Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study

<div><p>Background & Objectives</p><p>Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients.</p><p>Design, Setting, Participants, Measurements</p><p>A study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured.</p><p>Results</p><p>Compared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (<i>p</i> < 0.05). The vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, <i>p</i> < 0.05). After adjustment for age, albumin, pre-dialysis systolic blood pressure, and duration of dialysis, vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity.</p><p>Conclusions</p><p>The present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism.</p></div

Demographic differences between the vegetarian and non-vegetarian groups.

<p>Demographic differences between the vegetarian and non-vegetarian groups.</p

Comparison of dietary composition between vegetarians and non-vegetarians.

<p>Comparison of dietary composition between vegetarians and non-vegetarians.</p

Differences in biochemical and nutritional markers between the vegetarian and non-vegetarian groups.

<p>Differences in biochemical and nutritional markers between the vegetarian and non-vegetarian groups.</p

Prefrontal Lobe Brain Reserve Capacity with Resistance to Higher Global Amyloid Load and White Matter Hyperintensity Burden in Mild Stage Alzheimer’s Disease

<div><p>Background</p><p>Amyloid deposition and white matter lesions (WMLs) in Alzheimer's disease (AD) are both considered clinically significant while a larger brain volume is thought to provide greater brain reserve (BR) against these pathological effects. This study identified the topography showing BR in patients with mild AD and explored the clinical balances among BR, amyloid, and WMLs burden.</p><p>Methods</p><p>Thirty patients with AD were enrolled, and AV-45 positron emission tomography was conducted to measure the regional standardized uptake value ratio (SUVr) in 8 cortical volumes-of- interests (VOIs). The quantitative WMLs burden was measured from magnetic resonance imaging while the normalized VOIs volumes represented BR in this study. The cognitive test represented major clinical correlates.</p><p>Results</p><p>Significant correlations between the prefrontal volume and global (r = 0.470, p = 0.024), but not regional (r = 0.264, p = 0.223) AV-45 SUVr were found. AD patients having larger regional volume in the superior- (r = 0.572, p = 0.004), superior medial- (r = 0.443, p = 0.034), and middle-prefrontal (r = 0.448, p = 0.032) regions had higher global AV-45 SUVr. For global WML loads, the prefrontal (r = -0.458, p = 0.019) and hippocampal volume (r = -0.469, p = 0.016) showed significant correlations while the prefrontal (r = -0.417, p = 0.043) or hippocampal volume (r = -0.422, p = 0.04) also predicted better composite memory scores. There were no interactions between amyloid SUVr and WML loads on the prefrontal volume.</p><p>Conclusions</p><p>BR of the prefrontal region might modulate the adverse global pathological burden caused by amyloid deposition. While prefrontal volume positively associated with hippocampal volume, WMLs had an adverse impact on the hippocampal volume that predicts memory performance in mild stage AD.</p></div

Illustration of automatic quantification of 3D white matter (WM) lesion burden.

<p>(1) Individual T1-weighted image were registered to the corresponding FLAIR images using a 12 degrees of freedom affine transformation. (2) To obtain the transformation matrix, the coregistered T1-weighted images were registered to the averaged customized group T1 template in MNI space. (3) The inverse transformation matrix from step 2 was applied to the AAL template to generate corresponding AAL volumes in each individual's 3D T1WI native space for later calculation of normalized 3D WM volume. (4) WM volume of interest (VOI) on FLAIR sequences (5) Transfer the white matter volume of interest to the corresponding T1 image. (6) 3D WM volume constructions.</p

Partial correlations between cortical volume and GM AV-45 SUVr in 30 patients.

<p>Partial correlations between cortical volume and GM AV-45 SUVr in 30 patients.</p

Model of prefrontal brain reserve with related regional volumes, white matter lesions and amyloid pathological load.

<p>Model of prefrontal brain reserve with related regional volumes, white matter lesions and amyloid pathological load.</p

General characteristics of the Alzheimer's disease patients.

<p>General characteristics of the Alzheimer's disease patients.</p

Prefrontal regions showing brain reserve to amyloid burden or white matter lesion loads.

<p>Prefrontal regions showing brain reserve to amyloid burden or white matter lesion loads.</p