Acacia pycnantha and gum arabic an alternative to antacids and proton pump inhibitors in the management of gastroesophageal and laryngopharyngeal reflux

ABSTRACT A case report is presented where a patient with long-term gastroesophageal reflux and recently diagnosed laryngopharyngeal reflux (LPR) underwent an 8-week treatment with proton pump inhibitors (PPIs). On discontinuation of the PPIs, symptoms of LPR remained and the patient’s reflux symptoms returned with increased severity. Consumption of acacia gum exudates from Acacia pycnantha resolved the LPR. Acacia pycnantha or gum arabic were both found to reduced reflux symptoms to a manageable level. An evaluation of the therapeutic effect of acacia gums using questionnaires to evaluate reflux symptoms, quality of life and global refluxogenic scores was undertaken. It was found acacia gums can be taken after the evening meal in the same way as antacids to manage reflux symptoms but with more sustained overnight relief.

Eucaloric Balanced Diet Improved Objective Sleep in Adolescents with Obesity

Background: A better understanding of the influence of energy balance on sleep in adolescents, particularly those with obesity, could help develop strategies to optimize sleep in these populations. The purpose of this study was to investigate sleep under ad libitum-vs-controlled diets adjusted to energy requirement (eucaloric) among adolescents with obesity and their normal weight controls. Methods: Twenty-eight male adolescents aged between 12 and 15 years, n = 14 adolescents with obesity (OB: BMI ≥ 90th centile) and n = 14 normal weight age matched controls (NW), completed an experimental protocol comprising ad libitum or eucaloric meals for three days, in random order. During the third night of each condition, they underwent in home polysomnography (PSG). Results: An interaction effect of energy intake (EI) was detected (p < 0.001). EI was higher during ad libitum compared to the eucaloric condition (p < 0.001) and in OB compared to NW (p < 0.001) in the absence of any substantial modification to macronutrient proportions. Analyses of energy intake distribution throughout the day showed a significant interaction with both a condition and group effect during lunch and dinner. Sleep improvements were noted in OB group during the eucaloric condition compared to ad libitum with reduced sleep onset latency and N1 stage. Sleep improvements were correlated to reduced EI, especially during the evening meal. Conclusion: Simply adjusting dietary intake to energy requirement and reducing the energy proportion of the evening meal could have therapeutic effects on sleep in adolescents with obesity. However, positive energy balance alone cannot justify worsened sleep among adolescents with obesity compared to normal weight counterparts.

Levothyroxine Administration Timing in Hypothyroidism Patients

Levothyroxine is a synthetic T4 hormone that is biochemically and physiologically identical to the natural hormone, and it is used when the body is deficient in the natural hormone. This study was conducted to summarize the current evidence that compare evidence supporting morning dose to evening dose of levothyroxine in patients with hypothyroidism‎. A simple systematic review was carried out, searching databases PubMed, Google Scholar, and EBSCO. The authors extracted the needed data. There is conflicting data regarding effectiveness of morning dose versus evening dose in management of levothyroxine. More studies reported effectiveness of bedtime dose more than breakfast dose in hypothyroidism management. Numerous studies reported effectiveness of bedtime dose more than breakfast dose in hypothyroidism management. The most resent evidences recommended that, if possible, L‐T4 be consistently taken either 60 minutes before breakfast or at bedtime (3 or more hours after the evening meal), for optimal, consistent absorption.

Time of Eating and Cardiorespiratory Fitness in Patients with Heart Failure With Preserved Ejection Fraction and Obesity

Objectives To examine the impact of eating prior to or after the mean time of evening meal on cardiorespiratory fitness (CRF) in patients with heart failure with preserved ejection fraction (HFpEF) and concomitant obesity. Methods Twelve patients with HFpEF (left ventricular ejection fraction ≥50%) and obesity (body mass index (BMI) ≥30 kg/m2 or fat mass % (FM%) ≥25% men or ≥35% women) underwent a maximal cardiopulmonary exercise test to obtain peak oxygen consumption (VO2) relative to body weight (ml•kg−1•min−1) and exercise time. Bioelectrical impedance analysis was used to measure FM%. Mean evening meal time was established as 7:25 (SD = 2.1 hours) post meridiem (PM) by averaging three consecutive five-pass 24-hour dietary recalls. Participants were classified by having intake prior to (Group I) or after (Group II) 7:25 PM. Total caloric intake and physical activity were obtained at baseline. Differences between groups were assessed with Mann-Whitney U and Spearman's rank correlation was used to examine associations. Results Participants were 64 (52–65) years of age, 75% female, 58% black, and had a BMI of 36.6 (34.2–41.6) kg/m2 with a FM of 42.5 (36.1–45.5)%. Median peak VO2 was 14.6 (11–19.6) ml•kg−1•min−1 and exercise time was 566 (453–786) seconds. Group II had a significantly greater peak VO2 (Group 1: 10.4 (9.5–15.2) ml•kg−1•min−1; Group II: 14.8 (14.4–23.4) ml•kg−1•min−1, P = 0.028) and exercise time (Group 1: 452 (360–505) seconds; Group II: 662 (578–846) seconds, P = 0.007). Physical activity, body composition, age and total daily calories did not differ between groups (all P &gt; 0.1). On univariate analysis, both peak VO2 (r = 0.736, P = 0.006) and exercise time (r = 0.767, P = 0.004) demonstrated a favorable association with time of eating. Conclusions Caloric intake after the mean time of evening meal was associated with better CRF in patients with HFpEF and obesity. Providing nutrients later may help avoid fasting-related stress associated with cardiac metabolic abnormalities found in HF. Prospective randomized controlled trials examining the effects of later evening meal time in patients with HFpEF and obesity are warranted. Funding Sources Study funding was obtained through the American Heart Association, National Institutes of Health and Virginia Commonwealth University Health System.

Modeling the Effect of Subcutaneous Lixisenatide on Glucoregulatory Endocrine Secretions and Gastric Emptying in Type 2 Diabetes to Simulate the Effect of iGlarLixi Administration Timing on Blood Sugar Profiles

Background: As type 2 diabetes (T2D) progresses, intensification to combination therapies, such as iGlarLixi (a fixed-ratio GLP-1 RA and basal insulin combination), may be required. Here a simulation study was used to assess the effect of iGlarLixi administration timing (am vs pm) on blood sugar profiles. Methods: Models of lixisenatide were built with a selection procedure, optimizing measurement fits and model complexity, and were included in a pre-existing T2D simulation platform containing glargine models. With the resulting tool, a simulated trial was conducted with 100 in-silico participants with T2D. Individuals were given iGLarLixi either before breakfast or before an evening meal for 2 weeks and daily glycemic profiles were analyzed. In the model, breakfast was considered the largest meal of the day. Results: A similar percentage of time within 24 hours was spent with blood sugar levels between 70 to 180 mg/dL when iGlarLixi was administered pre-breakfast or pre-evening meal (73% vs 71%, respectively). Overall percent of time with blood glucose levels above 180 mg/dL within a 24-hour period was similar when iGlarLixi was administered pre-breakfast or pre-evening meal (26% vs 28%, respectively). Rates of hypoglycemia were low in both regimens, with a blood glucose concentration of below 70 mg/dL only observed for 1% of the 24-hour time period for either timing of administration. Conclusions: Good efficacy was observed when iGlarlixi was administered pre-breakfast; however, administration of iGlarlixi pre-evening meal was also deemed to be effective, even though in the model the size of the evening meal was smaller than that of the breakfast.

The association between major dietary patterns at dinner and obesity in adults living in Tehran: A population-based study

Introduction: Findings of studies on the association between evening meal and obesity are inconclusive. Thus, we sought to investigate the association between major dietary patterns at evening meal and obesity among apparently healthy adults in Tehran. Methods: This cross-sectional research was conducted using 833 adult men and women who lived in Tehran (age range: 20-59 years). Their dietary intake was evaluated by three, 24-h dietary recalls(24hDRs), and major patterns were identified using exploratory factor analysis. The association between major dietary patterns at dinner with general and central obesity was assessed using logistic regression analysis. Results: We identified 3 major dietary patterns at dinner including "prudent", "potatoes and eggs" and"Western" patterns. There was no significant relationship between prudent and general obesity (OR:0.76, 95% CI = 0.21, 1.15, P value = 0.20), and, a significant association was not observed between potatoes and eggs and general obesity (OR: 0.89, 95% CI = 0.60, 1.32, P value = 0.57) also, there was no significant relationship between Western dietary pattern and general obesity in this study (OR: 0.95,95% CI = 0.63, 1.43, P value = 0.82). Further analyses showed that there was no significant relationship between central obesity with any of the dietary patterns. Conclusion: The results of this study do not support a possible relationship between major dietary patterns at dinner with general and central obesity. However, the presented findings should be confirmed in prospective studies.

Effects of consuming later evening meal versus earlier evening meal on weight loss during a Weight Loss Diet: a randomized clinical trial

Previous evidence confirms a relationship between the timing of food intake and weight loss in humans. We aimed to evaluate the effect of late versus early evening meal consumption on weight loss and cardio-metabolic risk factors in women during a weight loss program. 82 Healthy women [BMI = 27- 35 kg/m2; age= 18-45 y] were randomly assigned into two hypo-caloric weight loss groups: Early Evening Meal Group (at 7:00-7:30 PM), (EEM), or Late Evening Meal Group (at 10:30-11:00 PM), (LEM) for 12 weeks. Baseline variables were not significantly different between the groups. A significant reduction in anthropometric measurements and significant improvements in lipid and carbohydrate metabolism characteristics were detected over the 12 weeks in both groups. Compared with LEM Group (mean± SD), EEM Group had a greater reduction in weight (EEM: -6.74 ± 1.92kg ; LEM: -4.81 ± 2.22kg; P<0.001), BMI (EEM: -2.60 ± 0.71kg/m²; LEM: -1.87 ±0.85kg/ m² ; P<0.001), waist circumference (EEM: -8± 3.25cm; LEM: -6± 3.05cm, P=0.007), total cholesterol (EEM: -0.51 ± 0.19 mmol/l, LEM: -0.43 ± 0.19 mmol/l, P=0.038), triglyceride (EEM: -0.28 ± 0.10 mmol/l, LEM: -0.19 ± 0.10 mmol/l, P<0.001, HOMA IR (EEM: -0.83 ±0.37; LEM: -0.55 ± 0.28, P<0.001) and fasting insulin (EEM: -2.64 ± 1.49 m IU/ml; LEM: -1.43 ± 0.88 m IU/ml; P<0.001) after the 12 weeks. In conclusion, eating an earlier evening meal resulted in favorable changes in weight loss during a 12-week weight loss program. It may also offer clinical benefits concerning changes in plasma cardio-metabolic risk markers.