Changes in weight and body composition after initiating insulin therapy and their relationship with metabolic control during the first year of type 1 diabetes in adults. InLipoDiab1 Study

Introduction. As in the general population, an increase in the incidence of overweight has been observed in individuals with type 1 diabetes (T1DM). Nevertheless, weight gain in this group may contribute to the deterioration of the metabolic management. The aim of this study was to evaluate changes in the body weight and body composition after initiating insulin therapy and to assess their relationship with the metabolic management during the first year of T1DM in adults.Material and Methods. The prospective analysis included 139 adults patients with newly diagnosed T1DM, treated with Intensive functional insulin therapy (IFI) from the onset of the disease (age 26.3 ± 5.9 years). Patients were assessed at the time of the diagnosis and after 12 months. Metabolic parameters, including the HbA1c and lipid profile were investigated. The group was divided according to weight gain during the follow-up period.Results. Weight gain was observed in 68.3% of participants (n = 95). In most cases an increase in body fat was found (41% vs 59% p = 0.01). Changes in the body weight corresponded to significant changes in body composition. Conversely, HbA1c decreased during the follow-up in all groups. The highest reduction was observed in a group with “excessive weight gain”. Additionally, a significant increase in high density lipoproteins was observed in each group. However, weight gain was not accompanied by a deterioration of the lipid profile.Conclusions. Weight gain is a considerable problem among adults with newly diagnosed T1DM and is connected mainly with an increase of adipose tissue above the normal range. Changes in the body weight, associated with body composition changes, did not result in the dysfunctions of the metabolic management.

‘Goal-directed extracorporeal circulation: transferring the knowledge and experience from daily cardiac surgery to extracorporeal membrane oxygenation’

Metabolism management plays an essential role in extracorporeal technologies. There are different metabolic management devices integrated to extracorporeal devices; the most commonly used and accepted metabolic target in adult patients is indexed oxygen delivery (280 mL/min/m2) and cardiac index (2.4 L/min/m2), which can be managed independently or according to other metabolic parameters. Extracorporeal membrane oxygenation (ECMO) is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. The goal-directed perfusion initiative during cardiopulmonary bypass (CPB) reduced the incidence of acute kidney injury after cardiac surgery. On the basis of the available literature, the identified goals to achieve during CPB include maintenance of oxygen delivery > 300 mL O2/min/m2 and reduction in vasopressor use. ECMO and CPB are conceptually similar but differ in many aspects and finality; in particular, they differ in the scientific evidence for metabolic management nadirs. As for CPB, predictive target parameters have been found and consolidated, particularly in terms of acute renal injury and the prevention of anaerobic metabolism, while for ECMO management, a blurred path remains. In this context, we review the strategies for optimal goal-directed therapy during CPB and ECMO, trying to transfer the knowledge and experience from daily cardiac surgery to veno-arterial ECMO.

Management algorithms and artificial intelligence systems for cardiopulmonary bypass

This article introduces management algorithms to support operators in choosing the best strategy for metabolic management during cardiopulmonary bypass using artificial intelligence systems. We developed algorithms for the identification of the optimal way for assessing metabolic parameters. Different management algorithms for extracorporeal procedures interfaced with metabolic monitoring systems already exist on the market and are applied in clinical practice. These algorithms could provide guidance for selecting the best metabolic strategy with the aim at reducing human error and optimizing management.

The European Society for Clinical Nutrition and Metabolism practical guideline: Clinical nutrition in liver disease

The Practical guideline is based on the current scientific ESPEN guideline on Clinical Nutrition in Liver Disease (Plauth M., Bernal W., Dasarathy S., Merli M., Plank L. D., Schütz T., Bischoff S. C. ESPEN guideline on clinical nutrition in liver disease // Clin Nutr. — 2019. — 38. — Р. 485—521). It has been shortened and transformed into flow charts for easier use in clinical practice. The guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with chronic liver disease. A total of 103 statements and recommendations are presented with short commentaries for the nutritional and metabolic management of patients with (i) acute liver failure, (ii) alcoholic steatohepatitis, (iii) non-alcoholic fatty liver disease, (iv) liver cirrhosis, and (v) liver surgery/transplantation. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in liver patients and on liver complications associated with medical nutrition. This practical guideline gives guidance to health care providers involved in the management of liver disease to offer optimal nutritional care.

Possible Nutrition-Related Mechanisms of Metabolic Management in Cancer Treatment

Context: Somatic mutation theory has been considered as a potential cause for cancer. However, major inconsistencies with the gene theory have necessitated serious reconsideration of this assumption. According to these inconsistencies, cancer may be considered as a metabolic disorder. According to the mitochondrial metabolic theory, substrate-level phosphorylation has been suggested to be superior to oxidative phosphorylation in cancer cells. Cancer metabolic therapies such as ketogenic diets (KD) and limitation in glutamine and calorie can be beneficial and are in line with this theory. In this study, we have reviewed the potential effects of KD as well as glutamine and calorie restriction in various types/stages of cancer with a focus on possible mechanisms. Evidence Acquisition: A comprehensive electronic search of different databases was performed using “cancer”, “ketogenic diet”, and “metabolic” as the main keywords. A comprehensive electronic search of different databases was performed using “cancer”, “ketogenic diet”, and “metabolic” as the main keywords. Results: Emerging evidence has indicated that KD can affect tumor cells by reducing glucose availability and simultaneous elevation of ketone bodies as non-fermentable metabolic fuels. KD has been suggested to be more effective as a non-toxic therapeutic measure in combination with glutamine targeting agents, chloroquine for lysosomal targeting, hyperbaric oxygen therapy, and calorie restriction. Conclusions: This metabolic approach can be considered as a promising non-toxic strategy for cancer management.