Dietary Intake as a Link between Obesity, Systemic Inflammation, and the Assumption of Multiple Cardiovascular and Antidiabetic Drugs in Renal Transplant Recipients.

Abstract We evaluated dietary intake and nutritional-inflammation status in ninety-six renal transplant recipients, 7.2±5.0 years after transplantation. Patients were classified as normoweight (NW), overweight (OW), and obese (OB), if their body mass index was between 18.5 and 24.9, 25.0 and 29.9, and ≥30 kg/m2, respectively. Food composition tables were used to estimate nutrient intakes. The values obtained were compared with those recommended in current nutritional guidelines. 52% of the patients were NW, 29% were OW, and 19% were OB. Total energy, fat, and dietary n-6 PUFAs intake was higher in OB than in NW. IL-6 and hs-CRP were higher in OB than in NW. The prevalence of multidrug regimen was higher in OB. In all patients, total energy, protein, saturated fatty acids, and sodium intake were higher than guideline recommendations. On the contrary, the intake of unsaturated and n-6 and n-3 polyunsaturated fatty acids and fiber was lower than recommended. In conclusion, the prevalence of obesity was high in our patients, and it was associated with inflammation and the assumption of multiple cardiovascular and antidiabetic drugs. Dietary intake did not meet nutritional recommendations in all patients, especially in obese ones, highlighting the need of a long-term nutritional support in renal transplant recipients

Les marges au prisme des représentations. Mots, discours, images

En suivant M. Foucault (1966), il s’est agi de saisir les marges étudiées à travers le cadre des conditions discursives, symboliques et sociales ainsi que des pratiques qui président à leur apparition et à leur « avènement ». Nos travaux, conduits sur des terrains partagés entre le Nord et le Sud de la Méditerranée, nous ont confortés dans l’idée que les marges urbaines étaient le plus souvent engendrées, produites et érigées par des processus ayant trait à des systèmes de représentations et à des pratiques de stigmatisation émanant des acteurs urbains dominants, mais qu’elles pouvaient résulter aussi de processus cumulatifs ou alternatifs d’endossement ou, au contraire, de résistance, voire de renversement de sens de la part de leurs populations

Body composition and cardiovascular risk factors in pretransplant hemodialysis patients

BACKGROUND: Obesity, hyperlipemia and cardiovascular complications contribute to a significant proportion of morbidity and mortality of renal transplant patients and have negative effects on renal survival. Aim of the present study was to evaluate the main abnormalities in body composition and the prevalence of some cardiovascular risk factors in a population of hemodialyzed (HD) patients awaiting renal transplantation. METHODS: We studied 151 HD patients, all included in a waiting list for renal transplantation, 97 males and 54 females, with mean age 47.4+/-12 years. Patients were divided into three groups according to their body mass index (BMI) (kg/m2): 18.5 to 24.9 (normoweight, NW); 25.0 to 29.9 (overweight, OW); > or =30 (obese, OB). The body composition measurements were obtained the day after the mid-week HD session using bioelectrical impedance analysis (BIA). RESULTS: We found that 47 patients were NW (31%), while 56 were OW (37%), and 48 were OB (32%). BIA-measured body cell mass was (BCM) significantly increased in the OW as compared with the NW group (P<0.001), but, of note, no significant difference was found in OB group in comparison with the OW. Total cholesterol and triglycerides plasma levels were significantly elevated in OW and OB patients with respect to NW (P<0.05) and an increased prevalence of diabetes was seen in OB patients (NW: 6%, OW: 5%, OB: 12%). CONCLUSIONS: These data show that a large proportion of patients awaiting renal transplant are overweight or obese and a consistent part of them have other cardiovascular risk factors associated. Furthermore, obese HD patients have a BCM lower than predicted on the basis of BMI and show an altered metabolic profile. A better understanding of the characteristics of patients included in the renal transplant waiting list is crucial in order to design prospective studies that aim to define the proper risk profile for the selection of patients

Prevalence of obesity and obesity-associated muscle wasting in patients on peritoneal dialysis

Background and aims: A progressive decrease in muscle mass until full-blown sarcopenia may occur in patients on peritoneal dialysis (PD) and worsen their life quality and expectancy. Here we investigate the prevalence of obesity and obesity-associated muscle wasting in PD patients. Patients and methods: The study design was observational, cross sectional. Body composition was assessed with BIA and BIVA in 88 PD patients (53.4 ± 13.1 years; 67% male). Patients with obesity and/or with reduced muscle mass were identified using FMI and SM/BW cutoff values, respectively. Inflammatory status was assessed by measuring CRP and fibrinogen blood levels. Results: A total of 44.3% of the patients showed a reduced muscle mass (37.5% moderate and 6.8% severe). The prevalence of obesity was 6.1%, 81.8%, and 100% in patients with normal, moderately, and severely reduced muscle mass, respectively (p < 0.05). Of the total, 15.2% of the patients with normal muscle mass, 18.4% of those with moderately reduced muscle mass, and 66.7% of those with severely reduced muscle mass had diabetes. The prevalence of severe muscle mass loss was higher in those with diabetes than in those without diabetes (22.2% vs. 2.8%, p < 0.05). Patients with obesity-associated muscle wasting showed higher fibrinogen (613.9 ± 155.1 vs. 512.9 ± 159.5 mg/dL, p < 0.05) and CPR (1.4 ± 1.3 vs. 0.6 ± 0.8 mg/dL, p < 0.05) blood concentrations than those with normal body composition. Conclusion: Obesity and diabetes were strongly associated with muscle mass loss in our PD patients. It remains to be established whether prevention of obesity with nutritional interventions can halt the occurrence of muscle mass loss in patients on PD

Effect of a Short-Course Treatment with Synbiotics on Plasma p-Cresol Concentration in Kidney Transplant Recipients.

We evaluated whether a short-term course with synbiotics may lower plasma p-Cresol concentrations in kidney transplant patients (KTRs) who accumulate this uremic toxin both because of increased production by their dysbiotic gut microbiome and because of reduced elimination by the transplanted kidneys. METHODS: Thirty-six KTRs (29 males, mean age 49.6 ± 9.1 years) with transplant vintage > 12 months, stable graft function, and no episode of acute rejection or infection in the last 3 months were enrolled in this single-center, parallel-group, double-blinded, randomized (2:1 synbiotic to placebo) study. Synbiotic (Probinul Neutro, CadiGroup, Rome, Italy) or placebo was taken at home for 30 days, as 5 g powder packets dissolved in water three times a day far from meals. The main outcome measure was the decrease in total plasma p-Cresol measured by high-performance liquid chromatography at baseline and after 15 and 30 days of placebo or synbiotic treatment. RESULTS: After 15 and 30 days of treatment, plasma p-Cresol decreased by 40% and 33% from baseline (both p < 0.05), respectively, in the synbiotic group, whereas it remained stable in the placebo group. After 30 days of treatment, no significant change was observed in either group in renal function, glycemia, plasma lipids, or albumin concentration. Treatment was well tolerated and did not induce any change in stool characteristics. CONCLUSION: The results of this pilot study suggest that treatment with synbiotics may be effective to lower plasma p-Cresol concentrations in KTRs. Prospective larger scale, longer term studies are needed to establish whether cardiovascular prognosis could also be improved with this nutritional intervention

Acoustic force measurements on polymer-coated microbubbles in a microfluidic device

This work presents an acoustofluidic device for manipulating coated microbubbles, designed for the simultaneous use of optical and acoustical tweezers. A comprehensive characterization of the acoustic pressure in the device is presented, obtained by the synergic use of different techniques in the range of acoustic frequencies where visual observations showed aggregation of polymer-coated microbubbles. In absence of bubbles, the combined use of laser vibrometry and finite element modelling supported a non-invasive measurement of the acoustic pressure and an enhanced understanding of the system resonances. Calibrated holographic optical tweezers were used for direct measurements of the acoustic forces acting on an isolated microbubble, at low driving pressures, and to confirm the spatial distribution of the acoustic field. This allowed quantitative acoustic pressure measurements by particle tracking, using polystyrene beads, and an evaluation of the related uncertainties. This process facilitated the extension of tracking to microbubbles, which have a negative acoustophoretic contrast factor, allowing acoustic force measurements on bubbles at higher pressures than optical tweezers, highlighting four peaks in the acoustic response of the device. Results and methodologies are relevant to acoustofluidic applications requiring a precise characterization of the acoustic field and, in general, to biomedical applications with microbubbles or deformable particles

Identification of sarcopenia and dynapenia in CKD predialysis patients with EGWSOP2 criteria: An observational, cross-sectional study

Objectives: Using the new European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, we identified sarcopenic and dynapenic patients in a cohort of predialysis patients with chronic kidney disease (CKD), and evaluated their clinical and laboratory characteristics. Methods: The study population consisted of 85 (55 men) clinically stable predialysis CKD patients (92.9% in stages 3–5), with a median age of 65.0 (52.5–72.0) y. We classified as sarcopenic the patients with handgrip strength (HGS) and muscle mass both lower than the respective EWGSOP2 cutoff values and as dynapenic those in whom only HGS was less than these reference values. HGS was measured with a hand dynamometer, whereas muscle mass was measured by bioimpedance analysis. Renal function was evaluated as Modification of Diet in Renal Disease estimated glomerular filtration rate. Results: The prevalence of sarcopenia and dynapenia was, respectively, 7.1% and 17.6%. As reported in previous studies, serum albumin and hemoglobin were lower in sarcopenic patients than in patients with preserved muscle mass and strength. However, unlike in these studies, sarcopenia prevalence did not increase with CKD stage, and estimated glomerular filtration rate was similar between groups. Moreover, no difference was identified in any of the aforementioned parameters between dynapenic patients and patients with preserved muscle mass and strength. Conclusions: The EWGSOP2 criteria identified sarcopenia in CKD with a prevalence similar to previous diagnostic criteria. In addition, they found that dynapenia was highly prevalent. Nevertheless, the EWGSOP2 criteria could be better adapted to CKD patients to improve their ability to detect high-risk sarcopenic and dynapenic patients

Impact of anthropic activities on soil quality under different land uses

Anthropization often leads to land use transformation, causing deep changes to soil properties and its quality. Land use change could be an environmental and socioeconomic problem, as it impacts soil quality and ecosystem services. There is an urgent need to understand the pressures affecting soil quality. The aim of the work is to quantify the impact of different land uses on soil abiotic and biotic properties and on its quality. To achieve the aims, soils from different land uses (forest, urban and agricultural) were collected in the surroundings of Naples and analyzed for pH, water content, contents of C and N, C/N ratio and total and available concentrations of Cu, Ni and Pb, microbial and fungal biomasses, basal respiration and metabolic quotient. Then, a soil quality index (SQI) was calculated for each land use. The results showed that soil abiotic and biotic properties of the agricultural sites differed from those of forest and urban sites. At agricultural sites, microbial abundances decreased due to low amount of C and N and to high amount of Cu and Pb. This caused low use efficiency of energetic substrates and a reduced soil quality of agricultural sites as compared to forest and urban sites