Incidental finding of lipaemia retinalis on diabetic retinal screening

Summary A 37-year-old female of South Asian origin was referred to our diabetes clinic for evaluation of an unusual finding during her retinal screening. Her retinal blood vessels appeared white in contrast to the normal pink-red colour. She had type I hyperlipidaemia, confirmed by genotype, and was recently diagnosed with diabetes, secondary to pancreatic insufficiency, for which she had suboptimal control and multiple hospitalisations with recurrent pancreatitis. On examination, she had multiple naevi on her skin; the rest of the examination was unremarkable. The patient did not report any visual disturbances and had intact visual acuity. Investigations showed raised total cholesterol (12.5 mmol/L) and triglycerides (57.7 mmol/L). Following evaluation, the patient was diagnosed with lipaemia retinalis, secondary to type I hyperlipidaemia. The patient was managed conservatively to reduce the cholesterol and triglyceride burdens. However, therapies with orlistat, statin, fibrates and cholestyramine failed. Only a prudent diet, omega-3 fish oil, medium-chain triglycerides oil and glycaemic control optimised with insulin showed some improvements in her lipid profile. Unfortunately, this led her to becoming fat-soluble vitamin deficient; hence, she was treated with appropriate supplementation. She was also recently started on treatment with volanesorsen. Following this, her lipid parameters improved and lipaemia retinalis resolved. Learning points Lipaemia retinalis is an uncommon incidental finding of type I hyperlipidaemia that may not affect vision. Management of associated dyslipidaemia is challenging with minimal response to conventional treatment. Increased awareness of lipaemia retinalis and specialist management is needed as part of regular patient monitoring and personalised management.

Role of dietary patterns and factors in determining the risk of knee osteoarthritis: A meta-analysis

ABSTRACT Objectives To evaluates the role of diet in determining knee osteoarthritis risk. Methods Literature search was conducted in Ovid, PubMed, Science Direct, and Springer. To estimate knee osteoarthritis risk with high use of vegetarian, prudent, and omnivorous diets, dairy products, vitamin C/E, and carotenoids, the odds ratios (ORs) or relative risks (RRs) reported by included studies were pooled. Results Fifteen studies (97,157 individuals) were included. High use of vegetarian diet {OR 0.71 [95% confidence interval (CI): 0.45, 0.97]}, prudent diet [OR 0.87 (95% CI: 0.76, 0.98)/RR 0.89 (95% CI: 0.82, 0.97)], and dairy [OR 0.66 (95% CI: –0.08, 1.39)/RR 0.58 (95% CI: 0.41, 0.75)] were associated with lower risk of knee osteoarthritis but risk was relatively higher with high use of omnivorous diet [OR 1.13 (95% CI: 0.95, 1.30)/RR 1.06 (95% CI: 0.84, 1.29) and 1.05 (0.78, 1.33)]. High intake of vitamin C [OR 0.92 (0.29, 1.56)] or E [OR 0.93 (0.64, 1.21)] did not reduce knee osteoarthritis risk, but high use of carotenoids was associated with the lower risk [OR 0.66 (0.37, 0.96)]. Conclusions Knee osteoarthritis risk is low with high use of vegetarian diet, prudent diet, and dairy, but cannt be reduced by high intakes of vitamin C/E.

The Gut Microbiome as Mediator Between Diet and its Impact on Immune Function

Background. Dietary habits may influence chronic low-grade inflammation in humans. Here we explore this interaction as well as the potential mediating role of the gut microbiome (GM), given that the GM is both involved in processing of dietary components and influences the immune system. Methods. A cross-sectional analysis of a sample of 482 healthy participants (207 males and 275 females) was performed. Dietary intake was assessed by a semiquantitative food questionnaire. Adipokines and soluble inflammatory mediators were assayed with multiple immunoassays and ELISA. Microbial DNA was extracted from frozen stool samples of the 471 participants. Polychoric correlation analysis was used to establish dietary patterns, and joint multivariate associations between these dietary patterns and immune biomarkers were studied using regression analyses with adjustment for sex, age, BMI, smoking, education levels and physical exercise and other dietary patterns. Non-parametric entropy mediation (NPEM) was applied to investigate whether diet-immune relationships are mediated by abundance of microbial species. Results. We identified 3 dietary patterns, characterized as “high-meat” (meat and sweetened drink), “prudent diet” (fish, fruit, legumes and vegetables) and “high alcohol” (higher alcohol consumption). Higher adherence to prudent diet was associated with a higher adiponectin level. The high alcohol pattern was associated with high concentrations of circulating concentrations of pro-inflammatory markers (CRP, IL-6, VEGF). Dialister invisus was found to mediate the relationship between a prudent dietary pattern and adiponectin, AAT, CRP, IL-6, and VEGF. Conclusion. A meat-based diet and a diet with high alcohol consumption were associated with high concentrations of biomarkers of chronic low-grade inflammation, and conversely, a prudent diet was associated with anti-inflammatory biomarkers. Diet-inflammation regulation may differ between sexes. Mediation analyses revealed that the association between prudent diet and immune function was partially mediated by the GM. Our study adds to our understanding of the associations between diet, the immune system and the GM in a healthy population.

The Moderating Role Of Diet Patterns In The Relationship Between Perceived Stress And Cognitive Function In Older Adults

The current study examined the moderating role of adherence to a healthy prudent diet and an unhealthy Western diet in the relationship between perceived stress and cognitive function among community-dwelling older adults. It was hypothesized that the association between perceived stress and cognition would be buffered by prudent diet and exacerbated by Western diet intake. 201 adults aged 60 and older participated in the study. Prudent diet was a significant effect-modifier, such that higher perceived stress was associated with poorer executive functioning at low levels of prudent diet. Prudent diet did not moderate the association between perceived stress and episodic memory. Western diet was not a significant effect-modifier in the perceived stress-cognition relationship. These findings provide preliminary evidence that a healthy diet may buffer the association between perceived stress and executive function in older adults. Future research with a more diverse sample is needed to confirm these findings.

The Moderating Role Of Diet Patterns In The Relationship Between Perceived Stress And Cognitive Function In Older Adults

The current study examined the moderating role of adherence to a healthy prudent diet and an unhealthy Western diet in the relationship between perceived stress and cognitive function among community-dwelling older adults. It was hypothesized that the association between perceived stress and cognition would be buffered by prudent diet and exacerbated by Western diet intake. 201 adults aged 60 and older participated in the study. Prudent diet was a significant effect-modifier, such that higher perceived stress was associated with poorer executive functioning at low levels of prudent diet. Prudent diet did not moderate the association between perceived stress and episodic memory. Western diet was not a significant effect-modifier in the perceived stress-cognition relationship. These findings provide preliminary evidence that a healthy diet may buffer the association between perceived stress and executive function in older adults. Future research with a more diverse sample is needed to confirm these findings.

Diet, Physical Activity, and Disinhibition in Middle-Aged and Older Adults: A UK Biobank Study

Disinhibition is a prominent feature of multiple psychiatric disorders, and has been associated with poor long-term somatic outcomes. Modifiable lifestyle factors including diet and moderate-to-vigorous physical activity (MVPA) may be associated with disinhibition, but their contributions have not previously been quantified among middle-aged/older adults. Here, among N = 157,354 UK Biobank participants aged 40–69, we extracted a single disinhibition principal component and four dietary components (prudent diet, elimination of wheat/dairy/eggs, meat consumption, full-cream dairy consumption). In addition, latent profile analysis assigned participants to one of five empirical dietary groups: prudent-moderate, unhealthy, restricted, meat-avoiding, low-fat dairy. Disinhibition was regressed on the four dietary components, the dietary grouping variable, and self-reported MVPA. In men and women, disinhibition was negatively associated with prudent diet, and positively associated with wheat/dairy/eggs elimination. In men, disinhibition was also associated with consumption of meat and full-cream dairy products. Comparing groups, disinhibition was lower in the prudent-moderate diet (reference) group compared to all other groups. Absolute βs ranged from 0.02–0.13, indicating very weak effects. Disinhibition was not associated with MVPA. In conclusion, disinhibition is associated with multiple features of diet among middle-aged/older adults. Our findings foster specific hypotheses (e.g., early malnutrition, elevated immune-response) to be tested in alternative study designs.

A Fundamental Role for Oxidants and Intracellular Calcium Signals in Alzheimer’s Pathogenesis—And How a Comprehensive Antioxidant Strategy May Aid Prevention of This Disorder

Oxidative stress and increased cytoplasmic calcium are key mediators of the detrimental effects on neuronal function and survival in Alzheimer’s disease (AD). Pathways whereby these perturbations arise, and then prevent dendritic spine formation, promote tau hyperphosphorylation, further amplify amyloid β generation, and induce neuronal apoptosis, are described. A comprehensive program of nutraceutical supplementation, comprised of the NADPH oxidase inhibitor phycocyanobilin, phase two inducers, the mitochondrial antioxidant astaxanthin, and the glutathione precursor N-acetylcysteine, may have important potential for antagonizing the toxic effects of amyloid β on neurons and thereby aiding prevention of AD. Moreover, nutraceutical antioxidant strategies may oppose the adverse impact of amyloid β oligomers on astrocyte clearance of glutamate, and on the ability of brain capillaries to export amyloid β monomers/oligomers from the brain. Antioxidants, docosahexaenoic acid (DHA), and vitamin D, have potential for suppressing microglial production of interleukin-1β, which potentiates the neurotoxicity of amyloid β. Epidemiology suggests that a health-promoting lifestyle, incorporating a prudent diet, regular vigorous exercise, and other feasible measures, can cut the high risk for AD among the elderly by up to 60%. Conceivably, complementing such lifestyle measures with long-term adherence to the sort of nutraceutical regimen outlined here may drive down risk for AD even further.

Body mass index, prudent diet score and social class across three generations: evidence from the Hertfordshire Intergenerational Study

BackgroundStudies describing body mass index (BMI) and prudent diet score have reported that they are associated between parents and children. The Hertfordshire Intergenerational Study, which contains BMI, diet and social class information across three generations, provides an opportunity to consider the influence of grandparental and parental BMI and prudent diet score across multiple generations, and the influence of grandparental and parental social class on child BMI.MethodsLinear regressions examining the tracking of adult BMI and prudent diet score across three generations (grandparent (F0), parent (F1) and child (F2)) were run from parent to child and from grandparent to grandchild. Linear mixed models investigated the influence of F0 and F1 BMI or prudent diet score on F2 BMI and prudent diet score. Linear regressions were run to determine whether social class and prudent diet score of parents and grandparents influenced the BMI of children and grandchildren.ResultsBMI was significantly associated across each generational pair and from F0 to F1 in multilevel models. Prudent diet score was significantly positively associated between grandparents and grandchildren. Lower grandparental and parental social class had a significantly positive association with F2 BMI (F0 low social class: b=1.188 kg/m2, 95% CI 0.060 to 2.315, p=0.039; F1 middle social class: b=2.477 kg/m2, 95% CI 0.726 to 4.227, p=0.006).ConclusionAdult BMI tracks across generations of the Hertfordshire Intergenerational Study, and child BMI is associated with parental and grandparental social class. The results presented here add to literature supporting behavioural and social factors in the transmission of BMI across generations.

Diet, physical activity and behavioural disinhibition in middle-aged and older adults: a UK Biobank study

Background and aimsBehavioural disinhibition is a prominent feature of multiple psychiatric disorders, and has been associated with poor long-term somatic health outcomes. Modifiable lifestyle factors including diet and moderate-to-vigorous physical activity (MVPA) may be associated with behavioural disinhibition, but their shared and unique contributions have not previously been quantified.MethodsN=157,354 UK Biobank participants who completed the online mental health assessment were included (age 40-69, 2006-2010). Using principal component analyses, we extracted a single disinhibition score and four dietary component scores (prudent diet, elimination of wheat/dairy/eggs, meat consumption, full-cream dairy consumption). In addition, latent profile analysis assigned participants to one of five empirical dietary groups: moderate-healthy, unhealthy, restricted, meat-avoiding, low-fat dairy. Participants self-reported MVPA in minutes/week. Disinhibition was regressed on the four dietary components, the dietary grouping variable and MVPA.Resultsin men and women, behavioural disinhibition was negatively associated with prudent diet scores, and positively associated with wheat/dairy/eggs elimination. In men only, disinhibition was associated with consumption of meat and full-cream dairy products. Comparing groups, disinhibition was lower in the moderate-and-prudent diet (reference) group compared to all other groups. Absolute βs ranged from 0.02-0.13 indicating very weak effects. Disinhibition was not associated with MVPA.ConclusionsAmong middle-aged and older adults, behavioural disinhibition is associated with multiple features of diet. While the observational nature of UK Biobank does not allow causal inference, our findings foster specific hypotheses (e.g. early malnutrition, elevated immune-response, dietary restraint) to be tested in alternative study designs.

Dose–Response Relationship between Western Diet and Being Overweight among Teachers in Malaysia

The rising prevalence of overweight and obesity is partly due to nutrition transition. The reported association between dietary patterns and overweight/obesity has been controversial because of inconsistent results and weak observed associations. Although it has been hypothesized that an unhealthy diet can increase obesity risk, none of the previous studies have examined the dose–response association using nonlinear dose–response analyses. This study aimed to examine the dose–response association between major dietary patterns and overweight/obesity. This was a cross-sectional study involving teachers selected through stratified multistage sampling from public schools in three Malaysian states. Dietary intake was assessed using a food frequency questionnaire, and two major dietary patterns (Western and Prudent diet) were extracted using factor analysis. Logistic regression followed by trend analysis was used to test the difference in odds of overweight and obesity in each quintile of diet score. A further analysis using restricted cubic spline models was performed to examine the dose–response associations of dietary patterns with odds of overweight/obesity. The logistic regression analysis showed that participants with the highest quintile of Western diet score were 1.4 times more likely to be overweight/obese compared to those in the lowest quintile (95% CI: 1.11, 1.83, p-trend < 0.001). The odds of overweight/obesity showed a significant increasing trend across quintiles of Western diet among both men and women (p-trend < 0.001). In the dose–response analysis, a positive linear association (Pnonlinearity = 0.6139) was observed where overweight/obesity was more likely to occur among participants with a Western diet score greater than a mean score of zero. There was an inverse trend of odds of overweight/obesity across quintiles of Prudent diet score, significant only for men (p for trend < 0.001). Linear association was found between Prudent diet score and odds of overweight/obesity among both men (Pnonlinearity = 0.6685) and women (Pnonlinearity = 0.3684) in the dose–response analysis. No threshold at the level of adherence to Prudent diet was linked to odds of overweight/obesity. Dose–response analysis indicated that women with a Western diet score greater than zero were more likely to be overweight or obese among women. In men, higher adherence to Western diet was associated with increased odds of overweight/obesity, while greater adherence to Prudent diet decreased the odds of overweight/obesity. Promoting and enhancing the consumption of Prudent diet and limit in Western diet may be used to guide the development of evidence-based diet interventions to curb overweight and obesity.