Advances in nutrition
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Currently, there are no standardized treatments for cachexia or severe wasting. There is a growing consensus advocating multimodal interventions to address the complex pathogenesis and metabolic alterations in these conditions. This review examined multimodal treatments intended to alleviate and/or stabilize cachexia and severe wasting. ⋯ Overall, the evidence from this review supports the role of multimodal interventions in the treatment of severe wasting. However, randomized controlled trials with a powered sample size and sufficiently lengthy interaction period are necessary to assess if multimodal interventions are effective forms of therapy for improving body composition and nutritional and physical status in patients with cachexia and wasting. The protocol for this review is registered with Prospero (ID: CRD42019124374).
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Advances in nutrition · Sep 2020
Perspective: Do Fasting, Caloric Restriction, and Diets Increase Sensitivity to Radiotherapy? A Literature Review.
Caloric starvation, as well as various diets, has been proposed to increase the oxidative DNA damage induced by radiotherapy (RT). However, some diets could have dual effects, sometimes promoting cancer growth, whereas proposing caloric restriction may appear counterproductive during RT considering that the maintenance of weight is a major factor for the success of this therapy. A systematic review was performed via a PubMed search on RT and fasting, or caloric restriction, ketogenic diet (>75% of fat-derived energy intake), protein starvation, amino acid restriction, as well as the Warburg effect. ⋯ Preclinical studies with ketogenic diets yielded more conflicting results, perhaps because cancer cells can sometimes metabolize fatty acids and/or ketone bodies. Randomized trials are awaited to specify the role of each strategy according to the clinical setting, although more stringent definitions of proposed diet, nutritional status, and consensual criteria for tumor response assessment are needed. In conclusion, dietary interventions during RT could be a simple and medically economical and inexpensive method that may deserve to be tested to improve efficiency of radiation.
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Advances in nutrition · Jul 2020
Systematic Review of Dietary Patterns and Sustainability in the United States.
Improving awareness and accessibility of healthy diets are key challenges for health professionals and policymakers alike. While the US government has been assessing and encouraging nutritious diets via the Dietary Guidelines for Americans (DGA) since 1980, the long-term sustainability, and thus availability, of those diets has received less attention. The 2015 Dietary Guidelines Advisory Committee (DGAC) examined the evidence on sustainable diets for the first time, but this topic was not included within the scope of work for the 2020 DGAC. ⋯ Our results challenge prior findings that diets adhering to national dietary guidelines are more sustainable than current average diets and indicate that the Healthy US-style dietary pattern recommended by the DGA may lead to similar or increased greenhouse gas emissions, energy use, and water use compared with the current US diet. However, consistent with previous research, studies meeting inclusion criteria generally support the conclusion that, among healthy dietary patterns, those higher in plant-based foods and lower in animal-based foods would be beneficial for environmental sustainability. Additional research is needed to further evaluate ways to improve food system sustainability through both dietary shifts and agricultural practices in the United States.
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Advances in nutrition · May 2020
ReviewTryptophan Metabolism: A Link Between the Gut Microbiota and Brain.
The gut-brain axis (GBA) is a bilateral communication network between the gastrointestinal (GI) tract and the central nervous system. The essential amino acid tryptophan contributes to the normal growth and health of both animals and humans and, importantly, exerts modulatory functions at multiple levels of the GBA. Tryptophan is the sole precursor of serotonin, which is a key monoamine neurotransmitter participating in the modulation of central neurotransmission and enteric physiological function. ⋯ We start by outlining existing knowledge on tryptophan metabolism, including serotonin synthesis and degradation pathways of the host, and summarize recent advances in demonstrating the influence of the gut microbiota on tryptophan metabolism. The latest evidence revealing those mechanisms by which the gut microbiota modulates tryptophan metabolism, with subsequent effects on brain function, is reviewed. Finally, the potential modulation of intestinal tryptophan metabolism as a therapeutic option for brain and GI functional disorders is also discussed.
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Advances in nutrition · Jan 2020
Perspective: The Application of A Priori Diet Quality Scores to Cardiovascular Disease Risk-A Critical Evaluation of Current Scoring Systems.
Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. ⋯ Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level.