Danijela Ristic-Medic

Effect of n‐3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients

Aims:  Nutrition as an aetiological factor participates a great deal in premature atherosclerosis in haemodialysis (HD) patients. The basic mechanisms of end‐stage renal disease and premature atherosclerosis are connected with changes in cell functions at the membrane level. We investigated the red cell membrane fatty acids and the effects of fish oil supplements on nutritional status and inflammatory markers in HD patients.

Abnormal fatty acid distribution of the serum phospholipids of patients with non-Hodgkin lymphoma

The data about the fatty acid (FA) status of non-Hodgkin lymphoma (NHL) patients are poor. Therefore, the aim of this study was to investigate the FA profile of serum phospholipids in NHL patients related to the aggressiveness and clinical stage of NHL. We analyzed the FA profile of serum phospholipids in 47 newly diagnosed, untreated NHL patients and in 29 healthy subjects. Significantly higher (p < 0.001) levels of palmitic (16:0), oleic (18:1 n-9) and arachidonic acids (20:4 n-6), saturated and monounsaturated FA were found in NHL patients, while linoleic acid (18:2 n-6) and the levels of total polyunsaturated FA (PUFA), n-3 PUFA, eicosapentaenoic (20:5 n-3) and docosahexaenoic (DHA, 22:6 n-3) were significantly reduced (p < 0.01). The level of oleic acid in patients with indolent NHL was significantly lower (p < 0.05) than in more aggressive types of disease. Contents of palmitoleic acid, docosatetraenoic (22:4 n-6), and PUFA was lower in very aggressive NHL. According to clinical stage (CS), patients with CS I had significantly higher SFA and lower n-6 FA than other three groups, and group with CS IV showed significantly decreased DHA and n-3 PUFA. Our results showed an abnormal FA profile in serum phospholipids in NHL patients.

Dietary assessment methods used for low-income populations in food consumption surveys: a literature review

In order to assess nutritional adequacy, reliable estimates of nutrient intake are required. Specifically, the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence needs clear guidelines on methods suitable for assessing micronutrient intakes among vulnerable population groups. The objective of this project was to collect, evaluate data and review the suitability of methods used to assess dietary intake of low-income groups across Europe. A comprehensive literature review methodology was employed, which involved structured search MEDLINE, from 1990 to 2008, on (nutrient intake methods) and (validity terms) and (human studies) and finally (low-income terms). In addition, manual searches were conducted for published books and national studies. Seven studies satisfied the selection criteria for inclusion in the review in which four dietary intake methods had been described and validated. Three other studies found in the grey literature used similar methods. Only one study tested a variety of methods to assess reliability and the method preferred by those having low incomes. Preferred methods were 24 h recalls and a FFQ which, compared with the weighed inventory, also yielded higher estimates of energy and nutrient intakes. Many of the methods used in low-income populations have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity when used in this population. Based on one study only, four multiple-pass 24 h recalls are recommended as the most appropriate method for the evaluation of nutritional adequacy in low-income households.

Plasma and erythrocyte phospholipid fatty acids composition in Serbian hemodialyzed patients.

Dyslipidemia is one of the possible risk factors for advanced atherosclerosis in patients with chronic renal failure. Abnormal phospholipid metabolism may play an important role in the progression of atherosclerosis in patients with renal failure. The aim of this study was to determine specific characteristics of plasma and erythrocyte phospholipid content and fatty acid composition in 37 patients with chronic renal failure on hemodialysis (HD). The results were compared with the characteristics of healthy subjects. Briefly, plasma triglyceride (p < 0.001), total cholesterol (p < 0.05), and total phospholipids (p < 0.01) levels were significantly higher and HDL-cholesterol level significantly lower (p < 0.01) in HD patients. Plasma phosphatidylcholine and phosphatidylethanolamine concentration were significantly higher (p < 0.001) in HD patients. The plasma phospholipid fatty acids composition indicated significantly (p < 0.01) higher level of oleic (18:1 n-9) and lower levels of eicopentaenoic (20:5 n-3 EPA) and docosahexaenoic (22:6 n-3 DHA) acids (p < 0.05). However, in HD patients, the relative concentration of plasma phospholipid n-6 polyunsaturated fatty acid (PUFA) was significantly lower (p < 0.05). The fatty acid composition of erythrocyte phospholipid in HD patients was modified with EPA and DHA levels significantly lowered (p < 0.05). Our results demonstrate an abnormal phospholipid metabolism and deficiency of n‐3 PUFA in plasma and erythrocyte phospholipids in hemodialyzed patients.

Abnormalities in the serum phospholipids fatty acid profile in patients with alcoholic liver cirrhosis - a pilot study

The fatty acid composition of serum phospholipids were analyzed in 20 patients with alcoholic liver cirrhosis (11 with malnutrition and 9 with acceptable nutritional status); 25 healthy age and sex-matched adults were used as controls. Cirrhotic patients showed higher levels of palmitic acid and total saturated fatty acids than healthy subjects. Total n-6 and n-3 polyunsaturated fatty acids (PUFA), and levels of linoleic, dihomo-gama linolenic, arachidonic, and docosahexaenoic acid were significantly lower (p<0.001) in patients with alcoholic cirrhosis compared to healthy controls. Significant changes were also found between patients stratified according to nutritional status. In particular, the sum of n-3 PUFA was significantly lower (p<0.001) and ratio of n-6/n-3 fatty acids was higher (p<0.01) in malnourished patients when compared to the patients with acceptable nutritional status. Furthermore, important changes in the levels of saturated fatty acids, palmitoleic and oleic acid and long-chain PUFA were found in well-nourished patients with alcoholic cirrhosis as well. Our present data confirmed evidence that malnutrition is one of the factors that led to lower levels of polyunsaturated fatty acids in patients with alcoholic liver cirrhosis. PUFA supplementation in the latter needs further investigation.

Effects of Dietary Milled Seed Mixture on Fatty Acid Status and Inflammatory Markers in Patients on Hemodialysis

Background. Plant seeds have gained interest for their health benefits due to their fatty acid content. The objective of this study was to determine the effects of dietary consumption of milled sesame/pumpkin/flax seed mixture on glycemic control, serum lipids, phospholipid fatty acid status, and inflammatory factors in patients on hemodialysis. Methods. Thirty patients with well nutrition status (18 male, 12 female) were enrolled in the study. Participants consumed 30 g of milled sesame/pumpkin/flax (6 g/6 g/18 g, resp.) seeds mixture added to their habitual diet. Results. Total n-6 and n-3 polyunsaturated fatty acids and levels of linoleic, dihomo-gamma-linolenic (DGLA), arachidonic, alpha-linolenic (ALA), eicosapentaenoic, docosapentaenoic, and docosahexaenoic (DHA) acid were increased after 12 weeks of supplementation. A significant decrease of the serum triglyceride level (P < 0.001), glucose, insulin, calculated IR HOMA (P < 0.05), and inflammatory markers (TNF-alpha, IL-6, and hs-CRP, P < 0.001) was observed after seed mixture treatment. The serum levels of CRP and TNF-alpha negative correlate with ALA, DHA, and DGLA. Conclusion. Results of this study indicated that dietary milled sesame/pumpkin/flax seed mixture added to a habitual diet lowered triglyceride and CRP, TNF-alpha, IL-6 levels, affect glycemic control and improved fatty acid profile and pruritus symptoms in hemodialysis patients.

Influence of dietary fats on serum phospholipid fatty acid composition and its relation to obesity in animals.

Dietary fat and its relation to obesity has been a controversial issue for many years. Experimental data shows that most, though not all animals, which consume a high fat diet, will become obese. However, the effect of fatty acids on animal obesity has not been studied in detail. In order to evaluate the effects of low versus high fat diet on serum phospholipids fatty acids composition a 4-wk study was conducted on male Wister rats. The rats were fed low-fat (10% energy) and high-fat (46% energy) foods containing constant proportions of fatty acids. Control group C was fed a standard laboratory diet (polyunsaturated/ saturated (P/S) fatty ratio 1.3), group M was fed a standard laboratory diet supplemented with margarine (P/S ratio 0.95), and the diet of the SL group was additionally supplemented with a sunflower oil-lard (1:1) mixture (P/S ratio 1.3). All lipid supplemented hyperenergetic diets caused an increase in the average daily energy intake. Both the final and the daily body weight gain were significantly higher in M and SL groups than in group C. Additionally, serum triglyceride levels, LDL-cholesterol and total cholesterol were also significantly higher in M and SL groups when compared to the control group. Serum phospholipids fatty acids varied in response to total dietary fat. A significant decrease in saturated fatty acids (SFA) content (16:0 and 18:0) and an increase in monounsaturated fatty acid (MUFA) content (18:1, n-9) was found in the M group when compared to both C and SL groups. In the SL group, SFA content (18:0) was higher and MUFA content (18:1, n-9) was lower than in group C. Polyunsaturated fatty acids (PUFA) content showed an increase in both experimental groups. The PUFA/SFA ratio was higher in the M group than in the C and SL groups. Our study suggests that the amount of dietary fat has a greater influence on obesity than the effects of the type of fat consumed. However, depending on the type of fat present in the diet the differences were observed in the composition of serum PL fatty acid suggesting that both total fat and individual fatty acids have to be considered when reaching conclusions about the effect of dietary fat and obesity in animals.

Systematic Review of Observational Studies with Dose-Response Meta-Analysis between Folate Intake and Status Biomarkers in Adults and the Elderly

Background: Dietary reference values for folate intake vary widely across Europe. Methods: MEDLINE and Embase through November 2016 were searched for data on the association between folate intake and biomarkers (serum/plasma folate, red blood cell [RBC] folate, plasma homocysteine) from observational studies in healthy adults and elderly. The regression coefficient of biomarkers on intake (β) was extracted from each study, and the overall and stratified pooled β and SE (β) were obtained by random effects meta-analysis on a double log scale. These dose-response estimates may be used to derive folate intake reference values. Results: For every doubling in folate intake, the changes in serum/plasma folate, RBC folate and plasma homocysteine were +22, +21, and –16% respectively. The overall pooled regression coefficients were β = 0.29 (95% CI 0.21–0.37) for serum/plasma folate (26 estimates from 17 studies), β = 0.28 (95% CI 0.21–0.36) for RBC (13 estimates from 11 studies), and β = –0.21 (95% CI –0.31 to –0.11) for plasma homocysteine (10 estimates from 6 studies). Conclusion: These estimates along with those from randomized controlled trials can be used for underpinning dietary recommendations for folate in adults and elderly.

Role of Diet on Risk of Diabetes

It is clear that dietary components can modulate blood glucose levels. Diets that improve glycemic control are rich in whole grains, fruits, vegetables, legumes, and nuts; poor in refined grains, red or processed meats, and sugar-sweetened beverages; and moderate in alcohol consumption. Low-carbohydrate, low-glycemic index, Mediterranean, and high-protein diets should be considered in the overall strategy of diabetes management.