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Objective:To systematically evaluate the clinical efficacy of compound α-ketoacid tablets in the treatment of diabetic kidney disease (DKD).Methods:CNKI, Wanfang database, EMBASE, PubMed and Cochrane Library database were searched for eligible records published from the establishment of individual database to November 13 th, 2022. The quality of the included studies were assessed, data were extracted, and meta-analysis was conducted using RevMan5.3. Results:A total of 26 randomized controlled trials were included, with a total of 2 790 DKD patients (1 465 in the experimental group and 1 325 in the control group). Multiple parameters were significantly improved in the experimental group compared with the control group, including 24-hour urinary protein, blood creatinine, urea nitrogen, nutritional index, oxidative stress level, fasting blood glucose, glycated hemoglobin, homocysteine, HGF, VEGF, TGF-β1, and systolic blood pressure.Conclusions:Limited low-quality evidence showed that compound α-ketoacid tablets combined with low-protein diet may be related to the improved 24-hour urinary protein, renal function, and glucose metabolism in patients with DKD. Due to the lack of randomized controlled trials designed for respective stages of DKD, the inclusion criteria of our study were relatively general, possibly leading to the lack of pertinence of the results. Some indicators showed apparent heterogeneity among different groups, and more high-quality multi-center studies with large sample sizes are still needed to verify our findings.
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Objective:To systematically evaluate the effects of protein restriction, low-sodium diet and alkaline diet on renal outcomes, the rate of change in estimated glomerular filtration rate (eGFR) and all-cause mortality in chronic kidney disease (CKD) patients.Methods:Three main databases, Ovid, EMBASE and the Cochrane Library database, were searched for randomized controlled trials about the effects of protein restriction, alkaline diet, low-sodium diet in chronic kidney disease. The primary outcome was renal composite endpoint events, the annual rate of change in eGFR and all-cause mortality. Renal composite endpoint events was defined as >25% or 50% decrease from baseline in eGFR, doubling of serum creatinine, or the development of end-stage renal diseaseas during follow-up.The studies were selected according to inclusion and exclusion criteria and assessed for quality using Jadad Scale. Two investigators were chosen to search, extract and evaluate the data independently. Software Stata 16.0 and RevMan 5.4 were used for meta-analysis.Results:A total of 34 studies with 5 589 participants were included. Protein restriction ( RR = 0.78, 95% CI: 0.64 to 0.96, P < 0.001), alkaline diet ( RR = 0.64, 95% CI: 0.43 to 0.98, P < 0.001) and low-sodium diet ( RR = 0.45, 95% CI: 0.28 to 0.73, P < 0.01) reduced the risk of renal composite outcomes. Protein restriction ( MD = 1.85, 95% CI: 0.77 to 2.93, P = 0.001), alkaline diet ( MD = 1.45, 95% CI: 0.53 to 2.37, P < 0.001) and low-sodium diet ( MD = 1.84, 95% CI: 1.06 to 2.63, P < 0.001) also decreased the rate of delince in eGFR. But these dietary patterns did not show a clear beneficial effect for all-cause mortality ( RR = 1.15, 95% CI: 0.76 to 1.73, P = 0.167 for protein restriction, RR = 0.96, 95% CI: 0.31 to 3.02, P = 0.546 for alkaline diet and RR = 0.82, 95% CI: 0.48 to 1.40, P = 0.057 for low-sodium diet). Conclusion:The three dietary interventions may decline the rate of renal function exacerbation and decrease the risk of unfavourable renal outcomes in CKD patients, while have no clear beneficial effect on all-cause mortality.
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INTRODUCCIÓN Se ha planteado que el uso de dieta muy baja en proteínas suplementado con keto análogos en pacientes enfermos renales crónicos pre diálisis podría enlentecer el avance hacia una enfermedad terminal e inicio de diálisis sin riesgo de desnutrición. Sin embargo, su uso habitual aún no ha sido implementado dada la incertidumbre que existe frente a su efectividad y seguridad. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, de los cuales, 12 corresponden a ensayos aleatorizados. Concluímos que una dieta muy baja en proteínas suplementada con keto análogos disminuye la progresión a enfermedad renal crónica terminal, probablemente disminuye la caída o deterioro de la función renal, podría disminuir mortalidad por cualquier causa y resultar en poca o nula diferencia en riesgo de desnutrición, siendo la certeza de la evidencia baja en estos dos últimos puntos.
INTRODUCTION It has been proposed that a very low protein diet supplemented with keto analogues in pre-dialysis chronic kidney disease patients can slow the progression to a terminal disease and delay the start of renal replacement therapy, without a malnutrition risk. However, its common use has not yet been implemented due to the uncertainty of its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified eight systematic reviews including 14 studies overall, of which 12 were randomized trials. We concluded that a very low protein diet supplemented with keto analogues delays the progression to end-stage kidney disease, probably reduces the fall or deterioration of renal function, could reduce mortality by any cause y result in little or no difference in malnutrition risk, but the certainty of the evidence is low for these last two results.
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Objective:To systematically evaluate the effects of low protein diet combined with α-keto acid on calcium and phosphorus metabolism and nutritional status in patients undergoing hemodialysis.Method:Randomized controlled Trials were searched in Cochrane Library, Web of Science, PubMed, Embase, CBM, CNKI, Wanfang and VIP databases from the establishment of respective database until July 2021, and meta-analysis is conducted using RevMan 5.4.Results:A total of 8 studies including 556 patients were selected. Meta-analysis showed that after receiving low protein diet combined with α-keto acid, patients demonstrated significantly reduced blood phosphorus [MD = -0.17, 95% CI (-0.25, -0.7), P < 0.01], calcium- phosphorus product [MD = -6.17, 95% CI (-6.67, -5.58), P < 0.01] and parathyroid hormone levels [MD = -35.36, 95% CI (-40.89, -29.83), P < 0.01]. There was no significant difference in serum calcium [MD = 0.03, 95% CI (-0.00, 0.07), P = 0.08] and serum albumin [MD = 0.41, 95% CI (-0.12, 0.95), P = 0.13]. Conclusion:Low protein diet combined with α-keto acid can reduce the levels of serum phosphorus, calcium-phosphorus product and parathyroid hormone in hemodialysis patients while the effects on serum calcium and serum albumin are undetermined and need further verification.
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@#Introduction: Although the benefit of low protein diet (LPD) on chronic kidney disease (CKD) progression is well documented, patients’ adherence remains as the main challenge. Therefore, this study sought to identify adherence towards LPD among CKD patients and determine possible associating factors. Methods: This cross-sectional study was done at the Hospital Pakar Sultanah Fatimah in Muar, Johor, among stage III to V CKD patients. Three-day dietary recalls were used to quantify dietary energy (DEI) and protein intake (DPI). Factors investigated include socio-demographic characteristics, medical history, anthropometry and body composition measurements, dietary knowledge, appetite level, handgrip strength, perceived stress, and health locus of control. Associating variables were analysed with logistic regression analysis. Results: The final analysis included 113 patients (54% male) with a mean estimated glomerular filtration rate of 17.5±11.2mL/min/1.73m2 and the average age of 56.3±12.8 years. Mean DEI and DPI were 22.4±5.9kcal/kg/day and 0.83±0.28g/kg/day, respectively. Only 34.5% of patients adhere to the LPD diet with 59% exceeding the DPI recommendation. Poorer LPD adherence was associated with longer duration of hospitalization (OR 0.707, 95%CI 0.50-1.00, p=0.048), higher energy intake (OR 0.744, 95%CI 0.65-0.85, p<0.001), advance CKD stage (OR 0.318, 95%CI 0.13-0.77, p=0.012) and having better dietary knowledge (OR 0.380, 95%CI 0.170.85, p=0.018). Conclusion: LPD adherence of CKD patients in our institution is very poor signifying the need for engagement at the earlier stage of CKD to identify and stratify the patients for a targeted dietary intervention.
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@#Introduction: High prevalence of malnutrition has impact that often causes problems in body organs. Various reports suggest an association between malnutrition and chronic kidney failure. However, the effect of malnutrition on the immunological status of the kidney has not been identified. Objective: to identify the effect malnutrition on the immunological status of the kidney. Methods: It was an experimental study with post test only control group design to compare two dietaries intake in two mice groups. Group 1, mice were given with standard intake. Group 2, mice were fed with low protein diet. The variables analyzed were the expression of IL-6, TNF-α and TGF-β in kidney tissue by immunohistochemistry and comparative test using Mann-Whitney test. Results: Eleven dead mice were found in the low protein diet group until day 75. At the end of observation, the number of mice in control group remained 10, while, in malnutrition group, there were 9 mice which were still alive but in a state of malnutrition. Based on comparative test between the group receiving and not receiving low protein diet, it was found that the expression of IL-6, TNF-α and TGF-β in kidney tissue showed a significant difference (p<0.05). Conclusion: Low protein diet in malnutrition affects the immunological status of the kidney as marked by the expression of IL-6, TNF-α, and TGF-β in the kidney tissue of mice model.
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Objective Intrauterine growth retardation (IUGR) is characterized by low birth weight of neonates. The aim of this study was to provide a reference for the establishment of IUGR models in scientific research, by comparing the experimental data of different rat models of IUGR established by three commonly-used methods. Methods A total of 20 pregnant rats on the day 0 of gestation were divided into 4 groups, with 5 rats in each group (n=5). Among them, 3 groups of rats were treated with alcohol intervention (group A), uterine artery ligation (group U), and low protein diet (LP group), respectively, to establish rat models of IUGR, and the fourth group served as the normal control group (CON group). Fetal rats were taken through cesarean section on the 20th day of gestation. The body mass, brain mass, placental mass, two-kidney mass, body length and tail length of the fetal rats were measured, and the incidence rate of IUGR, stillbirth rate and their brain to placenta ratio were calculated. The fetal rats in each group were continuously raised and the body mass, perirenal fat pad mass and some organ masses were determined at the 3rd, 6th and 12th weeks. Results The average body mass of the fetal rats in the groups A, U and LP group was significantly lower than that of the normal control group (P＜ 0. 05), and the incidence rate of IUGR of the fetal rats was significantly higher than that of the normal control group (P＜ 0. 05). In addition, the stillbirth rate of pregnant rats in the group U was significantly higher than those of the group A and LP group (P ＜ 0. 05). After raising the rats for 3 weeks, the average body mass of rats in the three experimental groups was significantly lower than that of the normal control group (P ＜ 0. 05), and after raising for 6 weeks, the average body mass in the three experimental groups was still lower than that of the normal control group, but with a non-significant difference (P＞ 0. 05). However, after raising for 12 weeks, the average body mass of the rats in the group A and LP group was significantly higher than that of the normal control group (P ＜ 0. 05). Conclusions Rat models of IUGR can be successfully established either by alcohol intervention, uterine artery ligation or low protein diet. The IUGR model established by low protein diet has the advantages of a higher incidence rate of IUGR and lower stillbirth rate, being more suitable for animal model research. As regards the catch-up growth, the average body mass of the rats during the postpartum period and lactation period after delivered by cesarean section in the group A and LP group is lower than that of the normal control group, but after lactation the rats grow faster than those in the normal control group, indicating the existence of a catch-up growth in the group A and LP group.
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Aims: Maternal low-protein diet induces several impairments on cardiac system. Conversely, moderate exercise has been widely recommended to health improvement due to its effects on heart function. Thus, we investigated whether the moderate physical training is capable to offset the lasting injuries of a maternal protein restriction on the hearts of male adult rats. Methods: Pregnant rats were divided into two groups: Control (C=17% casein) and undernutrition (U=8% casein). Offspring from the undernutrition group, at 60 days of life, were subdivided into undernutrition (U) and undernutrition+exercise (UT) groups. Treadmill exercise was performed: (8 weeks, 5 days/week, 60 min/day at 70% of VO2máx). 48 hours after last exercise session, tissues were collected for morphological and biochemical analysis. Results Despite the deleterious effect induced by low-protein diet, physical training was able to restore morphological parameters to similar levels to the control group. Additionally, oxidative stress index was also improved in UT group, due to the increase in antioxidant enzymatic defense. In metabolic enzymes, maternal low-protein diet induced a change in metabolism, and moderate physical training improved oxidative metabolism. Conclusion: We demonstrated that moderate physical training can offset the cardiac metabolism in adult rats that were exposed to a maternal low-protein diet.(AU)
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Animals , Male , Rats , Exercise/physiology , Oxidative Stress , Maternal Nutrition , Animal Nutritional Physiological Phenomena , Rats, WistarABSTRACT
Objective To explore the effects of α-keto acid combined with low protein diet on oxidative stress and electrolyte levels in patients with diabetic nephropathy. Methods Ninety-eight cases with type 2 diabetic nephropathy were randomLy divided into the treatment group(low-protein diet with α-keto acid 1 tablet,n=58) and the control group(normal protein intake,n=40). The 24 h urinary albumin excretion rate,glomerular filtra-tion rate ,serum oxidative stress (SOD ,MDA ,AOPPs) and electrolyte levels were measured before and after treatment. Results After 24 weeks of treatment,the 24 h urinary albumin excretion rate of DN patients in the treatment group was significantly lower than that before treatment and the control group (P < 0.05). However, there was no significant change in the glomerular filtration rate of the patients. Compared with the control group , the serum SOD activity of DN patients was significantly increased and the levels of MDA and AOPPs were decreased(P < 0.05)after 24 weeks of treatment. Simultaneously,the levels of serum potassium and phosphorus in the treatment group was decreased ,while the levels of calcium and magnesium were improved (P < 0.05). Conclusion α-keto acid combined with low protein diet can significantly reduce the urinary albumin excretion rate,improve the body′s antioxidant activity,and maintain serum electrolytes balance.
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Animals , Female , Pregnancy , Cell Communication/physiology , Diet, Protein-Restricted , Diabetes, Gestational/diet therapy , Intercellular Junctions/metabolism , Islets of Langerhans/metabolism , RNA, Messenger/metabolism , Analysis of Variance , Actins/metabolism , Adherens Junctions/metabolism , Blood Glucose/analysis , /metabolism , Connexins/metabolism , Diabetes, Gestational/prevention & control , Gap Junctions/metabolism , Glucose/administration & dosage , Insulin/metabolism , Insulin , Rats, Wistar , Real-Time Polymerase Chain Reaction , beta Catenin/metabolismABSTRACT
Objective To investigate the effect of α-keto acid combined with low protein diet on kidney function, calcium-phosphorus metabolism and adenosine deaminase activity in malnourished patients with long term peritoneal dialysis.Methods Forty-six cases malnourished patients with long term peritoneal dialysis were selected from May 2013 to August 2014 in the hospital and divided into two groups.The control group (n=23) were treated by conventional therapy, acceptable daily intake of protein 1.2 g/(kg? d).The experiment group (n=23) were treated by α-keto acid combined with low protein diet, acceptable daily intake of protein 0.8 g/(kg? d).Two groups were treated for three months.Serum calcium, phosphorus, nutritional status assessment, adenosine deaminase activity and renal function were observed and compared after treatment.ResuIts After twelve months ’ treatment, compared with control group, serum creatinine, blood urea nitrogen, serum uric acid of experiment group were lower ( P0.05).ConcIusion α-keto acid combined with low protein diet could effectively increase serum calcium level, reduce serum phosphorus level, ADA activity and WBC count, and improve nutritional status in long-term peritoneal dialysis patients, which has important significance.
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Objective To explore the effects of the continuous quality improvement ( CQI) on recovery and health of patients with chronic kidney disease ( CKD) .Methods The clinical data of 485 cases with CKD undergoing standard treatment from Jan .30th, 2012 to Dec.30th, 2012 in Shaoxing People's Hospital were retro-spectively analyzed .A professional team introduced four-step intervention of continuous quality change .The nu-tritional status, renal function changes , and patients'cognition and compliance with low protein diet before and af-ter treatment were compared .Results The nutritional status of patients significantly improved after the treat-ment.The patients with score ≥23 points increased 58.14%.After CQI intervention , urinary albumin/creati-nine (mg/g) was calculated and it was 82.17 before treatment and 64.23 after treatment.The difference had sta-tistical significance (t=11.321,P＜0.05).After the treatment, 82.06% patients understood low-protein diet concept .The treatment was implemented well and the overall data improved significantly .Conclusions CQI has beneficial effects on immunity and renal function recovery of patients with CKD .It can significantly improve the patients'nutritional status , and their cognition of low protein diet .
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Objective To observe the muscle wasting in diabetic kidney disease (DKD) model of type 2 and non-obese diabetes mellitus in Goto-Kakizaki (GK) rats,and to evaluate the effect of lowprotein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-weekage GK rats were randomly divided into three groups:normal protein diet group (22％ casein diet,NPD),low protein diet group (6％ casein diet,LPD) and LPD + α-keto group (5％ casein + 1％ α-keto,Keto).Fifteen gender-and age-matched Wistar rats were served as the control group (CTL).The living condition of GK rats was observed and body weight was measured once a week.Urine albumin,serum glucose,lipids,albumin,creatinine and urea nitrogen were measured at the age of 24,32,40,48 weeks.Soleus muscle at the age of 48-week was observed to calculate the muscle size with software.Expressions of atrogin-1,MuRF-1 and MyoD,myogenin were examined by Q-PCR and Western blotting.Results Compared with the CTL group,NPD,LPD,Keto groups had lower body weight [(317.90± 13.81),(330.38±11.96),(390.44±12.25) g vs (429.43± 16.85) g,all P ＜ 0.05],higher urine albumin [(14.36±5.52),(8.12±4.61),(5.58±3.50) mg/24 h vs (0.61±0.16) mg/24 h,all P ＜ 0.05],higher serum creatinine [(81.50±7.88),(66.32±8.36),(63.44±8.21) μmol/L vs (24.43±6.15) μmol/L,all P ＜0.05] and urea nitrogen [(7.53±1.05),(5.63±1.40),(5.54±0.97) mmol/L vs (2.98±0.62) mmol/L,all P ＜0.05].The cross-sectional area of soleus muscle fibers was larger in CTL group.Compared with CTL group,the expression levels of atrogin-1 and MuRF-1 increased significantly (all P ＜ 0.05),and of MyoD and myogenin decreased significantly in NPD,LPD,Keto groups (all P ＜ 0.05).In Keto group after 40 weeks,muscle wasting was improved compared with NPD and LPD group [body weight (381.62± 15.82) g vs (331.50±17.58),(326.60± 13.43) g,all P ＜ 0.05],cross-sectional area of soleus muscle increased,levels of urine albumin,serum creatinine and urea nitrogen decreased (all P ＜ 0.05),the protein expressions of atrogin-1 and MuRF-1 decreased,and myogenin and MyoD were higher as compared to CTL group (all P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,the genes which control muscle atrophy are activated,and proliferation and differentiation of the muscle satellite cells are impaired.Low-protein diet supplemented with α-keto acids can improve muscle wasting induced by DKD.
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Introdução: a maioria dos distúrbios metabólicos presentes na Doença Renal Crônica (DRC) resulta, principalmente, do acúmulo de produtos do metabolismo do nitrogênio presentes nos alimentos ricos em proteínas. A dietoterapia tem um papel importante no tratamento da DRC, consistindo, principalmente, naadequação da oferta diária de proteínas.Objetivo: discutir a resposta inflamatória e terapia nutricional empregada no tratamento conservador e as vantagens do emprego de dieta normoproteica à base de soja.Métodos: realizada revisão da literatura por meio de busca de artigos científicos indexados em bases de dados online, publicados preferencialmente nos últimos dez anos, além de livros técnicos e outras formas de publicações.Resultados: as complicações metabólicas estabelecem consequênciasimportantes na DRC e podem comprometer o estado nutricional do indivíduo. Ainda são poucas as referências ao uso de dieta normoproteica à base de soja, sendo destacados apenas alguns benefícios em curto prazo, com pouca ênfase às metodologias usadas para a terapia nutricional.Considerações Finais: a evolução do tratamento depende de sua qualidade e das estratégias que serão adotadas durante sua implementação. A dietoterapia é importante no tratamento da DRC, consistindo, principalmente, na redução de oferta diária de proteínas. A presença da inflamação influencia negativamente o estado nutricional e a evolução da função renal do indivíduo.Mais estudos com dieta à base de soja são necessários.
Introduction: Most metabolic disorders present in Chronic Kidney Disease (CKD) results mainly from the accumulation of products of nitrogen metabolism in foods rich in protein. The diet therapy plays an important role in the treatment of CKD, consisting mainly, on the matching of supply daily protein.Objective: discuss the inflammatory response and nutritional therapyused in the conservative treatment and the advantages of using a normalprotein diet based on soy.Methods: literature review was conducted by searching scientific articlesindexed in online databases, preferably published in the last ten years, and technical books and others publications.Results: Metabolic complications establish important consequences in CKD and may compromise the nutritional status of the individual.Although, there are few references to the use of a normal protein dietbased on soy, and posted just a few short-term benefits, with little emphasison the methodologies used for nutritional therapy.Final Remarks: The evolution of treatment depends on the quality and the strategies to be adopted during its implementation. The diet therapy plays an important role in the treatment of CRF, consisting mainly inthe reduction of daily supply of proteins. The presence of inflammation adversely affects the nutritional status of renal function and evolution of the individual. More studies with soy-based diet are needed.
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Humans , Diet Therapy , Kidney , Diet, Protein-Restricted , Diet , Inflammation , Soy FoodsABSTRACT
A incompatibilidade entre a desnutrição perinatal e uma nutrição adequada durante o desenvolvimento aumenta o risco de aparecimento precoce de doenças não transmissíveis na vida adulta. Todavia, acredita-se que a atividade física materna possa atenuar estas consequências. O presente estudo teve como objetivo avaliar os efeitos do treinamento físico durante a gestação na evolução ponderal, circunferência abdominal, glicemia e colesterolemia de filhotes adultos submetidos à desnutrição perinatal. Ratas Wistar (n = 12) foram divididas em quatro grupos: controle (C, n = 3), treinada (T, n = 3), desnutrida (D, n = 3) e treinada desnutrida (T+D, n = 3). Durante a gestação e lactação, os grupos D e T+D receberam dieta baixa em proteína (8% caseína) e os grupos C e T receberam dieta normoproteica (caseína a 17%). O protocolo de treinamento físico moderado foi realizado em esteira ergométrica (cinco dias/semana, 60 min/dia, a 65% do VO2max) e iniciou quatro semanas antes da gestação. Na gestação, a duração e a intensidade do treinamento foram reduzidas (cinco dias/semana, 20 min/dia, a 30% do VO2max) até o 19º dia pré-natal. Após o desmame, os filhotes (C F = 9, T F = 9, D F = 7, T+D F = 9) receberam dieta padrão de biotério e foram avaliados aos 270 dias de idade. A circunferência abdominal (CA) foi avaliada relativa ao peso corporal. Para avaliação da glicemia e colesterolemia foi utilizado o método enzimático colorimétrico da glicose-oxidase/peroxidase e da colesterol-oxidase, respectivamente. Ratos do grupo D F apresentaram um maior ganho de peso corporal ao longo do crescimento, maiores valores de CA, glicemia e colesterolemia quando comparados ao grupo C F. Para o grupo T+D F, o ganho de peso foi atenuado, e a CA, a glicemia e a colesterolemia foram normalizadas (p < 0,05). Esses resultados demonstram que o treinamento físico durante a gestação atenua os efeitos da desnutrição perinatal sobre alguns indicadores murinométricos e bioquímicos nos filhotes adultos.
The incompatibility of perinatal undernutrition and adequate nutrition during development increases the risk of early onset of non-communicable diseases in adulthood. However, it has been considered that maternal physical activity may attenuate these effects. This study aimed to evaluate the effects of physical training during pregnancy on body weight gain, waist circumference, glycaemia and cholesterolemia in adult offspring submitted to perinatal undernutrition. Female Wistar rats (n = 12) were divided into four groups: control (C, n = 3), trained (T, n = 3), undernourished (D, n = 3) undernourished and trained (T+D, n = 3). During gestation and lactation, D and T+D groups were fed a low protein diet (8% casein) and C and T groups fed a normal protein diet (17% casein). The protocol of moderate physical training was performed on a treadmill (5 days/week, 60 min/day, at 65% of VO2max) and began 4 weeks before pregnancy. At pregnancy, the duration and intensity of training were reduced (5 days/week, 20 min/day, at 30% VO2max) until the 19th prenatal day. At weaning, male pups (CP = 9, TP = 9, DP = 7, T+DP = 9) received standard diet and evaluations took place at 270 days old. Abdominal circumference (AC) was evaluated in relation to body weight. Enzymatic colorimetric method glucose-oxidase/peroxidase and cholesterol-oxidase was used to evaluate fasting glycaemia and cholesterolemia, respectively. Rats from DP group showed high body weight gain during growth, values of CA, glycaemia and cholesterolemia when compared to CP. Concerning the T+DP group,body weight gain was attenuated, and the CA, glycaemia and cholesterolemia were normalized (p<0.05). These results demonstrate that physical training during pregnancy reduces the effects of perinatal undernutrition on some murinometric and biochemical indicators of adult offspring.
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Objective To evaluate the effects of continuous quality improvement (CQI) management on nutritional status,renal function progression,and compliance of low protein diet in patients with chronic kidney disease (CKD).Methods Totally 115 CKD patients who were regularly followed up in CKD clinic services were recruited in this study.Plan,Do,Check,and Act (PDCA) method was adopted to manage the dietary of these patients for 12 months.The clinical indicators and diet compliance before and after receiving CQI management were compared.Results After receiving the CQI management,the nutritional status of patients was well maintained;meanwhile,the average hand strength and the hemoglobin,serum albumin,total cholesterol,and triglyceride levels showed no significant changes (all P ＞ 0.05).Subjective feelings of patients were improved.The modified Subjective Global Assessment of Nutrition (mSGA) score was decreased from 7.0 (7.0,8.0) to 7.0 (7.0,7.0) (P =0.000).The estimated glomerular filtration rate (eGFR) calculated by formula of modified MDRD was decreased from (40.74 ± 14.49) to (37.94 ± 16.86) ml/(min · 1.73 m2) (P =0.000),and the average descended speed was (2.81 ±7.42) ml/(min · 1.73 m2) per year.The creatinine clearance rate had no statistical difference between pre-and post management (P =0.910),and the average descended speed was (0.19 ± 17.01) ml/min per year.The daily protein intake (DPI) and protein equivalent of nitrogen appearance rate (PNA) were both significandy descended:DPI/kg decreased from (0.79 ± 0.27) to (0.64 ± 0.15) g/ (24 h · kg) (P =0.000),and PNA/kg dropped from (1.02 ± 0.32) to (0.82 ± 0.24) g/ (24 h · kg) (P =0.000).The scores of awareness and compliance of patients on low protein diet were significantly increased after CQI management (P =0.000).Conculsion Applying CQI on dietary and nutrition management in CKD patients can maintain the good nutritional status and improve the compliance of low protein diet.
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Heart autonomic ganglia are known to play an important role in cardiac rhythm control, protecting againstcertain arrhythmias due to their parasympathetic activity. Cardiac disorders may arise following starvingstates during pregnancy; cardiac performance and cardiac fibers have been shown to suffer deleterious effectsunder starvation. Morphology of these plexuses may suffer interference of extrinsic factors, but data is stilllacking about the effects of low protein diet during pregnancy and early postnatal period on subepicardialneuron structure. Two groups of pregnant Wistar rats were submitted to different diets according to itsprotein content, normal and 5% casein, until 21 days after delivery. The offspring was divided in two groups,D and N, according to their motherLs diet, low and normal protein respectively, and then sacrificed. Theatrial neurons were identified by À-nicotinamide adenine dinucleotide (NADH) and adenine dinucleotidephosphate diaphorase (NADPH-d) staining. Profile areas of the nerve cell bodies were measured. NADHstaining did not show significant differences between groups but NADPH- d profile areas of nerve cell bodiesfrom group D were smaller than in control group. Ultrastructural changes were observed in group D rats:agglomerated ribosomes, increase in nucleoli density and irregular chromatin.Low-protein diet in rats at earlydevelopmental stages interferes in size, and ultrastructure of subepicardial neurons. Even though underfeedingduring perinatal period did not produce neuronal death, neuron development is delayed and permanentchanges can supervene in long term.
Subject(s)
Animals , Female , Pregnancy , Rats , Arrhythmias, Cardiac , Diet, Protein-Restricted , Ganglia , Malnutrition , Neurons , Ribosomes , Malnutrition/diet therapy , Rats, WistarABSTRACT
A low-protein diet leads to functional and structural pancreatic islet alterations, including islet hypotrophy. Insulin-signaling pathways are involved in several adaptive responses by pancreatic islets. We determined the levels of some insulin-signaling proteins related to pancreatic islet function and growth in malnourished rats. Adult male Wistar rats (N = 20 per group) were fed a 17 percent protein (normal-protein diet; NP) or 6 percent protein (low-protein diet; LP), for 8 weeks. At the end of this period, blood glucose and serum insulin and albumin levels were measured. The morphometric parameters of the endocrine pancreas and the content of some proteins in islet lysates were determined. The β-cell mass was significantly reduced (≅65 percent) in normoglycemic but hypoinsulinemic LP rats compared to NP rats. Associated with these alterations, a significant 30 percent reduction in insulin receptor substrate-1 and a 70 percent increase in insulin receptor substrate-2 protein content were observed in LP islets compared to NP islets. The phosphorylated serine-threonine protein kinase (pAkt)/Akt protein ratio was similar in LP and NP islets. The phosphorylated forkhead-O1 (pFoxO1)/FoxO1 protein ratio was decreased by 43 percent in LP islets compared to NP islets (P < 0.05). Finally, the ratio of phosphorylated-extracellular signal-related kinase 1/2 (pErk1/2) to total Erk1/2 protein levels was decreased by 71 percent in LP islets compared to NP islets (P < 0.05). Therefore, the reduced β-cell mass observed in LP rats is associated with the reduction of phosphorylation in mitogenic-related signals, FoxO1 and Erk proteins. The cause/effect basis of this association remains to be determined.
Subject(s)
Animals , Male , Rats , Forkhead Transcription Factors/metabolism , Insulin-Secreting Cells/pathology , /metabolism , Nerve Tissue Proteins/metabolism , Protein-Energy Malnutrition , Diet, Protein-Restricted , Phosphorylation , Protein-Energy Malnutrition/metabolism , Protein-Energy Malnutrition/pathology , Rats, WistarABSTRACT
A study was undertaken to investigate the effect of administering praziquantel (PZQ), focusing on the liver stereological findings of malnourished mice infected with Schistosoma mansoni. Thirty female Swiss Webster mice (age: 21 days; weight: 8-14 g) were fed either a low-protein diet (8 percent) or standard chow (22 percent protein) for 15 days. Five mice in each group were infected with 50 cercariae each of the BH strain (Brazil). PZQ therapy (80 mg/kg body weight, per day) was started on the 50th day of infection and consisted of daily administration for 5 days. Volume density (hepatocytes, sinusoids and hepatic fibrosis) was determined by stereology using a light microscope. Body weight gain and total serum albumin levels were always lower in undernourished mice. Our stereological study demonstrated that treatment increased both volume density of hepatocytes in mice fed standard chow (47.56 percent, treated group and 12.06 percent, control) and low-protein chow (30.98 percent, treated group and 21.44 percent, control), and hepatic sinusoids [standard chow (12.52 percent, treated group and 9.06 percent, control), low-protein chow (14.42 percent, treated group and 8.46 percent, control)], while hepatic fibrosis was reduced [standard chow (39.92 percent, treated group and 78.88 percent, control) and low-protein chow (54.60 percent, treated group and 70.10 percent, control)]. On the other hand, mice fed low-protein chow decreased density volume of hepatocytes and hepatic fibrosis. In conclusion, our findings indicate that treatment with PZQ ameliorates hepatic schistosomiasis pathology even in mice fed a low-protein diet.
Subject(s)
Animals , Female , Mice , Anthelmintics/therapeutic use , Diet, Protein-Restricted , Liver/pathology , Praziquantel/therapeutic use , Schistosomiasis mansoni/drug therapy , Hepatocytes/pathology , Liver Cirrhosis/pathology , Liver/parasitology , Schistosomiasis mansoni/pathology , Serum Albumin/analysis , Weight GainABSTRACT
Protein energy malnutrition (PEM) is a syndrome that often results in immunodeficiency coupled with pancytopenia. Hemopoietic tissue requires a high nutrient supply and the proliferation, differentiation and maturation of cells occur in a constant and balanced manner, sensitive to the demands of specific cell lineages and dependent on the stem cell population. In the present study, we evaluated the effect of PEM on some aspects of hemopoiesis, analyzing the cell cycle of bone marrow cells and the percentage of progenitor cells in the bone marrow. Two-month-old male Swiss mice (N = 7-9 per group) were submitted to PEM with a low-protein diet (4 percent) or were fed a control diet (20 percent protein) ad libitum. When the experimental group had lost about 20 percent of their original body weight after 14 days, we collected blood and bone marrow cells to determine the percentage of progenitor cells and the number of cells in each phase of the cell cycle. Animals of both groups were stimulated with 5-fluorouracil. Blood analysis, bone marrow cell composition and cell cycle evaluation was performed after 10 days. Malnourished animals presented anemia, reticulocytopenia and leukopenia. Their bone marrow was hypocellular and depleted of progenitor cells. Malnourished animals also presented more cells than normal in phases G0 and G1 of the cell cycle. Thus, we conclude that PEM leads to the depletion of progenitor hemopoietic populations and changes in cellular development. We suggest that these changes are some of the primary causes of pancytopenia in cases of PEM.