Nutritional Regulation of Hepatic FGF21 by Dietary Restriction of Methionine

FGF21 is a potent metabolic regulator of energy balance, body composition, lipid metabolism, and glucose homeostasis. Initial studies reported that it was increased by fasting and the associated increase in ketones, but more recent work points to the importance of dietary protein and sensing of essential amino acids in FGF21 regulation. For example, dietary restriction of methionine produces a rapid transcriptional activation of hepatic FGF21 that results in a persistent 5- to 10-fold increase in serum FGF21. Although FGF21 is a component of a complex transcriptional program activated by methionine restriction (MR), loss-of-function studies show that FGF21 is an essential mediator of the resulting effects of the MR diet on energy balance, remodeling of adipose tissue, and enhancement of insulin sensitivity. These studies also show that FGF21 signaling in the brain is required for the MR diet-induced increase in energy expenditure (EE) and reduction of adiposity. Collectively, the evidence supports the view that the liver functions as a sentinel to detect and respond to changes in dietary amino acid composition, and that the resulting mobilization of hepatic FGF21 is a key element of the homeostatic response. These findings raise the interesting possibility that therapeutic diets could be developed that produce sustained, biologically effective increases in FGF21 by nutritionally modulating its transcription and release.

Fortification of food with micronutrients: development of methodological and regulatory framework in the Russian Federation

The available scientific literature, domestic and international regulatory codes of normative documents concerning the fortification of various types of food products have been analyzed. The groups of food products of conventional and regular consumption included into the diets of all categories of consumers, recommended for fortification with essential micronutrients, have been determined: wheat and cereal flour (spelt wheat, buckwheat, oat, corn flour, etc.); pastry; milk and dairy products, including ice cream; non-alcoholic soft drinks; mineralized drinking water; fruit and vegetable juices; fat and oil products (vegetable oils, margarines, spreads, mayonnaise); confectionery and sweets (pastry, sugar, chocolate); cereals (breakfast cereals, muesli, ready-to-eat extruded cereals, instant pasta and cereals, mixtures for bakery, flour for sweet pastry); food concentrates (jelly, instant drinks, concentrates of sweet foods, instant food, instant cereal concentrates); table salt. The groups of food products assigned for certain categories of population are used as part of therapeutic diets for patients with various diseases (metabolic disorder syndrome, cardio-vascular system pathology with atherosclerotic vascular injury, type 2 diabetes mellitus, gastrointestinal tract diseases, non-alcoholic fatty liver disease, diabetic nephropathy, etc.), as well as assigned to reduce the risk of diseases developing, the nutrients are recommended for targeted fortification of certain types of food. Examples of micronutrients fortification of sausages and minced meat semifinished products are given below. Requirements for fortification of mass consumption food products and for fortification of foods for special dietary uses are formulated in this article, the amount of fortifying components in the various groups of food products are justified, ensuring their efficiency for improving the micronutrient status and safety of its consumption. Based on the analysis of the available scientific literature, domestic and international regulatory framework of normative documents on fortification of various types of food products, recommendations have been developed for fortification of food with micronutrients.

Conservative possibilities influencing PCOS syndrome – the importance of nutrition

Polycystic ovary syndrome (PCOS) is a common pathological condition in women. Conservative treatment is used in the treatment of polycystic ovary syndrome. Conservative treatment options include increased physical activity and diet. The main aim of the article is to discuss the therapeutic treatment of infl uencing PCOS from a nutritional point of view. PCOS is associated with several comorbidities, including infertility, metabolic syndrome, obesity, impaired glucose tolerance, diabetes mellitus II, and increased cardiovascular risk. Several therapeutic diets can be used in the treatment of PCOS, such as the DASH diet, the low-carbohydrate diet, and a diet based on a low glycemic index. A change in eating habits is associated with improvement in PCOS symptoms. Key words: polycystic ovary syndrome – nutrition – diet – metabolic syndrome

PHYSIOLOGICAL EFFICIENCY OF DRINKS FROM FENUGREEK SEEDS

Background. Today, diabetes is one of the most common diseases with a steady upward trend. In particular in Ukraine it ranks 2nd among endocrine diseases in the number of patients. The annual growth of such patients averages 9.8–11 %. In the treatment of endocrine diseases, dietary nutrition aimed at normalizing metabolismis of great importance. It is recommended to add to the diet special, func­tionally-oriented foods based on biologically valuable raw materials. The aim of the workis to determine the physiological efficiency of drinks from fenugreek seeds. Materials and methods. The physiological effects of fenugreek seed drinks were determined from clinical trials involving 54 patients with type II diabetes and 40 patients diagnosed with pre-diabetes. Two groups of 32 patients who did not consume the product were also selected. Biochemical methods were used to assess the effect of the product on the correction of condition of patients according to the indicators of the general condition of patients, the indicator of the level of glucose and cholesterol in the blood.The assessment of physical and psycho-emotional states was conducted by a survey. Drink is a plant-based milk analogue from the fenugreek seeds is presented in a ready-to-drink form.Depending on the disease and the condition of the body, participants in clinical trials drank the developed drink daily at 200–400 cm3/day (1–2 times a day at 200 cm3) for 30–60 days together with an individually prescribed treatment package. Results. It was found that patients who consumed a drink of fenugreek seeds in addition to the main diet had a faster normalization of blood glucose levels, more pronounced improvement in physical condition, as well as a reduction in the overall duration of treatment than patients in the control group. There was an improvement in lipid metabolism in patients of both study groups who drank a plant-based milk analogue from fenugreek seeds, and patients have noted that consumption of the developed drink helped to improve the condition of the gastrointestinal tract.This can be explained by the large number of galactomannans in the fenugreek seeds, which promote the secretion of mucous substances during the production of the drink. Conclusion. The new plant-based milk analogue from fenugreek seeds helps to normalize blood sugar and cholesterol levels, and therefore can be recommended for use in dietary and therapeutic diets of people with diabetes and atherosclerosis during treatment and recovery. Taking into accountthe properties of fenugreek seeds, the developed product can be recommended to protect the organs of the gastrointestinal tract in these diseases and in general to normalize metabolism.

Canadian Hospital Food Service Practices to Prevent Malnutrition

Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition. Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions). Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook–serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The “regular menu” (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400 kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150. Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM)

Aim: Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals. Methods: These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism). Results: Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1—harmonized vocabulary related to food and diets in hospitals; 2—quantitative and qualitative food propositions; 3—nutritional prescriptions; 4—diet patterns and patient adaptations; 5—streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6—emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients. Conclusion: These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities

Indigenous peoples in Canada, and globally, experience a disproportionate burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) (1-4). ESRD patients in remote Indigenous communities might experience significant challenges in adhering to dietary guidelines (5). Much research has documented the poor quality, high cost, and limited availability of healthy foods in remote, Indigenous communities (6-8) Food quality and availability is poor in remote communities – indicating that persons with ESRD and CKD might have limited ability to adhere to dietary guidelines (5). This article reports on research designed to understand food access barriers in remote First Nations for persons living with Stage 4 and 5 CKD/ESRD. The study involved semi - structured interviews with 38 patients in remote communities. It concludes with some reflections on the significance of this issue in the context of dietetic practice.

Are Therapeutic Diets in Long-Term Care Affecting Resident Food Intake and Meeting their Nutritional Goals?

Purpose: To examine health characteristics of long-term care (LTC) residents prescribed therapeutic diets (promoting or restricting intake of key food components), to determine how these diets influenced intake and whether there were differences in food intake and malnutrition risk between residents with and without restrictive diets. Methods: Secondary analysis of the Making the Most of Mealtimes Study includes 435 residents with no/mild cognitive impairment in 32 LTC homes across 4 provinces. Health records were reviewed for diet prescriptions and other characteristics. Weighed and observed food and fluid consumption over 3 nonconsecutive days determined intake. Bivariate and multivariable linear regressions identified associations between therapeutic diets and intake and key nutrients. Results: Almost half (42%) of participants were prescribed a therapeutic diet. Residents receiving restrictive diets (28%) consumed absolute calories consistent with those receiving a regular diet, but kcal/kg was significantly lower (22.1 ± 5.5 vs 23.6 ± 5.3). Low sodium and weight-promoting diets were the only therapeutic diets associated with their corresponding key nutrient profiles. Restrictive therapeutic diets were not associated with energy or protein intake when adjusting for covariates. Conclusions: Restrictive therapeutic diets among those with mild to no cognitive deficits do not appear to impair food intake.