Crosstalk between dietary patterns, obesity and nonalcoholic fatty liver disease

The prevalence of nonalcoholic fatty liver disease (NAFLD) is rising worldwide, paralleling the epidemic of obesity. The liver is a key organ for the metabolism of proteins, fats and carbohydrates. Various types of fats and carbohydrates in isocaloric diets differently influence fat accumulation in the liver parenchyma. Therefore, nutrition can manage hepatic and cardiometabolic complications of NAFLD. Even moderately reduced caloric intake, which leads to a weight loss of 5%-10% of initial body weight, is effective in improving liver steatosis and surrogate markers of liver disease status. Among dietary patterns, the Mediterranean diet mostly prevents the onset of NAFLD. Furthermore, this diet is also the most recommended for the treatment of NAFLD patients. However, clinical trials based on the dietary interventions in NAFLD patients are sparse. Since there are only a few studies examining dietary interventions in clinically advanced stages of NAFLD, such as active and fibrotic steatohepatitis, the optimal diet for patients in these stages of the disease must still be determined. In this narrative review, we aimed to critically summarize the associations between different dietary patterns, obesity and prevention/risk for NAFLD, to describe specific dietary interventions’ impacts on liver steatosis in adults with NAFLD and to provide an updated overview of dietary recommendations that clinicians potentially need to apply in their daily practice

Higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance in women with unsuccessful weight loss

Background/Aim. Obesity is a chronic and relapsing condition, and since recently, it has been considered a global epidemic. Current guidelines for tripartite treatment of obesity emphasize a program of lifestyle modifications such as medical nutrition therapy, aerobic exercise, and behavioral intervention. The aim of the study was to evaluate whether specific psychological factors (general attitudes and beliefs and frustration tolerance) could be predictors of successful weight loss, i.e., factors that can be further addressed as part of the integrated therapy approach. Methods. A total of 84 consecutive overweight and obese female participants who were apparently healthy and homogeneous in age, level of education, and marital or employment status were prescribed the same medical nutrition therapy protocol as a single six-month therapeutic intervention. Prior to starting the therapy, the General Attitude and Belief Scale (GABS) and the Frustration Discomfort Scale (FDS) were administered. The participants were divided into two groups: successful (group A) and unsuccessful (group B). Group A, or the successful group [with the mean body mass index (BMI) ± standard deviation (SD) of 24.1 ± 5.81 kg/m2], consisted of 40 participants who have reached the corresponding loss, i.e., they lost ≥ 10% of the starting body weight (BW). Group B, or the unsuccessful group (with the mean BMI ± SD of 28.51 ± 2.74 kg/m2), consisted of 44 participants who have not reached the corresponding loss, i.e., they lost < 10% of the starting BW. Results. Participants in group B had significantly higher scores (p < 0.05) on the GABS subscales for the Need for Approval, Need for Comfort, and Other Downing. A statistically significant difference between groups (p < 0.05) was shown for FDS subscales of Emotional Intolerance, Entitlement, and Achievement Frustration. Conclusion. Results of our study showed that participants who were unsuccessful in medical nutrition therapy had a higher degree of dysfunctional attitudes and beliefs and higher scores of frustration intolerance when compared to successful participants. The recommendation, based on our results, would be to include psychotherapeutic techniques in the integrative obesity treatment, aimed at cognitive changes and increasing frustration tolerance

Proteinsko-energetski gubitak kod bolesnika na hroničnoj hemodijalizi - etiologija i dijagnostički kriterijumi

The available evidence suggests that nutritional status in the HD patients is an extremely important predictive and causative factor for the good clinical outcome. Nutritional deficits and PEW are frequent problems in the dialysis population and implies an increased risk of negative health outcomes such as mortality risk and quality of life deterioration. There is no single specific measurement that provides complete assessment of the nutritional status in the HD patients, and the results should be analysed in the clinical context of each individual patients. As malnutrition is potentially reversible with appropriate nutritional support, early identification of patients at high nutritional risk may facilitate effective treatment and improve prognosis in the HD patients.

Liver disease and COVID-19: The link with oxidative stress, antioxidants and nutrition

Varying degrees of liver injuries have been reported in patients infected with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). In general, oxidative stress is actively involved in initiation and progression of liver damage. The liver metabolizes various compounds that produce free radicals. Maintaining the oxidative/antioxidative balance is important in coronavirus disease 2019 (COVID-19) patients. Antioxidant vitamins, essential trace elements and food compounds, such as polyphenols, appear to be promising agents, with effects in oxidative burst. Deficiency of these nutrients suppresses immune function and increases susceptibility to COVID-19. Daily micronutrient intake is necessary to support anti-inflammatory and antioxidative effects but for immune function may be higher than current recommended dietary intake. Antioxidant supplements (βcarotene, vitamin A, vitamin C, vitamin E, and selenium) could have a potential role in patients with liver damage. Available evidence suggests that supplementing the diet with a combination of micronutrients may help to optimize immune function and reduce the risk of infection. Clinical trials based on the associations of diet and SARS-CoV-2 infection are lacking. Unfortunately, it is not possible to definitively determine the dose, route of administration and best timing to intervene with antioxidants in COVID-19 patients because clinical trials are still ongoing. Until then, hopefully, this review will enable clinicians to understand the impact of micronutrient dietary intake and liver status assessment in COVID-19 patients

Fatty acid composition including trans-fatty acids in salty snack food from the Serbian market

The rapid increase in the consumption of salty snack products has led to increased concern about their composition and nutritional value. The aim of this study was to investigate the fat content and fatty acid profile in salty snack products from the Serbian market. A total of 58 different snack products from 3 categories (Baked products, Chips & flips products, Cereal products) were analyzed. The fatty acid composition was determined using gas chromatography. Total fat content ranged from 3.1 % in expanded rice to 35.7 % in potato chips. Palmitic, oleic and linoleic acids constituted gt 80 % of all fatty acids (FAs) in categories Baked products and Chips & flips. Linoleic acid was more abundant in the category Cereal products (15.5-49.3 %). The trans-FAs elaidic (C18:1 - 9t) and linolelaidic FAs (18: 2 - 9t, 12t) were identified in 66 % of the products. The flips products had the highest average t-FAs content (16.3 %), followed by flips group (9.3 %). Potential t-FAs intake from 100 g of analyzed products was in range 0.1-4.9 g. This study provided a large database on saturated fatty acids and t-FAs content in salty snack products and indicated that by consuming only one package of some products, the t-FAs intake could surpass the recommended maximum of 1 % of daily energy

Serumski C-reaktivni protein i nutritivni parametri kod bolesnika na hemodijalizi

Background/Aim. Inflammation is the most important factor in the genesis of vascular complication in the endstage renal disease. The serum C-reactive protein (CRP) level is a sensitive marker of systemic inflammation as well as a predisposing factor for cardiovascular and all cause mortality in patients on hemodialysis. Albumin is the negative acute phase protein and its synthesis declines during the inflammation. The patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition, due to reduced protein synthesis and increased degradation. The low serum albumin levels in these patients originate from the complex setting of conditions with systemic inflammatory response as a major cause, malnutrition and overhydratation. The aim of this study was to determine the prevalence of elevated CRP levels in the dialysis patients and to analyse its correlation with serum albumin levels and other parameters of nutritional status. Methods. The study included 49 patients on maintenance hemodialysis at the Department of Hemodialysis, Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia. In order to analyse the parameters, the blood samples were taken during the arteriovenous fistula (AVF) puncture and before the second weekly dialyse. The following parameters were determined: serum levels of urea and creatinine before and after the dialysis procedure, CRP, hemoglobin, fasting glycemia, total cholesterol, triglycerides, albumins, iron, glycosylated hemoglobin (HbA1c), fasting insulinemia and C-peptide only before the dialysis. Results. Out of 49 patients on maintenance hemodialysis, 37 (75.5%) were males and 12 (24.5%) females with the average age of 56.04 ± 13.93 years. The average duration of the dialysis treatment was 7.37 ± 5 years. The high serum CRP levels (more than 3 mg/L) was found in 65.3% of patients. Singificantly more diabetic patients were observed in the group with the higher CRP levels (n = 12) compared to the group with the normal CRP levels (n = 3) (p ≤ 0.05). A significant positive correlation was found between the CRP value and urea values after the dialysis procedure. We found negative correlation between the CRP values and serum albumin, HbA1c, total cholesterol and triglyceride levels, with no statistical significance. Conclusion. Our study observed a high rate of inflammation in the dialysis patients presenting as high frequency of the elevated CRP levels in the examined group. Negative correlation between CRP levels and serum albumin as well as with some other parameters of nutritional status, suggests that chronic inflammation may be the missing link that actually connect protein energy malnutrition with high morbiditiy and mortality rate in these patients.Uvod/Cilj. Inflamacija je jedan od glavnih faktora odgovornih za nastanak vaskularnih komplikacija kod bolesnika sa terminalnom bubrežnom insuficijencijom. C reaktivni protein (CRP) se smatra senzitivnim markerom sistemske inflamacije, kao i faktorom koji doprinosi povećanom riziku od opšteg i kardiovaskularnog mortaliteta. Albumin je negativni protein akutne faze zapaljenja i njegova sinteza opada sa napredovanjem sistemske inflamacije. Za bolesnike na hemodijalizi poznato je da pate od visokog stepena proteinske malnutricije usled smanjene sinteze proteina i njihove pojačane razgradnje. Nizak nivo serumskog albumina kod tih bolesnika je posledica kompleksnog stanja koje podrazumeva sistemsku inflamaciju, malnutriciju i prekomernu hidrataciju. Cilj naše studije bio je da se ispita učestalost povišenog serumskog CRP-a u našoj populaciji dijaliznih bolesnika i da se utvrdi stepen njegove korelacije sa serumskim albuminom i drugim parametrima nutritivnog statusa. Metode. Ispitivanjem je obuhvaćeno 49 bolesnika na hroničnom programu hemodijalize u Centru za hemodijalizu Klinike za nefrologiju Vojnomedicinske akademije u Beogradu. Uzorci krvi za analizu uzimani su tokom punkcije arteriovenske fistule, a pre druge nedeljne hemodijalize. Određivanu su sledeći parametri: serumski nivo uree i kreatinina pre i posle procedure, CRP, hemoglobin, glikemija, ukupni holesterol, trigliceridi, glikozilirani hemoglobin (HbA1c), insulinemija i C-peptid pre hemodijalize. Rezultati. Od ukupno 49 dijaliznih bolesnika, bilo je 37 (75,5%) muškaraca i 12 (24,5%) žena, prosečne starosti 56,04 ± 13,93 godine. Dužina lečenja hemodijalizom je prosečno iznosila 7,37 ± 5 godina. Povišene vrednosti serumskog CRP-a (više od 3 mg/L) imalo je 65,3% bolesnika. U grupi bolesnika sa povišenim nivoom CRP-a u serumu, bilo je značajno više dijabetičara (n=12) u odnosu na grupu sa normalnim nivoom CRP-a u serumu (n = 3) (p ≤ 0,05). Uočili smo postojanje značajne pozitivne korelacije između serumskog CRP-a i serumske uree nakon dijaliznog procesa. U ispitivanoj grupi postojala je negativna korelacija između serumskog CRPa i serumskog albumina, HbA1c, ukupnog holesterola i triglicerida. Ta korelacija nije bila statistički značajna. Zaključak. Naša studija je potvrdila visok stepen sistemske inflamacije kod dijaliznih bolesnika izražene kroz visoku učestalost povišenih vrednosti serumskog CRP-a. Negativna korelacija između nivoa serumskog CRP-a i serumskog albumina kao i drugih nutritivnih parametara, sugeriše da hronična inflamacija može biti ključna karika koja povezuje proteinsku malnutriciju sa visokim morbiditetom i mortalitetom ovih bolesnika

Eating behaviors and physical activity during the COVID-19 pandemic lockdown: Experiences of breast cancer patients on adjuvant hormonal therapy

Background/Aim. Since the coronavirus disease 2019 (COVID-19) pandemic led to a strict lockdown in Serbia, the population has experienced drastic lifestyle changes. Physical distancing, self-isolation, limited availability of essential food products, and the stress related to the availability of therapy during the pandemic particularly affected the lives of vulnerable groups, such as breast cancer (BrC) patients. The aim of this study was to examine the changes in eating behaviors and physical activity of postmenopausal BrC patients on adjuvant hormonal therapy under the COVID-19 lockdown conditions. Methods. This observational retrospective pre-post cohort study included 32 women treated with aromatase inhibitors (AIs) who responded to telephone interviews using a structured questionnaire. The questionnaire aims to collect data on eating habits (intake of certain foods on a daily/weekly basis, as well as changes in the usual choice of food), intake of supplements, changes in weight, and physical activity before and during the lockdown. Results. The results showed that, due to problems in obtaining groceries, the patients cooked and consumed homemade sweets and fruit more often (47% of the respondents), while fewer (31%) consumed fresh fish. Nearly 41% of patients reported increased food intake, and 88% reported decreased physical activity, which led to an increase in body weight in as many as 47% of subjects. The intake of supplements was doubled. Conclusion. The COVID-19 lockdown with home confinement exacerbated health risks and affected dietary patterns and physical activity, which may have had a negative impact on the long-term health of BrC patients treated with AIs

Polinezasićene masne kiseline u zdravlju i bolesti

Polyunsaturated fatty acids (PUFAs) are necessary for overall health. Two PUFAs families, n-6 and n-3 fatty acids, are physiologically and metabolically distinct. The proportion of PUFAs in serum and erythrocyte phospholipids, which depends on endogenous metabolism controlled by genetic polymorphisms and dietary intake, is an important determinant of both health and disease. Both n-3 and n-6 PUFAs are processed to powerful promoters of eicosanoids synthesis at the cyclooxygenase and lipoxygenase level. Evidence from observational and intervention studies suggest that n-3 PUFAs are cardio-protective, perhaps through their anti-inflammatory, anti-arrhythmic, lipid-low­ering and antihypertensive effects. In contrast, dietary n-6 PUFAs have pro-inflammatory effects. Low n-3 and elevated n-6 PUFAs levels were found in patients with cancer on different sites. The present review focuses on current knowledge related to PUFAs intake and status in health and disease, with reference to the Serbian population.Polinezasićene masne kiseline (PMK) su neophodne za normalno funkcionisanje organizma. Dve PMK familije, n-6 i n-3 masne kiseline se fiziološki i metabolički razlikuju. Udeo PMK u fosfolipidima seruma i eritrocita je važan pokazatelj zdravlja i bolesti, i zavisi od endogenog metabolizma, koji je kontrolisan genetskim polimorfizmom, i unosa hrane. I n-6 i n-3 PMK su prekursori za sintezu eikozanoida na ciklooksigenaznom i lipooksigenaznom nivou. Opservacione i interventne studije ukazuju da n-3 PMK imaju kardioprotektivni efekat, delujući anti-inflamatorno, anti-aritmogeno, hipolipidemično i antihipertenzivno. Nasuprot tome, smatra se da n-6 PMK imaju pro-inflamatorno dejstvo. Nizak nivo n-3 i povišen udeo n-6 PMK je pokazan kod pacijenata sa različitim tipovima maligniteta. U okviru ovog rada dat je pregled najnovijih saznanja o dijetarnom unosu i biomarkerima statusa PMK u promociji zdravlja i prevenciji bolesti, sa posebnim osvrtom na rezultate u našoj populaciji

Lipid Peroxidation and Antioxidant Supplementation in Neurodegenerative Diseases: A Review of Human Studies

Being characterized by progressive and severe damage in neuronal cells, neurodegenerative diseases (NDDs) are the major cause of disability and morbidity in the elderly, imposing a significant economic and social burden. As major components of the central nervous system, lipids play important roles in neural health and pathology. Disturbed lipid metabolism, particularly lipid peroxidation (LPO), is associated with the development of many NDDs, including Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS), all of which show elevated levels of LPO products and LPO-modified proteins. Thus, the inhibition of neuronal oxidation might slow the progression and reduce the severity of NDD; natural antioxidants, such as polyphenols and antioxidant vitamins, seem to be the most promising agents. Here, we summarize current literature data that were derived from human studies on the effect of natural polyphenols and vitamins A, C, and E supplementation in patients with AD, PD, and ALS. Although these compounds may reduce the severity and slow the progression of NDD, research gaps remain in antioxidants supplementation in AD, PD, and ALS patients, which indicates that further human studies applying antioxidant supplementation in different forms of NDDs are urgently needed

Efekat dugotrajnog napornog vežbanja na masnokiselinski profil fosfolipida plazme kod rukometaša

Background/Aim. Consensus on the exercise effect on the fatty acid metabolism has not been reached, and probably depends on the type of sports (aerobic, anaerobic or mixed). The aim of this study was to investigate effect of long-term handball training on the body composition, lipid profile and the plasma phospholipid fatty acid composition in female and male younger players. Methods. Seventeen female and 15 male active handball players, aged 16-20 years, who competed at the national/international level, were enrolled in the study. A control group was established from healthy, sedentary individuals (13 females and 19 males, aged 17-21 years), comparable to the athletes in terms of age, sex and body mass index. Results. In both groups of handball players a higher percentage of palmitoleic acid and alpha linolenic acid (18:3, n-3), were found and lower percentage of oleic acid and docosahexaenoic acid (22:6, n-3), when compared with corresponding control group. On the other hand, the lower level of stearic acid and estimated activity of plasma elongase was detected in female players than in sedentary women. Furthermore, higher proportion of linoleic acid (18:2, n-6), n-6 polyunsaturated fatty acids (PUFA) and total PUFA was found only in female players in comparison to the control group. Conclusion. The observed differences between handball players and sedentary individuals showed that handball training influenced lipid and fatty acid metabolism. Follow-up of these changes could indicate potential need for supplementation or nutritional intervention in young handball players.Uvod/Cilj. Konsenzus o uticaju treniranja na metabolizam masnih kiselina nije postignut, a taj uticaj verovatno zavisi od tipa sporta - aerobno, anaerobno ili mešovito vežbanje. Cilj ove studije bio je da se ispita efekat dugotrajnog, aktivnog treniranja rukometa na telesnu kompoziciju, profil lipida i masnih kiselina fosfolipida plazme kod mlađih kategorija rukometaša oba pola. Metode. U studiju je bilo uključeno 17 devojaka i 15 mladića, starosne dobi od 16 do 20 godina koji treniraju rukomet i takmiče se na nacionalnom i internacionalnom nivou. Kontrolnu grupu činilo je 13 devojaka i 19 mladića starosti od 17 do 21 godine, koji su bili uporedivi sa sportistima po godinama, polu i indeksu telesne mase. Rezultati. Procenat palmitoleinske i alfa-linolenske kiseline (18:3, n-3) bio značajno viši, dok je procenat oleinske i dokozaheksaenske kiseline (22:6, n-3) bio značajno niži u fosfolipidima plazme kod obe grupe sportista u odnosu na kontrolnu grupu. Sa druge strane, niži nivo stearinske kiseline i procenjene aktivnosti elongaze, ali i visok nivo linolne kiseline (18:2, n-6), ukupnih n-6 masnih kiselina, kao i ukupnih polinezasićenih masnih kiselina, utvrđen je kod rukometašica u odnosu na ispitanice iz kontrolne grupe, dok u grupi muškaraca nisu utvrđene takve razlike. Zaključak. Utvrđene razlike između rukometaša i rukometašica, sa jedne strane, i kontrolne grupe, sa druge strane, ukazale su na to da treniranje rukometa utiče na metabolizam lipida i masnih kiselina. Praćenje tih promena moglo bi ukazati na moguću potrebu za suplementacijom kod mladih rukometaša i rukometašica