The benefits of dietary fiber: the gastrointestinal tract and beyond

Predictors of hyperkalemia in pediatric patients on dialysis: international prospective observational study

BACKGROUND

Hyperkalemia is an important issue in kidney failure. The aim of the study was to investigate the predictors of hyperkalemia in children receiving maintenance dialysis.

METHODS

This was an international prospective cross-sectional observational study involving patients < 18 years receiving chronic hemodialysis or peritoneal dialysis. Hyperkalemia was defined as serum potassium (sK+) ≥ 5 mEq/L based on the Pediatric Renal Nutrition Taskforce recommendations. We recorded age, dialysis vintage, urine output (24-h urine collection); dietary K+, energy, protein and sodium intake (three-day diaries); office blood pressure (BP) in children < 5 years and 24-h ABPM in older patients; biochemistry (creatinine, urea, sodium, bicarbonate, hemoglobin, phosphate, albumin) and antihypertensive drugs.

RESULTS

Forty-one patients were enrolled (10 peritoneal dialysis, 31 hemodialysis), median age 13.3 (IQR 10.6-15.8) years; 15 of them (36.6%) showed hyperkalemia, and median sK+ was 4.7 (4.4-5.0) mEq/L. Renin-angiotensin-aldosterone system inhibitors (RAASi) were prescribed in 9/15 patients with hyperkalemia (60%) and 7/26 (26.9%) without hyperkalemia (p = 0.04). Patients with hyperkalemia were older and had higher urea and creatinine than those with normal sK+. A backward stepwise multivariable model showed that the only predictors of hyperkalemia were age (b = 0.53, p = 0.01), urea (b = 0.02, p = 0.03) and treatment with RAASi (b = 2.75, p = 0.021).

CONCLUSIONS

While higher age, higher urea levels and treatment with RAASi independently predicted the occurrence of hyperkalemia, K+ intake was not associated with sK+ in children on dialysis. This emphasizes the importance of considering non-dietary causes of hyperkalemia and considering the bioavailability of K+ more than the total dietary K+ intake.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and gut microbiota composition: what do we know?

Post-streptococcal autoimmune neuropsychiatric disorders (PANDAS) are a group of pathological condition characterized by sudden-onset obsessive-compulsive and tic disorders following beta-hemolytic Streptococcus group A (GAS) infection, hypothesized to be caused by autoimmune mechanisms targeting the basal ganglia. Scant literature is available regarding the microbiota composition in children with PANDAS, however few studies support the hypothesis that streptococcal infections may alter gut microbiota composition in these patients, leading to chronic inflammation that may impact the brain function and behavior. Notable changes include reduced microbial diversity and shifts in bacterial populations, which affect metabolic functions crucial for neuroinflammation. Elevated serum levels of sNOX2-dp and isoprostanes indicate oxidative stress, while the presence of lipopolysaccharides (LPS) may contribute to neuroinflammation. The aim of this narrative review is to explore the link between PANDAS and gut microbiota composition. The potential connection between gut microbiota and neuropsychiatric symptoms in PANDAS might suggest the importance of dietary interventions, such as promoting the Mediterranean diet and fiber intake, to reduce the inflammatory state of this patients and therefore improve their outcome.

Nutritional and technological potential of umbu-caja and soursop co-product flours

Umbu-caja and soursop from the Northeast region of Brazil are rich in nutrients and bioactive compounds and are widely processed by the fruit agroindustry. However, there is a lack of research examining the composition and nutritional/technological potential of these co-product fruits. The present study evaluated the nutritional and technological characteristics of umbu-caja and soursop co-product flours (UCF and SCF, respectively), in addition to cytotoxicity in healthy cells. The results demonstrated that they are rich in dietary fiber (approximately 53 %), low in protein (approximately 8.0 %), and have minimal moisture content (<15 %). The mineral composition of the flours exhibited a notable presence of copper, iron, zinc, manganese, and boron. The evaluation of antioxidant capacity using the DPPH, ABTS, and FRAP methods demonstrated the presence of antioxidants that resisted processing, indicated by a high antioxidant capacity. Furthermore, the flours were found to contain phenolic compounds, predominantly rutin (UCF) and p-coumaric acid (SCF). The cytotoxicity test demonstrated that both co-product flours did not exert detrimental effects on healthy cells according to the MTT assay. The technological analyses highlighted low pH values (2.38 and 3.61 for UCF and SCF, respectively), which is favorable for a greater shelf life and suggests applications in fermented products. In addition, the flours have good water and oil holding capacity and low foaming, and they could be incorporated into food products that require these properties. The results demonstrated promising qualities of the UCF and SCF for incorporation into the human diet and product development, mainly due to their high fiber content, antioxidant capacity and low cytotoxicity.

Nutritional management of the child with chronic kidney disease and on dialysis

While it is widely accepted that the nutritional management of the infant with chronic kidney disease (CKD) is paramount to achieve normal growth and development, nutritional management is also of importance beyond 1 year of age, particularly in toddlers, to support the delayed infantile stage of growth that may extend to 2-3 years of age. Puberty is also a vulnerable period when nutritional needs are higher to support the expected growth spurt. Inadequate nutritional intake throughout childhood can result in failure to achieve full adult height potential, and there is an increased risk for abnormal neurodevelopment. Conversely, the rising prevalence of overweight and obesity among children with CKD underscores the necessity for effective nutritional strategies to mitigate the risk of metabolic syndrome that is not confined to the post-transplant population. Nutritional management is of primary importance in improving metabolic equilibrium and reducing CKD-related imbalances, particularly as the range of foods eaten by the child widens as they get older (including increased consumption of processed foods), and as CKD progresses. The aim of this review is to integrate the Pediatric Renal Nutrition Taskforce (PRNT) clinical practice recommendations (CPRs) for children (1-18 years) with CKD stages 2-5 and on dialysis (CKD2-5D). We provide a holistic approach to the overall nutritional management of the toddler, child, and young person. Collaboration between physicians and pediatric kidney dietitians is strongly advised to ensure comprehensive and tailored nutritional care for children with CKD, ultimately optimizing their growth and development.

The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce

The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.

Comparative analysis of the nutritional, physicochemical, and bioactive characteristics of Artemisia abyssinica and Artemisia arborescens for the evaluation of their potential as ingredients in functional foods

Artemisia abyssinica and Artemisia arborescens are unique plants that show significant bioactive properties and are used for the treatment of a variety of diseases. This study assessed the nutritional values, functional properties, chemical composition, and bioactive attributes of these plants as functional nutritional supplements. Compared to A. arborescens, A. abyssinica had higher fat (4.76%), fiber (16.07%), total carbohydrates (55.87%), and energy (302.15 kcal/100 g DW), along with superior functional properties, including higher water and oil absorption capacities (638.81% and 425.85%, respectively) and foaming capacity and stability (25.67% and 58.48%). The investigation of volatile compounds found that A. abyssinica had higher amounts of hotrienol (4.53%), yomogi alcohol (3.92%), caryophyllene (3.67%), and carvotanacetone (3.64%), which possess anti-inflammatory, antimicrobial, and antioxidant properties. Artemisia abyssinica contributed over 30% of the recommended dietary intake (RDI) of amino acids. It displayed superior levels of sodium (31.46 mg/100 g DW) and calcium (238.07 mg/100 g DW). It also exhibited higher levels of organic acids, particularly malic acid, butyric acid, and succinic acid, compared to A. arborescens. Fatty acid analysis revealed palmitic and linoleic acids as primary components in both plants, with A. abyssinica having a higher palmitic acid content. Artemisia abyssinica also had higher vitamin C and thiamine levels. Although A. arborescens showed the highest total phenolic content (TPC), antioxidant activity, and capacity, A. abyssinica demonstrated acceptable efficiency in TPC and antioxidant content. These findings highlight the potential of both Artemisia species, particularly A. abyssinica, as valuable sources of nutrients and bioactive compounds for various applications.

Plant-Based Meat Analogues: Exploring Proteins, Fibers and Polyphenolic Compounds as Functional Ingredients for Future Food Solutions

As the lack of resources required to meet the demands of a growing population is increasingly evident, plant-based diets can be seen as part of the solution, also addressing ethical, environmental, and health concerns. The rise of vegetarian and vegan food regimes is a powerful catalyzer of a transition from animal-based diets to plant-based diets, which foments the need for innovation within the food industry. Vegetables and fruits are a rich source of protein, and bioactive compounds such as dietary fibres and polyphenols and can be used as technological ingredients (e.g., thickening agents, emulsifiers, or colouring agents), while providing health benefits. This review provides insight on the potential of plant-based ingredients as a source of alternative proteins, dietary fibres and antioxidant compounds, and their use for the development of food- and alternative plant-based products. The application of these ingredients on meat analogues and their impact on health, the environment and consumers' acceptance are discussed. Given the current knowledge on meat analogue production, factors like cost, production and texturization techniques, upscaling conditions, sensory attributes and nutritional safety are factors that require further development to fully achieve the full potential of plant-based meat analogues.

The Effects of Food Nutrients and Bioactive Compounds on the Gut Microbiota: A Comprehensive Review

It is now widely recognized that gut microbiota plays a critical role not only in the development and progression of diseases, but also in its susceptibility to dietary patterns, food composition, and nutritional intake. In this comprehensive review, we have compiled the latest findings on the effects of food nutrients and bioactive compounds on the gut microbiota. The research indicates that certain components, such as unsaturated fatty acids, dietary fiber, and protein have a significant impact on the composition of bile salts and short-chain fatty acids through catabolic processes, thereby influencing the gut microbiota. Additionally, these compounds also have an effect on the ratio of Firmicutes to Bacteroides, as well as the abundance of specific species like Akkermansia muciniphila. The gut microbiota has been found to play a role in altering the absorption and metabolism of nutrients, bioactive compounds, and drugs, adding another layer of complexity to the interaction between food and gut microbiota, which often requires long-term adaptation to yield substantial outcomes. In conclusion, understanding the relationship between food compounds and gut microbiota can offer valuable insights into the potential therapeutic applications of food and dietary interventions in various diseases and health conditions.

Mulberry branch fiber improved lipid metabolism and egg yolk fatty acid composition of laying hens via the enterohepatic axis

BACKGROUND

The utilization of mulberry branch fiber (MF), the largest by-product of the sericulture industry, is an important issue. Supplementation with MF as a dietary fiber for poultry may serve as a useful application. However, little is known about the effects of MF on liver lipid metabolism and egg yolk fatty acid composition of laying hens and their underlying mechanisms. In this study, we performed a multi-omics investigation to explore the variations in liver lipid metabolism, egg yolk fatty acid composition, gut microbiota, and the associations among them induced by dietary MF in laying hens.

RESULTS

Dietary MF had no harmful effects on the laying performance or egg quality in laying hens. The enzyme activities associated with lipid metabolism in the liver were altered by the addition of 5% MF, resulting in reduced liver fat accumulation. Furthermore, dietary 5% MF induced the variation in the fatty acid profiles of egg yolk, and increased the polyunsaturated fatty acid (PUFA) content. We observed a significant reduction in the diversity of both gut bacteria and changes in their compositions after the addition of MF. Dietary MF significantly increased the abundance of genes involved in fatty acid biodegradation, and short-chain fatty acids biosynthesis in the gut microbiota of laying hens. The significant correlations were observed between the liver lipid metabolism enzyme activities of hepatic lipase, lipoprotein lipase, and total esterase with gut microbiota, including negative correlations with gut microbiota diversity, and multiple correlations with gut bacteria and viruses. Moreover, various correlations between the contents of PUFAs and monounsaturated fatty acids in egg yolk with the gut microbiota were obtained. Based on partial-least-squares path modeling integrated with the multi-omics datasets, we deduced the direct effects of liver enzyme activities and gut bacterial compositions on liver fat content and the roles of liver enzyme activities and gut bacterial diversity on egg yolk fatty acid composition.

CONCLUSIONS

The results indicate that dietary MF is beneficial to laying hens as it reduces the liver fat and improves egg yolk fatty acid composition through the enterohepatic axis. Video Abstract.

Association between Self-Perception of Chewing, Chewing Behavior, and the Presence of Gastrointestinal Symptoms in Candidates for Bariatric Surgery

Given the changes in the digestive tract post-bariatric surgery, adapting to a new pattern of eating behavior becomes crucial, with special attention to the specifics of chewing mechanics. This study aimed to investigate the association between self-perception of chewing, chewing behavior, and the presence of gastrointestinal symptoms in preoperative patients undergoing bariatric surgery. Sixty adult candidates for bariatric surgery at a public hospital in Belém (Brazil) were analyzed. Participants predominantly exhibited unilateral chewing patterns (91.6%), a fast chewing rhythm (73.3%), a large food bolus (80%), liquid intake during meals (36.7%), and 41.7% reported that chewing could cause some issue. Significant associations were found between the perception of causing problems and chewing scarcity (p = 0.006), diarrhea (p = 0.004), absence of slow chewing (p = 0.048), and frequent cutting of food with front teeth (p = 0.034). These findings reveal a relationship between the perception of chewing problems and chewing scarcity, presence of diarrhea, and fast chewing.

Composition of Whole Grain Dietary Fiber and Phenolics and Their Impact on Markers of Inflammation

Inflammation is an important biological response to any tissue injury. The immune system responds to any stimulus, such as irritation, damage, or infection, by releasing pro-inflammatory cytokines. The overproduction of pro-inflammatory cytokines can lead to several diseases, e.g., cardiovascular diseases, joint disorders, cancer, and allergies. Emerging science suggests that whole grains may lower the markers of inflammation. Whole grains are a significant source of dietary fiber and phenolic acids, which have an inverse association with the risk of inflammation. Both cereals and pseudo-cereals are rich in dietary fiber, e.g., arabinoxylan and β-glucan, and phenolic acids, e.g., hydroxycinnamic acids and hydroxybenzoic acids, which are predominantly present in the bran layer. However, the biological mechanisms underlying the widely reported association between whole grain consumption and a lower risk of disease are not fully understood. The modulatory effects of whole grains on inflammation are likely to be influenced by several mechanisms including the effect of dietary fiber and phenolic acids. While some of these effects are direct, others involve the gut microbiota, which transforms important bioactive substances into more beneficial metabolites that modulate the inflammatory signaling pathways. Therefore, the purpose of this review is twofold: first, it discusses whole grain dietary fiber and phenolic acids and highlights their potential; second, it examines the health benefits of these components and their impacts on subclinical inflammation markers, including the role of the gut microbiota. Overall, while there is promising evidence for the anti-inflammatory properties of whole grains, further research is needed to understand their effects fully.

Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4-5 and on dialysis

BACKGROUND

Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.

METHODS

We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4-5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5-10 g per dose; age-based) either short-term (< 30 days) or long-term (> 30 days).

RESULTS

Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (n = 5) and access dysfunction (n = 4), and was useful during palliative care (n = 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (P < 0.001). Long-term SZC for 5.3 (4.2, 10.1) months achieved decline in serum potassium from 6.1 (5.8, 6.4) to 4.8 (4.2, 5.4) mEq/L (P < 0.001). SZC use was associated with liberalization of diet (n = 6) and was useful in patients with poor adherence to dietary restriction (n = 3). Adverse events or edema were not observed; serum sodium and blood pressure remained stable.

CONCLUSIONS

SZC was safe and effective for the management of acute and chronic hyperkalemia in children with CKD4-5/5D. Its use was associated with relaxation of dietary potassium restriction. Studies to examine its routine use to improve diet and nutritional status in children with CKD are required.

Lower Diet Quality Associated with Subclinical Gastrointestinal Inflammation in Healthy United States Adults

BACKGROUND

Higher diet quality has been associated with lower risk of developing inflammatory bowel disease, but associations between diet and gastrointestinal (GI) inflammation in healthy adults prior to disease onset are understudied.

OBJECTIVES

The purpose of this project was to examine associations between reported dietary intake and markers of GI inflammation in a healthy adult human cohort.

METHODS

In a cross-sectional observational trial of 358 healthy adults, participants completed ≤3 unannounced 24-h dietary recalls using the Automated Self-Administered Dietary Assessment Tool and a Block 2014 Food Frequency Questionnaire to assess recent and habitual intake, respectively. Those who provided a stool sample were included in this analysis. Inflammation markers from stool, including calprotectin, neopterin, and myeloperoxidase, were measured by ELISA along with LPS-binding protein from plasma.

RESULTS

Recent and habitual fiber intake was negatively correlated with fecal calprotectin concentrations (n = 295, P = 0.011, 0.009). Habitual soluble fiber intake was also negatively correlated with calprotectin (P = 0.01). Recent and habitual legume and vegetable intake was negatively correlated with calprotectin (P = 0.013, 0.026, 0.01, 0.009). We observed an inverse correlation between recent Healthy Eating Index (HEI) scores and calprotectin concentrations (n = 295, P = 0.026). Dietary Inflammatory Index scores were calculated and positively correlated with neopterin for recent intake (n = 289, P = 0.015). When participants with clinically elevated calprotectin were excluded, recent and habitual fiber, legume, vegetable, and fruit intake were negatively correlated with calprotectin (n = 253, P = 0.00001, 0.0002, 0.045, 0.001, 0.009, 0.001, 0.004, 0.014). Recent total HEI score was inversely correlated with subclinical calprotectin (P = 0.003).

CONCLUSIONS

Higher diet quality may be protective against GI inflammation even in healthy adults. This trial was registered at clinicaltrials.gov as NCT02367287.

The role of dietary prehabilitation on anastomotic healing

PURPOSE OF REVIEW

As the microbiome takes center stage in biomedical research and emerging medical treatments, here we review the scientific basis and role of dietary modulation to prevent anastomotic leakage.

RECENT FINDINGS

It is becoming increasingly clear that dietary habits have a profound influence on an individual's microbiome and that the microbiome plays a key and causative role in anastomotic leak etiology and pathogenesis. A review of recent studies indicates that the gut microbiome can become significantly shifted in composition, community structure and function within an extremely short time period of 2 or 3 days simply by changing one's diet.

SUMMARY

From a practical standpoint to improve outcome from surgery, these observations, when paired with next generation technology, suggest that it is now possible to manipulate the microbiome of surgical patients to their advantage prior to surgery. This approach will allow surgeons to modulate the gut microbiome with the endpoint of improving the outcome from surgery. Thus a new emerging field termed 'dietary prehabilitation' is now gaining popularity and similar to smoking cessation, weight loss and exercise, may be a practical method to prevent postoperative complications including anastomotic leak.

Physical activity and nutrition in chronic kidney disease

PURPOSE OF REVIEW

Lifestyle intervention is considered a cornerstone in chronic kidney disease management and has been recommended in different international or regional clinical practice guidelines in chronic kidney disease. However, evidence was largely based on the general population. Here we summarized the latest evidence supporting lifestyle intervention in chronic kidney disease.

RECENT FINDINGS

Both observational cohort studies as well as randomized controlled trials have demonstrated health benefits with more physical activity in chronic kidney disease. There are compelling observational data supporting different health and kidney benefits with a healthy dietary pattern rich in fruits and vegetables, whole grains, plant-based foods and low in salt, low in sugar, saturated fat, red meat and ultraprocessed foods, a plant-based diet or Mediterranean diet in chronic kidney disease population. Clinical and epidemiologic studies also showed that higher 24 h urine potassium excretion (as proxy of higher dietary potassium intake) may be associated with lower blood pressure, better kidney outcomes and lower mortality in chronic kidney disease population. Randomized controlled trials also suggested that salt substitutes improved blood pressure control, reduced all-cause death and cardiovascular event risk in the general population compared with regular salt.

SUMMARY

Accumulating evidence supports the current recommendation of encouraging physical activity and promoting a healthy dietary pattern in chronic kidney disease patients. Whether potassium needs restriction in chronic kidney disease diet requires further review. The safety versus benefits of salt substitutes in patients with moderate and advanced chronic kidney disease warrants further investigation.