Some useful links

There is plenty of basic information on dietary therapy throughout the Internet. If you are interested in the latest medical findings you should consult the global database PUBMED of the medical publications. Below are examples of IBS-related studies:

[Clinical and genetic characteristics of focal epilepsy in children caused by GATOR1 complex gene variation].

Objective: To summarize the clinical and genetic characteristics of focal epilepsy in children caused by GATOR1 complex gene variation. Methods: The clinical data, gene variation and treatment outcome of 12 children with focal epilepsy caused by GATOR1 complex gene variation admitted to Beijing Children's Hospital Affiliated to Capital Medical University from June 2016 to October 2018 were retrospectively analyzed. Results: There were 7 males and 5 females in 12 cases. The epilepsy onset age was 5.5 months, and from 11 days to 16 months of age. The epileptic seizure types were all focal motor seizures, and one case combined with epileptic spasms. The frequency of seizures in all patients was more than one time per day. Seven cases had frontal lobe epilepsy and two cases had lateral temporal lobe epilepsy. One case had a family history of febrile seizures and two had a family history of suspicious epilepsy. Epileptic form discharges were observed in 9 patients during the interictal phase by electroencephalograms (EEG), and all of them were focal discharges. Eight cases had clinical seizures detected by EEG, in 4 of whom the seizures were originated in frontal region. There were no abnormalities in brain magnetic resonance imaging in 11 cases whereas 1 case had malformation of cortical development of left frontal lobe. Eight patients had DEPDC5 gene variation, one had NPRL2 gene variation, three had NPRL3 gene variation. One case had de novo variation and the other 11 had hereditary variation. There were 11 types of gene variation, including 5 nonsense variations, 3 missense variations, 2 frame shift variations and 1 in frame deletion variation. There was no clear relationship between the clinical phenotype and the genotype. During the follow-up period from 6 months to 2 years and 6 months, 6 cases had seizure control, 3 of them were controlled by oxcarbazepine. The other 6 cases had drug-refractory epilepsy, 2 of them failed with vagus nerve stimulation and ketogenic dietary therapy as well, meanwhile combined with mental retardation. Conclusions: GATOR1 complex gene variation can lead to genetic focal epilepsy, which usually has early onset with frequent seizures. Most of the patients have focal epileptic form discharges on EEG, and there is usually no structural lesion in brain imaging. Most of the patients have hereditary loss-of-function variations. Approximately half of cases are drug-resistant epilepsy. 目的: 总结GATOR1复合物基因变异所致儿童局灶性癫痫的临床特征及遗传学特点。 方法: 回顾性总结首都医科大学附属北京儿童医院2016年6月至2018年10月收治的12例GATOR1复合物基因变异所致局灶性癫痫患儿的临床资料,分析其基因变异及治疗转归。 结果: 12例患儿中男7例、女5例,起病年龄为5.5(3.0,12.0)月龄,范围11日龄至16月龄。癫痫发作类型均为局灶性运动性发作,1例合并痉挛发作,发作频率均超过1次/d。7例为额叶癫痫,2例为外侧颞叶癫痫。1例有热性惊厥家族史,2例有可疑癫痫家族史。9例患儿脑电图发作间期可见痫性放电,且均为局灶性;8例脑电图监测到发作,其中4例起始于一侧额区。11例患儿头颅磁共振成像未见异常,1例为左额皮质发育畸形。8例患儿为DEPDC5基因变异,1例为NPRL2基因变异,3例为NPRL3基因变异;1例为新生变异,11例为遗传性变异。共11种基因变异类型,分别为无义变异5种、错义变异3种、移码变异2种、整码缺失1种。患儿临床表型与基因变异的类型、来源无明确关系。随访6个月至2年6个月,6例发作控制,其中3例加用奥卡西平后控制;另6例为药物难治性癫痫,其中2例分别联合迷走神经刺激及生酮饮食治疗亦未能控制发作,合并精神发育迟滞。 结论: GATOR1复合物基因变异可导致遗传性局灶性癫痫,通常起病早,发作频繁,脑电图多为局灶性痫样放电,而影像学常无结构性病灶,多数患儿为遗传性功能丧失性变异,约半数呈药物难治性癫痫。.

KEYWORDS: Epilepsy, Genes, DEPDC5, Genes, GATOR1, Genes, NPRL, Genetics

Effects of Low-FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial.

There is limited evidence that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) reduces gut symptoms in quiescent inflammatory bowel disease (IBD). We performed a randomized, controlled trial to investigate the effects of a low-FODMAP diet on persistent gut symptoms, the intestinal microbiome, and circulating markers of inflammation in patients with quiescent IBD. We performed a single-blind trial of 52 patients with quiescent Crohn's disease or ulcerative colitis and persistent gut symptoms at 2 large gastroenterology clinics in the United Kingdom. Patients were randomly assigned to groups that followed a diet low in FODMAPs or a control diet, with dietary advice, for 4 weeks. Gut symptoms and health-related quality of life were measured using validated questionnaires. Stool and blood samples were collected at baseline and end of trial. We assessed fecal microbiome composition and function using shotgun metagenomic sequencing and phenotypes of T cells in blood using flow cytometry. A higher proportion of patients reported adequate relief of gut symptoms following the low-FODMAP diet than the control diet. Patients had a greater reduction in irritable bowel syndrome severity scores following the low-FODMAP diet than the control diet, although this difference was not statistically significant. Following the low-FODMAP diet, patients had higher health-related quality of life scores than patients on the control diet. A targeted analysis revealed that in stool samples collected at the end of the study period, patients on the low-FODMAP diet had significantly lower abundance of Bifidobacterium adolescentis, B longum, and Faecalibacterium prausnitzii than patients on control diet. However, microbiome diversity and markers of inflammation did not differ significantly between groups. In a trial of the low-FODMAP diet vs a control diet in patients with quiescent IBD, we found no significant difference after 4 weeks in change in irritable bowel syndrome severity scores, but significant improvements in specific symptom scores and numbers reporting adequate symptom relief. The low-FODMAP diet reduced fecal abundance of microbes believed to regulate the immune response, compared with the control diet, but had no significant effect on markers of inflammation. We conclude that a 4-week diet low in FODMAPs is safe and effective for managing persistent gut symptoms in patients with quiescent IBD. no: ISRCTN17061468.


Plasma polyphenols associated with lower high-sensitivity C-reactive protein concentrations: a cross-sectional study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Experimental studies have reported on the anti-inflammatory properties of polyphenols. However, results from epidemiological investigations have been inconsistent, and especially studies using biomarkers for assessment of polyphenol intake have been scant. We aimed to characterize the association between plasma concentrations of 35 polyphenol compounds and low-grade systemic inflammation state as measured by high-sensitivity C-reactive protein (hsCRP). A cross-sectional data analysis was performed based on 315 participants in the European Prospective Investigation into Cancer and Nutrition cohort with available measurements of plasma polyphenols and hsCRP. In logistic regression analysis the odds and 95% confidence intervals (CI-s) of elevated serum hsCRP were calculated within quartiles and per standard deviation (SD) higher level of plasma polyphenol concentrations. In multivariable-adjusted model, the sum of plasma concentrations of all polyphenols measured (per SD) was associated with 29% lower odds of elevated hsCRP. In the class of flavonoids, daidzein was inversely associated with elevated hsCRP. Among phenolic acids, statistically significant associations were observed for 3,5-dihydroxyphenylpropionic acid, 3,4-dihydroxyphenylpropionic acid, ferulic acid, and caffeic acid. The odds of elevated hsCRP were significantly reduced for hydroxytyrosol. This study showed that polyphenol biomarkers are associated with lower odds of elevated hsCRP. Whether diet rich in bioactive polyphenol compounds could be an effective strategy to prevent or modulate deleterious health effects of inflammation should be addressed by further well-powered longitudinal studies.

KEYWORDS: BMI body mass index, C-reactive protein, CI confidence interval, CVD cardiovascular diseases, EPIC European Prospective Investigation into Cancer and Nutrition, HRT hormone replacement therapy, OR odds ratio, RCT randomized controlled trial, SD standard deviation, chronic diseases, hsCRP high-sensitivity C-reactive protein, inflammation, plasma measurements, polyphenols

Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study.

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish "Anthropometry, Intake, and Energy Balance Study" (ANIBES), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0-7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults showed better DQIs than adults, without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population compared with the plausible energy reporters, whereas for medium and high scores the percentages were higher in plausible reporters. In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

KEYWORDS: adequacy of intake, diet quality, diet quality indexes, dietary recommended intakes, nutrients

Practical and personal education of dietary therapy in hypertensive patients.

The guidelines for the management of hypertension by the Japanese Society of Hypertension defined blood pressure (BP) levels of 130-139/80-89 mmHg as "elevated blood pressure". The JSH2019 also revised the target level of BP control to a lower level. Thus, lifestyle modifications are quite important regardless of the use of antihypertensive drugs. Among the lifestyle modifications, salt reduction is most important, especially among East Asian people, who still consume a significant amount of salt. Since the awareness of salt reduction may not necessarily lead to actual salt reduction, the assessment of individual salt intake is essential when members of the medical staff provide practical guidance regarding salt reduction. The evaluation methods of salt intake are classified as the assessment of dietary contents and the measurement of urinary sodium (Na) excretion. Since highly reliable methods, such as the measurement of 24-h urinary Na excretion, are not convenient in practical clinical settings, the combination of the assessment of dietary contents using questionnaires and the estimation of salt intake using spot urine is recommended as a practical evaluation procedure. Repeated assessment of salt intake and practical guidance from dieticians are useful for long-term adherence to salt reduction. The Japanese Society of Hypertension Salt Reduction Committee began to certify flavorful foods as being low in salt content in 2013. More than 200 products have been certified as of April 2019. The utilization of these products is expected to aid in the salt reduction of hypertensive individuals as well as the Japanese general population.

KEYWORDS: Dietary survey, Guidelines, Salt reduction, Urinary Na measurement

Implementation of the low FODMAP diet in functional gastrointestinal symptoms: A real-world experience.

The low FODMAP (fermentable oligo-, di-, monosaccharides, and polyols) diet reduces functional gastrointestinal symptoms (FGID) when implemented by dietitian-delivered education in clinical trials, but it is unknown how well the diet is followed in routine clinical care and if differences exist when implemented by physician or dietitian. This study aimed to evaluate the real-world experience of patients recommended the diet. This case-series interviewed FGID patients attending a gastroenterology clinic with previous recommendation to trial the low FODMAP diet, examining who recommended the diet and what their percentage improvement was. To evaluate implementation of the diet's 3 phases, questions were constructed based on current literature and clinical guidelines regarding length of initial restriction and food knowledge, number of foods re-challenged and food re-introduction as tolerated. The comprehensive nutrition assessment questionnaire provided daily FODMAP intake. Data were analyzed using chi-squared tests. In 80 patients, the diet was recommended by the gastroenterologist in 53%, general practitioner 22%, dietitian 9% and other 15%. 30% saw a dietitian for guidance. 55% reported a ≥50% symptom improvement. The diet was followed appropriately during Phase-1 by 78%, Phase-2 by 48% and Phase-3 by 40%. A FODMAP intake of <12 g/d (considered therapeutic) was achieved by 44%. Symptom improvement was reported in half of patients, but many did not reach the therapeutic FODMAP intake target, especially without dietitian education. Compliance was poor in Phase-2 and Phase-3 but improved with dietitian guidance.

KEYWORDS: FODMAPs, carbohydrates, dietary therapy, functional bowel disorders

Sterol Characteristics in Silkworm Brain and Various Tissues Characterized by Precise Sterol Profiling Using LC-MS/MS.

Sterols, especially cholesterol (Chl), are fundamental for animal survival. Insects lacking the ability to synthesize Chl are sterol auxotrophic animals and utilize dietary Chl and phytosterols to survive. The sterols obtained from a diet are distributed to the tissues; however, sterol homeostasis in insect tissues remains to be elucidated. This study sought to understand the sterol characteristics of insect tissues through detailed sterol quantification and statistics. The combination of sterol quantification using liquid chromatography tandem mass spectrometry (LC-MS/MS) and principal component analysis (PCA) revealed tissue-specific sterol characteristics in the silkworm, Bombyx mori , a phytophagous insect. We found that insect tissues have tissue-intrinsic sterol profiles. The brain has a unique sterol composition as compared to other tissues-high concentration of Chl and less accumulation of phytosterols. Other tissues also have intrinsic sterol characteristics, which when defined by dietary sterols or Chl metabolites, indicate preference for a sterol and consistently manage their own sterol homeostasis. Though most tissues never change sterol profiles during development, the brain drastically changes its sterol profile at the wandering stage, indicating that it could alter sterol composition in preparation for metamorphosis. These results suggest the existence of tissue- and sterol-specific systems for sterol homeostasis in insects.

KEYWORDS: LC-MS/MS, brain, cholesterol, dietary sterol, metamorphosis, phytosterol, principal component analysis, silkworm

Dietary Inflammatory Index Scores Are Associated with Pressure Pain Hypersensitivity in Women with Fibromyalgia.

Pain hypersensitivity has been described as one of the most disabling symptoms of fibromyalgia syndrome (FMS). Here we analyzed the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS. This cross-sectional study included 95 women diagnosed with FMS and 98 menopause-status matched controls. The Dietary Inflammatory Index (DII) was calculated by conducting a 24-hour diet recall interview. The PPTs of tender point sites and self-reported global pain levels were evaluated by algometry and the visual analog scale, respectively. Disease severity, fatigue, sleep anxiety, and central sensitization were also evaluated. Linear regression analysis revealed that the PPTs of tender point sites including the occiput, trapezius, zygapophyseal joint, second rib, gluteus, greater trochanter, and knee were associated with DII score after adjustments for the age, menopausal status, and global energy levels reported by the patients with FMS. No significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms. Analyses of covariance showed that the PPTs of the aforementioned tender point sites were also significantly associated with the DII score quartiles in patients with FMS, but no significant differences were found between these quartiles and the other clinical symptoms. A pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS.

KEYWORDS: Dietary Inflammatory Index, Fibromyalgia, Pressure Algometry, Pressure Pain Threshold

Is SIBO A Real Condition?

Small intestinal bacterial overgrowth (SIBO) has gained popularity on the internet in addition to certain clinical and research circles. This interest has expanded awareness of important new dietary, nutraceutical, and pharmaceutical treatments in addition to laboratory evaluation assessment options. Concomitantly, there appears a loss of parsimony regarding how to use these tools resulting in an untenable degree of testing and treatment for this condition. A balanced review of the data regarding SIBO testing, treatment, and management with the goal of establishing non-biased best practices. Non-systematic review. The results for the review fall into two categories. Ineffective Action: Treat only SIBO labs; Treat for SIBO if no symptoms are exhibited; Recommending eating or avoiding foods because they might be good or bad for SIBO; Recommending treatments that are non-validated. Effective Action: Use SIBO breath results, in addition to history and current symptoms, to determine the best treatment; Find foods that work for patients based on dietary elimination and reintroduction; Apply validated treatment for SIBO and IBS in a logical 'step-up' like treatment approach. Testing and treating for SIBO can offer patients clinically significant relief. However, these tests and treatments must be applied with circumspection to prevent over-testing, over-treatment, squandering resources, or creating a fear around certain foods.

Perioperative dietary therapy in inflammatory bowel disease.

The incidence of inflammatory bowel disease (IBD) is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomized controlled trials of dietary therapy are lacking, expert IBD centres have long established interdisciplinary care, including tailored nutritional therapy, to optimize clinical outcomes and resource utilization. This topical review aims to share expertise and offers current practice recommendations to optimize outcomes of IBD patients who undergo surgery. A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists convened by the European Crohn's and Colitis Organisation performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimization, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. A total of 26 current practice positions were formulated that address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimization by oral, enteral, or parenteral nutrition, dietary fibre and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome were addressed. Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimize the outcomes of patients with Crohn's disease and ulcerative colitis taking advantage of contemporary nutrition science.

KEYWORDS: Inflammatory bowel disease (IBD), Nutrition, Surgery

Mechanisms and Uses of Dietary Therapy as a Treatment for Epilepsy: A Review.

One-third of patients with epilepsy do not respond to antiepileptic drugs and may seek complementary and alternative treatment modalities. Dietary therapies such as the ketogenic diet (KD), the modified Atkins, the medium-chain triglyceride, and the low glycemic index diet have been successfully implemented in some forms of epilepsy and are growing in utilization. The KD is a high-fat, low-protein, low-carbohydrate diet that has been used for various conditions for over a century. Insights into the mechanism of action of these diets may provide more targeted interventions for patients with epilepsy. Knowledge of these mechanisms is growing and includes neuroprotective effects on oxidative stress, neuroinflammation, potassium channels in the brain, and mitochondrial function.

KEYWORDS: epilepsy, ketogenic diet, ketosis, low glycemic index, modified Atkins diet

Effects of Diet Based on IgG Elimination Combined with Probiotics on Migraine Plus Irritable Bowel Syndrome.

Several research studies have revealed that migraine has a solid link with gastrointestinal diseases especially irritable bowel syndrome (IBS). This study was carried out to investigate therapeutic potential of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. A total of 60 patients diagnosed with migraine plus IBS were recruited for the study. IgG antibodies against 266 food varieties were detected by ELISA. Then, the subjects were randomized into three groups for treatment of IgG elimination diet or probiotics or diet combined with probiotics. Migraine symptom, gut function score, medication use, and serum serotonin level were measured at baseline, 7 weeks, and 14 weeks. Improvement of migraine and gut symptom was achieved at a certain time point. Reduced use of over-the-counter- (OTC-) analgesics was seen in all groups. However, use of triptans did not show significant difference. An increased serum serotonin level was seen in subjects treated with elimination diet and elimination diet combined with probiotics. IgG elimination diet combined with probiotics may be beneficial to migraine plus IBS. It may provide new insight by understanding the intricate relationship between migraine and gastrointestinal diseases.

Effect of changes in adherence to Mediterranean diet on nutrient density after 1-year of follow-up: results from the PREDIMED-Plus Study.

The prevalence of overweight/obesity and related manifestations such as metabolic syndrome (MetS) is increasing worldwide. High energy density diets, usually with low nutrient density, are among the main causes. Some high-quality dietary patterns like the Mediterranean diet (MedDiet) have been linked to the prevention and better control of MetS. However, it is needed to show that nutritional interventions promoting the MedDiet are able to improve nutrient intake. To assess the effect of improving MedDiet adherence on nutrient density after 1 year of follow-up at the PREDIMED-Plus trial. We assessed 5777 men and women with overweight or obesity and MetS at baseline from the PREDIMED-Plus trial. Dietary changes and MedDiet adherence were evaluated at baseline and after 1 year. The primary outcome was the change in nutrient density. Multivariable-adjusted linear regression models were fitted to analyse longitudinal changes in adherence to the MedDiet and concurrent changes in nutrient density. During 1-year follow-up, participants showed improvements in nutrient density for all micronutrients assessed. The density of carbohydrates, saturated fatty acids and total energy intake decreased. These changes were more pronounced in the subset of participants with higher improvements in MedDiet adherence. The PREDIMED-Plus dietary intervention, based on MedDiet recommendations for older adults, maybe a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity.

KEYWORDS: Mediterranean diet, Metabolic syndrome, Nutrient density

Extra-virgin olive oil for potential prevention of Alzheimer disease.

Observational epidemiological studies provide valuable information regarding naturally occurring protective factors observed in populations with very low prevalences of vascular disease. Between 1935 and 1965, the Italian-American inhabitants of Roseto (Pennsylvania, USA) observed a traditional Italian diet and maintained half the mortality rates from myocardial infarction compared with neighboring cities. In the Seven Countries Study, during 40years Crete maintained the lowest overall mortality rates and coronary heart disease fatalities, which was attributed to strict adherence to the Mediterranean diet. In the French Three-City Study, a ten-year follow-up showed that higher consumption of olive oil was associated with lower risk of death, as well as protection from cognitive decline and stroke. A large number of population-based studies and intervention trials have demonstrated that the Mediterranean diet is associated with lower prevalence of vascular disease, obesity, arthritis, cancer, and age-associated cognitive decline. Many of these effects are the result of consumption of fruits, seeds, legumes and vegetables but olive oil is the chief dietary fat in Mediterranean countries and the main source of monounsaturated fatty acids, as well as an important source of beneficial polyphenols and other antioxidants. Considering the critical role of vascular factors in the pathogenesis of late-onset Alzheimer disease it seems appropriate to focus on disease modification through proven dietary therapy. The authors base their hypothesis on meta-analyses of epidemiological data, numerous experimental studies, and a comprehensive review of the mechanisms of action of extra-virgin olive oil and its components in the prevention of vascular disease. In addition, extra-virgin olive oil has had positive effects on experimental animal models of Alzheimer disease. We therefore propose that extra-virgin olive oil is a promising tool for mitigating the effects of adverse vascular factors and may be utilized for potential prevention of late-onset Alzheimer disease.

KEYWORDS: Alzheimer disease, Cerebrovascular disease, Environmental neurology, Mediterranean diet, Olive oil

Low FODMAP diet significantly improves IBS symptoms: an Irish retrospective cohort study.

There is growing evidence that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) improves symptoms in irritable bowel syndrome (IBS) patients. We aimed to retrospectively investigate the effects of this diet in Irish IBS cohort over a 12-month follow-up period, including after re-introduction of the high FODMAP foods. All the tertiary referrals seen by an FODMAP-trained dietician were reviewed. Patients were evaluated for IBS symptoms by a questionnaire (four-point Likert scale). Subsequently, advice regarding the low FODMAP diet was given. Symptoms' response was assessed at 3-, 6-, and 12-month follow-up, by use of the same questionnaire. Re-introduction of high FODMAP foods was aimed to commence at the subsequent follow-up. A total of 164 patients were identified. Thirty-seven patients were excluded due to failure to attend for follow-up. Hundred and twenty-seven patients completed the initial 3-month follow-up. Forty-five percent and twenty-five percent of the patients had continued follow-up at 6 and 12 months, respectively. Of the 127 patients who returned for follow-up, their commonest baseline symptoms were lethargy, bloating, flatulence, and abdominal pain. All symptoms were significantly improved at the initial follow-up. Most patients were satisfied with their overall symptoms control. In patients who had a longer follow-up duration, all symptoms remained significantly improved compared to the baseline. After re-introduction of the high FODMAP foods, all patients maintained their symptomatic response. The best symptoms' improvement was seen in those who were fully adherent to the FODMAP diet. In this Irish retrospective cohort study, the low FODMAP diet significantly improved all IBS symptoms at 3-, 6-, and 12-month follow-up. Following the re-introduction of the high FODMAP foods in a subgroup of patients, they were able to maintain their long-term symptomatic response up to 9 months. The low FODMAP diet might be continued for longer than 3 months; however, further studies are needed to assess the long-term safety of this diet.

KEYWORDS: Ireland, Irritable bowel syndrome, Low FODMAP diet, Retrospective study

The Dietary Management of Patients with Irritable Bowel Syndrome: A Narrative Review of the Existing and Emerging Evidence.

Even though irritable bowel syndrome (IBS) has been known for more than 150 years, it still remains one of the research challenges of the 21st century. According to the current diagnostic Rome IV criteria, IBS is characterized by abdominal pain associated with defecation and/or a change in bowel habit, in the absence of detectable organic causes. Symptoms interfere with the daily life of patients, reduce health-related quality of life and lower the work productivity. Despite the high prevalence of approximately 10%, its pathophysiology is only partly understood and seems multifactorial. However, many patients report symptoms to be meal-related and certain ingested foods may generate an exaggerated gastrointestinal response. Patients tend to avoid and even exclude certain food products to relieve their symptoms, which could affect nutritional quality. We performed a narrative paper review of the existing and emerging evidence regarding dietary management of IBS patients, with the aim to enhance our understanding of how to move towards an individualized dietary approach for IBS patients in the near future.

KEYWORDS: dietary fiber, dietary management, exclusion diets, gluten-free diet, irritable bowel syndrome, lactose-free diet, low FODMAP diet

Maternal dietary diversity and risk of small for gestational age newborn: Findings from a case-control study.

An inadequate nutrients intake during pregnancy has been related to an increase of having a small for gestational age (SGA) newborn. A diversity dietary (DD) intake could decrease the risk of SGA delivery, providing the adequate nutrient requirements during pregnancy. The aim of this study was to assess the effect of DD on adequate nutrient intake in a sample of Spanish pregnant women, further to investigate their association on SGA delivery. A matched case-control study of 518 cases and controls of pregnant women was performed in five hospitals in Eastern Andalusia (Spain). Cases were women with a newborn with SGA. Data about demographic characteristics and diet were collected by trained midwives. DD score (DDS) adjusted by total energy intake was gathered through a validated food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the recommended dietary intake according to dietary recommendations intake (DRI) for pregnant women. The association between DDS and SGA was assessed by logistic regression models with adjustment for confounding factors. The prevalence of nutrient inadequate intake decreased across total DDS quintiles. Women in higher strata of total DDS presented less SGA risk. According to each DDS component, the consumption of high diversity of dairy products showed a significative protection against the risk of having a SGA newborn. SGA mothers had higher prevalence of nutritional inadequacies and lower DDS compared to their counterparts. Poor total DDS and less variety of dairy products were associated with higher risk of SGA newborn. Efforts to promote DD during pregnancy need to be strengthened to reduce the prevalence of SGA in Spain.

KEYWORDS: Dietary diversity, Maternal diet, Newborn, Pregnancy, Small for gestational age

The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn.

Gastroesophageal reflux disease (GERD) is a common esophageal disorder that is characterized by troublesome symptoms associated with increased esophageal acid exposure. Cornerstones of therapy include acid suppressive agents like proton pump inhibitors (PPI) and lifestyle modifications including dietary therapy, although the latter is not well defined. As concerns regarding long term PPI use continue to be explored, patients and providers are becoming increasingly interested in the role of diet in disease management. The following is a review of dietary therapy for GERD with an emphasis on the effect food components have on pathophysiology and management. Although sequential dietary elimination of food groups is common, literature supports broader manipulation including reduction of overall sugar intake, increase in dietary fiber, and changes in overall eating practices.

KEYWORDS: Gastroesophageal reflux disease (GERD), diet, esophageal disease, lifestyle, nutrition, reflux

Ketoacid Analogues Supplementation in Chronic Kidney Disease and Future Perspectives.

Diet is a key component of care during chronic kidney disease (CKD). Nutritional interventions, and, specifically, a restricted protein diet has been under debate for decades. In order to reduce the risk of nutritional disorders in very-low protein diets (VLDP), supplementation by nitrogen-free ketoacid analogues (KAs) have been proposed. The aim of this review is to summarize the potential effects of this dietary therapy on renal function, uremic toxins levels, and nutritional and metabolic parameters and propose future directions. The purpose of this paper is also to select all experimental and randomized clinical studies (RCTs) that have compared VLDP + KA to normal diet or/and low protein diet (LPD). We reviewed the SCOPUS, WEB of SCIENCES, CENTRAL, and PUBMED databases from their inception to 1 January, 2019. Following duplicate removal and application of exclusion criteria, 23 RCTs and 12 experimental studies were included. LPD/VLPD + KAs appear nutritionally safe even if how muscle protein metabolism adapts to an LPD/VLPD + KAs is still largely unknown. VLPD + KAs seem to reduce uremic toxins production but the impact on intestinal microbiota remains unexplored. All studies observed a reduction of acidosis, phosphorus, and possibly sodium intake, while still providing adequate calcium intake. The impact of this diet on carbohydrate and bone parameters are only preliminary and need to be confirmed with RCTs. The Modification of Diet in Renal Disease study, the largest RCTs, failed to demonstrate a benefit in the primary outcome of the decline rate for the glomerular filtration rate. However, the design of this study was challenged and data were subsequently reanalyzed. However, when adherent patients were selected, with a rapid rate of progression and a long-term follow up, more recent meta-analysis and RCTs suggest that these diets can reduce the loss of the glomerular filtration rate in addition to the beneficial effects of renin-angiotensin-aldosterone system (RAAS) inhibitors. The current evidence suggests that KAs supplemented LPD diets should be included as part of the clinical recommendations for both the nutritional prevention and metabolic management of CKD. More research is needed to examine the effectiveness of KAs especially on uremic toxins. A reflection about the dose and composition of the KAs supplement, the cost-effective features, and their indication to reduce the frequency of dialysis needs to be completed.

KEYWORDS: chronic kidney disease, dialysis, intestinal microbiota, ketoacid analogues, low protein diet

Gut Microbial Dysbiosis in the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies.

Irritable bowel syndrome (IBS) is the most common functional digestive condition in the industrialized world. The gut microbiota plays a key role in disease pathogenesis. A systematic review and meta-analysis on case-control studies was conducted to determine whether there is gut microbial dysbiosis in participants with IBS in comparison with healthy controls and, if so, whether the dysbiosis pattern differs among IBS subtypes and geographic regions. This review was conducted and reported according to the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) 2000 and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines. Research articles published up to May 9, 2018 were identified through MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane Library),, EMBASE, and Web of Science. Study quality was assessed using the Newcastle-Ottawa Scale. Case-control studies of participants with IBS who had undergone quantitative gut microbial stool analysis were included. The primary exposure measure of interest is log 10 bacterial counts per gram of stool. Meta-analyses were performed to estimate the mean difference (MD) in gut microbiota between participants with IBS and healthy controls using the random-effects model with inverse variance in Revman 5.3 and R 3.5.1. Publication bias was assessed with funnel plots and Egger's test. Between-study heterogeneity was analyzed using Higgins I 2 statistic with 95% CIs. There were 6,333 unique articles identified; 52 qualified for full-text screening. Of these, 23 studies were included for analysis. Overall, the studies were moderate in quality. Comparing participants with IBS to healthy controls, lower fecal Lactobacillus and Bifidobacterium, higher Escherichia coli, and marginally higher Enterobacter. No difference was found between participants with IBS and healthy controls in fecal Bacteroides and Enterococcus. Publication bias was not observed except in Bifidobacterium. Subgroup analyses on participants with diarrhea-predominant and constipation-predominant IBS showed consistent results with the primary results. A subgroup analysis of Chinese studies was consistent with the primary results, except for fecal Bacteroides, which was increased in participants with IBS vs healthy controls. Although substantial heterogeneity was detected in most comparisons, the direction of the effect estimates is relatively consistent across studies. IBS is characterized by gut microbial dysbiosis. Prospective, large-scale studies are needed to delineate how gut microbial profiles can be used to guide targeted therapies in this challenging patient population.

KEYWORDS: Bifidobacteria, Dysbiosis, Gut microbiome, Irritable bowel syndrome, Lactobacillus