene expression signature that could discriminate tolerant recipients from immunosuppression-dependent patients with high accuracy. This signature included genes encoding for gamma delta T-cell and NK receptors, and for proteins involved in cell proliferation arrest. In addition, tolerant recipients exhibited significantly greater numbers of circulating potentially regulatory T-cell subsets (CD4(+)CD25(+) T-cells and V delta 1(+) T cells) than either non-tolerant patients or healthy individuals. Our data provide novel mechanistic insight on liver allograft operational tolerance, and constitute a first step in the search for a non-invasive diagnostic signature capable of predicting tolerance before undergoing drug weaning

Using transcriptional profiling to develop a diagnostic test of operational tolerance in liver transplant recipients

A fraction of liver transplant recipients are able to discontinue all immunosuppressive therapies without rejecting their grafts and are said to be operationally tolerant to the transplant. However, accurate identification of these recipients remains a challenge. To design a clinically applicable molecular test of operational tolerance in liver transplantation, we studied transcriptional patterns in the peripheral blood of 80 liver transplant recipients and 16 nontransplanted healthy individuals by employing oligonucleotide microarrays and quantitative real-time PCR. This resulted in the discovery and validation of several gene signatures comprising a modest number of genes capable of identifying tolerant and nontolerant recipients with high accuracy. Multiple peripheral blood lymphocyte subsets contributed to the tolerance-associated transcriptional patterns, although NK and γδTCR+ T cells exerted the predominant influence. These data suggest that transcriptional profiling of peripheral blood can be employed to identify liver transplant recipients who can discontinue immunosuppressive therapy and that innate immune cells are likely to play a major role in the maintenance of operational tolerance in liver transplantation

Proyecto "Gastronomía y Salud": resumen de resultados y conclusiones

Proyecto multidisciplinario dirigido a la restauración comercial con la finalidad de facilitar la adaptación de sus menús y ampliar la oferta gastronómica destinada a la población que presenta algún tipo de restricción, intolerancia y/o alergia alimentaria. El objetivo principal es conocer las necesidades que tienen estos usuarios cuando comen fuera de casa y así proporcionar las herramientas adecuadas a los establecimientos de restauración comercial que quieran llevar a cabo una oferta de alimentación adaptada a las diferentes dietas. Las herramientas utilizadas han sido encuestas dirigidas a usuarios y restauradores. La observación de los resultados obtenidos muestra la clara necesidad de ofrecer formación específica a los restauradores para poder responder a la demanda social del colectivo afectado.Projecte de recerca sobre gastronomia i salut finançat pel HUB

Proyecto "Gastronomía y Salud": resumen de resultados y conclusiones

Proyecto multidisciplinario dirigido a la restauración comercial con la finalidad de facilitar la adaptación de sus menús y ampliar la oferta gastronómica destinada a la población que presenta algún tipo de restricción, intolerancia y/o alergia alimentaria. El objetivo principal es conocer las necesidades que tienen estos usuarios cuando comen fuera de casa y así proporcionar las herramientas adecuadas a los establecimientos de restauración comercial que quieran llevar a cabo una oferta de alimentación adaptada a las diferentes dietas. Las herramientas utilizadas han sido encuestas dirigidas a usuarios y restauradores. La observación de los resultados obtenidos muestra la clara necesidad de ofrecer formación específica a los restauradores para poder responder a la demanda social del colectivo afectado.Projecte de recerca sobre gastronomia i salut finançat pel HUB