Profiling the diet and body composition of subelite adolescent rhythmic gymnasts.

The aim of this study was to investigate the body composition and dietary intake of competitive club-level rhythmic gymnasts, who represent the larger cohort of the sport's practitioners. Fifty-five rhythmic gymnasts and 55 nonathlete females (13-19 years of age) were seen individually to collect a dietary recall and to take anthropometric data and bioelectric-impedance analysis. Gymnasts had lower body-mass index and lesser skinfold thickness, although middle arm-muscle circumference was similar in the 2 groups. Gymnasts had lower body-fat measures but normal levels of fat-free mass (FFM) and body-cellular mass. Gymnasts had better dietary habits than the age-matched controls. Low levels of calcium, phosphorous, iron, and zinc and a disparity between reported energy intake and estimated energy requirement were observed in both groups.

Soy protein diet improves endothelial dysfunction in renal transplant patients.

BACKGROUND: Since it has been demonstrated that soy diet can improve endothelial function, in the present study we evaluated the effect of dietary substitution of 25 g of animal proteins with soy proteins on endothelial dysfunction in renal transplant patients. METHODS: In 20 renal transplant patients (55 +/- 11 years, serum creatinine 1.7 +/- 0.6 mg/dl), brachial artery flow mediated dilation (FMD) and endothelium-independent vasodilation (sublingual nitroglycerine, 25 microg) were measured at baseline, after 5 weeks of a soy diet and finally after 5 weeks of soy wash-out. Changes in plasma lipids, markers of oxidative stress (lipid peroxides, LOOH) and inflammation (C-reactive protein), isoflavones (genistein and daidzein), asymmetric dimethyl arginine (ADMA) and L-arginine were also evaluated. RESULTS: At baseline, patients showed a significantly lower FMD as compared with age-matched healthy subjects (3.2 +/- 1.8 vs 6.3 +/- 1.9, respectively; P < 0.001), while response to nitroglycerine was similar. After soy diet, actual protein intake was not changed, cholesterol and lipid peroxides were significantly reduced, and isoflavones were detectable in plasma. Soy diet was associated with a significant improvement in FMD (4.4 +/- 2.0; P = 0.003 vs baseline), while response to nitroglycerine was unchanged. Improvement in FMD was related to L-arginine/ADMA ratio changes, but no significant relation was found to changes in cholesterol, lipid peroxides or genistein and daidzein plasma concentrations. After 5 weeks of soy diet discontinuation, FMD (3.3 +/- 1.7%) returned to baseline values and isoflavones were no longer detectable in plasma. CONCLUSIONS: A soy protein diet for 5 weeks improves endothelial function in renal transplant patients. This effect seems to be strictly dependent on soy intake as it disappears after soy withdrawal and is mediated by an increase in the L-arginine/ADMA ratio, independently of change in lipid profile, oxidative stress or isoflavones.

Early detection of cardiac dysfunction in patients with anorexia nervosa by tissue Doppler imaging.

BACKGROUND: Cardiac damage is a major complication of chronic starvation. The aim of this study was to evaluate the changes of left ventricular function in patients with anorexia nervosa by means of pulsed tissue Doppler imaging. METHODS: A total of 20 females (age 22.4+/-4.3 years) with overt anorexia nervosa, 20 matched healthy thin females with body mass index < 19 kg/m2 and 20 matched healthy normal-weight females underwent both standard echocardiography and tissue Doppler imaging. Myocardial systolic wave (Sm) and early (Em) and atrial (Am) diastolic waves were measured on the basal lateral segment and the basal interventricular septum from the apical four-chamber view. RESULTS: When compared with control groups, the anorexia nervosa group showed lower left ventricular mass (p < 0.0001), lower Sm peak of both lateral wall (6.5+/-0.9 vs. 9.4+/-2.1 and vs. 9.5+/-1.9 cm/sec, p < 0.001) and septum (5.6+/-1.5 vs. 8.6+/-1.6 and vs. 8.8+/-1.5 cm/sec, p < 0.001), and comparable Em, Am and Em/Am ratio. The ratio between transmitral peak E and Em was significantly greater in anorexic patients than in controls (lateral wall: 8.1+/-0.1 vs. 6.8+/-0.2 and vs. 6.9+/-0.2, p < 0.001; septum: 10.8+/-0.4 vs. 8.8+/-0.5 and vs. 8.8+/-0.3, p < 0.001). No differences were observed between thin and normal-weight females. In the anorexia nervosa group, S(m) peak was significantly related to left ventricular mass indexed, at both septum (r = 0.55, p < 0.02) and lateral wall (r = 0.49, p < 0.03) levels. CONCLUSIONS: These results show that anorexia nervosa is associated with left ventricular systolic dysfunction, which is related with the reduction of cardiac mass. Tissue Doppler imaging can give useful information in the identification of regional left ventricular dysfunction, in addition to traditional parameters.

Nutritional status and dietary manipulation in predialysis chronic renal failure patients.

OBJECTIVE: A properly implemented dietary treatment for patients with chronic renal failure (CRF) can correct several metabolic and endocrine disturbances and delay initiation of dialysis, but concerns exist about the risk of malnutrition and protein depletion. The goal of this study is to evaluate nutritional status and its relation to the dietary treatment in patients with advanced CRF. DESIGN: Cross-sectional survey. SETTING: Predialysis outpatient clinic. PATIENTS: Seventy patients (43 males, 27 females, 50 +/- 12 years) with severe CRF (glomerular filtration rate [GFR] <15 mL/min) being treated with a low-protein (0.6 g/kg/day) diet (LPD) or a very-low-protein (0.3 g/kg/day) diet supplemented with essential amino acids and ketoacids (KAD). Fifty-two healthy subjects with comparable age and sex served as controls. MAIN OUTCOME MEASURES: In all patients and controls, we performed biochemistry, anthropometry, bioelectrical impedance vector analysis (BIVA), and subjective global assessment (SGA), and the patients' outcomes were also assessed. RESULTS: Values of anthropometry and BIVA were similar in patients and controls. SGA scores showed a normal nutritional status (SGA-0) in 50 patients (71.4%) and mild to moderate SGA abnormalities (SGA-1) in 20 patients (28.6%); none had severe malnutrition. The SGA-1 patients differed from the SGA-0 patients by having higher serum urea, lower bicarbonate, and lower renal function (87% of SGA-1 patients had GFR <10 mL/min.). At the same GFR values (6.6 +/- 2.3 versus 6.6 +/- 2.3 mL/min) SGA-1 patients had lower bicarbonate (21.9 +/- 4.3 versus 25.3 +/- 2.7 mM, P <.01) and higher serum urea (115 +/- 29 versus 82 +/- 38 mg/dL, P =.01) and protein intake than SGA-0 patients; SGA-1 score was more prevalent with LPD compared with KAD treatment (45% versus 27%, P <.05). BIVA and anthropometry, serum levels of albumin, prealbumin, insulin-like growth factor-1, hematocrit, and lymphocyte count did not differ between SGA-1 and SGA-0 patients, but the number entering dialysis was higher in the group scoring as SGA-1 compared with SGA-0 (82% versus 47%, P <.05). CONCLUSIONS: With a planned dietary regimen, severe or overt malnutrition does not occur in predialysis CRF without other serious illnesses. However, some mild to moderate SGA abnormalities were detected in association with a more severe renal insufficiency, a lower serum bicarbonate, a higher serum urea and dietary protein levels and were predictive of poor renal outcome. This study emphasizes the role of proper dietary implementation, correction of metabolic acidosis, and clinical monitoring including SGA in the predialysis conservative care of CRF patients.

Effect of a soy protein diet on serum lipids of renal transplant patients.

OBJECTIVE: The aim of the present study was to evaluate the effect of a soy-protein diet on plasma lipid levels of renal transplant recipients with moderate hypercholesterolemia. DESIGN: Dietary intervention case-control observational study. SETTING: Renal transplantation outpatient clinic. PATIENTS: Fifteen stable patients who had renal transplantation (serum creatinine < 2 mg/dL) with moderate hypercholesterolemia (low-density lipoprotein [LDL] cholesterol > 140 mg/dL). INTERVENTION: After a baseline dietary interview, dietary counseling was given individually with the goal of substituting 25 g of animal protein with 25 g of soy protein for a 5-week period, using commercially available soy foods, according to each patient's own preference. Main outcome measures Before and after the soy-diet period, plasma lipid profiles including total, LDL, and high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 and B were determined. Protein catabolic rate was assumed as a measure of dietary protein intake. RESULTS: Two patients dropped out. After the soy diet, total cholesterol (254 +/- 22 to 231 +/- 31 mg/dL, P <.05) and LDL cholesterol (165 +/- 20 versus 143 +/- 20 mg/dL, P <.01) decreased significantly. No significant changes were observed regarding HDL cholesterol and triglycerides. Dietary protein intake did not differ at baseline (73.2 +/- 22.9 g/day) and during the soy diet (72.6 +/- 15.6 g/day), when the reported actual soy protein intake resulted 26 +/- 8 g/day. CONCLUSIONS: This study shows that soy proteins given as part of the daily protein intake have beneficial effects on serum LDL cholesterol levels of renal transplant recipients with moderate hypercholesterolemia. Soy proteins could be of use in the nutritional management of renal transplant recipients.

Effect of telmisartan on the proteinuria and circadian blood pressure profile in chronic renal patients.

Telmisartan is a type 1 angiotensin II (AT(1)) receptor blocker, effective and safe in the treatment of arterial hypertension. However, data with respect to circadian blood pressure (BP) monitoring and urinary protein (uP) excretion are lacking in normotensive or mild hypertensive patients with chronic renal diseases. This study has evaluated the effects of 80 mg telmisartan, given as monotherapy, on 24 h BP levels and uP loss in 16 non-diabetic patients affected by proteinuric renal disease. These patients did not meet the recommended values of mean BP, i.e. < 98 mmHg, when proteinuria was 0.5-1.0 g/d and mean BP < 92 mmHg, when proteinuria was 1-3 g/d. Patients with diastolic BP > 114 mmHg, nephrotic syndrome or severe renal failure (creatinine clearance < 20 ml/min) were excluded. After 4.2 +/- 2.7 month therapy, ambulatory BP monitoring showed a significant decrease (P < 0.001) of 24 h BP levels: systolic 135 +/- 11 vs. 122 +/- 13 mmHg, diastolic 84.4 +/- 8.1 vs. 75.9 +/- 8.5 mmHg, mean 101 +/- 8 vs. 91 +/- 9 mmHg. The effect was quite evident during either day-time or night-time. Clinic BP levels also significantly decreased (P < 0.001), and five patients reached the target values. uP excretion lowered by 37% (median) from 1.60 +/- 0.90 to 1.06 +/- 0.63 g/24 h (P < 0.01). No change in creatinine clearance (53.3 +/- 31.1 vs. 51.7 +/- 30.9 ml/min) or serum potassium level (4.3 +/- 0.3 vs. 4.4 +/- 0.4 mEq/l) was observed. Our results show that 80 mg of telmisartan, taken once daily, is effective in reducing uP excretion and BP throughout the 24 h, in normotensive or mild hypertensive renal patients. Since evidence exists that adequate control of BP, including during night-time, and reduction of proteinuria play a crucial role in the protection of renal function, telmisartan can be usefully considered in the conservative treatment of renal patients.

Phosphate control in chronic uremia: don't forget diet.

Control of the phosphate balance is a major concern for chronic dialysis patients and it depends on dietary intake, intestinal binding and dialytic removal. Phosphorus mass transfer through dialysis and new phosphorus binders have been widely investigated, but negligible attention has been given to dietary phosphorus management, because of the problems of poor compliance and conflict with the recommended high protein intake. The nutritional target in dialysis patients should be a diet supplying adequate protein but limited phosphate intake, without dramatic changes of dietary habits and lifestyle. It is important to educate patients regarding phosphorus content of current foods so that foods providing less phosphorus with the same protein content can be selected, thus preventing dietary phosphate overload. On the basis of a three-day dietary record, dieticians should give the patient personalised advice in order to reduce phosphorus intake while ensuring the desired protein and energy intake. Dietary manipulation may have little impact on the dialysis population but in individual patients dietary counselling can greatly improve phosphate control. Close co-operation between nephrologists and dieticians is needed to motivate patients and ensure compliance, if dietary intervention is to succeed. All patients should be given dietary education and counselling, especially young-adults, because dietary phosphate control is an important component of an integrated therapeutic approach to phosphate retention and hyperphosphatemia in end-stage renal disease.

Nutrition knowledge and dietary composition in Italian adolescent female athletes and non-athletes.

This study aims to investigate dietary composition and nutrition knowledge of 60 athlete and 59 non-athlete adolescent females (age, 14-18 years), using a 3-day food recall and a questionnaire on nutrition. The reported daily energy intake was similar in athletes and non-athletes, but less than the recommended and the estimated requirements. In the athletes, the energy supply from breakfast was higher than in the non-athletes (18.5 +/- 6.6 vs. 15.0 +/- 8.2%, p < .005). Energy intake from carbohydrates was higher (53.6 +/- 6.2 vs. 49.8 +/- 6.3%, p < .05) and that from lipids was lower (30.4 +/- 5.5 vs. 34.2 +/- 5.2%, p < .001) in athletes than in non-athletes. Athletes also showed higher fiber (20.0 +/- 5.8 vs. 14.1 +/- 4.3 g/day, p < .001), iron (10.6 +/- 5.1 vs. 7.5 +/- 2.1 mg/day, p < .001) and vitamin A (804 +/- 500 vs. 612 +/- 456 micrograms/day, p < .05) reported intake than non-athletes. Calcium, iron, and zinc intake were less than 100% RDA in both groups. Athletes gave a slightly higher rate of correct answers on the nutrition knowledge questionnaire (77.6 vs. 71.6%, p < .01) than non-athletes. In conclusion, the overall recalled dietary intake and nutrition knowledge of the studied adolescent females show some misconceptions and nutrient deficiencies, but the results in athletes are quite better than in non-athletes, suggesting a favorable role of sport practice on dietary habits and nutrition knowledge.

Ultrasonic tissue characterization of the carotid artery in chronic renal failure patients.

The ultrasonic reflectivity of the carotid wall, measured by means of integrated backscatter (IBS) analysis, has recently been evaluated in patients with atherosclerotic diseases and it was considered to be a prognostic marker. We performed B-mode measurement and IBS analysis of the carotid wall in 30 chronic renal failure (CRF) patients (serum creatinine 548 +/- 230 micromol/l) on conservative treatment and free of clinical evidence of cardiovascular complications; 14 were normotensives (NT) and 16 were treated hypertensives (TH). Thirty sex- and age-matched healthy subjects served as controls. The IBS carotid index was significantly higher in CRF patients than in controls (31.7 +/- 3.5 vs. 28.9 +/- 2.3 dB; p < 0.001), and no difference was observed between TH and NT CRF patients. The IBS index was negatively correlated with low-density lipoprotein cholesterol plasma levels (r = -0.46, p < 0.05), and within the group of TH CRF patients the IBS index was also negatively correlated with the body mass index and diastolic blood pressure. The carotid intima-media thickness was similar between uremic patients and controls. This study demonstrates an increment in carotid ultrasonic reflectivity in CRF patients, independent of the presence of overt atherosclerotic damage, and probably related to vascular remodelling linked to CRF. IBS analysis can be a useful tool to detect early changes in arterial wall structure. However, prospective studies should be planned to define its prognostic importance in uremic patients.

Vegetarian diet alternated with conventional low-protein diet for patients with chronic renal failure.

OBJECTIVES: A dietary management program, consisting of the alternation between a vegetarian low-protein diet (VD) and an animal-based conventional low-protein diet (CLPD), aims to increase foods choices and to improve compliance with dietary prescriptions, psychologic aspects, and the quality of life of renal patients. The present study investigates the subjective effects and the practical consequences of this dietary approach in patients with chronic renal failure. METHODS: Twenty patients (13 men, 7 women, 53 +/- 10 years) with chronic renal failure (creatinine clearance, <45 mL/min) were given the possibility to alternate (at their own convenience) the CLPD with the VD. After a follow-up period of 9 +/- 8 months, biochemistries were drawn and a questionnaire was mailed to asses the patients' subjective remarks about the proposed dietary management. RESULTS: Most of the patients (90%) favorably accepted this dietary schedule because it provided more variety, it was less repetitive, and it was more suitable for those leading an active life. In many cases, patients reported that their quality of life and some psychologic problems were improved, as well as the palatability of the diet. On this dietary regimen, monthly demands of starch-made foods can be reduced and, hence, the social and/or individual costs. These features contributed to better compliance with dietary prescriptions. Nutritional parameters did not change significantly, and a decrease in total and low-density lipoprotein cholesterol levels were observed. CONCLUSIONS: Our observations suggest that alternating between an animal-based CLPD and a vegetable-based VD can provide a useful dietary management for renal patients, giving them more chances for long-lasting dietary compliance.