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Oudmaijer CAJ, Pol RA, Minnee RC, Vermeij WP, IJzermans JNM. Chocolate brownies and calorie restriction: the sweetest paradox? BMJ 2023; 383:2585. [PMID: 38123171 DOI: 10.1136/bmj.p2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- C A J Oudmaijer
- Erasmus MC Transplant Institute, department of surgery, division of hepatobiliary and transplantation surgery, University Medical Center, Rotterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | - R A Pol
- Department of transplantation surgery, University Medical Center Groningen, Groningen, Netherlands
| | - R C Minnee
- Erasmus MC Transplant Institute, department of surgery, division of hepatobiliary and transplantation surgery, University Medical Center, Rotterdam, Netherlands
| | - W P Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | - J N M IJzermans
- Erasmus MC Transplant Institute, department of surgery, division of hepatobiliary and transplantation surgery, University Medical Center, Rotterdam, Netherlands
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Oudmaijer CAJ, Pol RA, Minnee RC, Vermeij W, Ijzermans JNM. Do treats facilitate the interpretation of findings on caloric restriction? BMJ Nutr Prev Health 2023; 6:374-382. [PMID: 38618535 PMCID: PMC11009534 DOI: 10.1136/bmjnph-2023-000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Food can build social bonds and enhance interpersonal relationships. An area of research perhaps at odds with food abundance, is caloric restriction (CR), intermittent fasting (IF) or short-term fasting (STF). We aimed to study the impact of offering treats on the audience during presentations on IF and STF and whether this impacted the audience's reception of the subject. The contradiction of the tempting nature of sharing brownies juxtaposed with the potential health benefits presented is a light-hearted subject in a world where nutritional intake and health outcomes are the object of intense academic discussion. Objective Investigate how treats influence hospital personnel interpretation of information presented on the potential benefits of CR, IF and STF. Methods This trial consists of a cross-sectional study (CSS) and a randomised controlled trial (RCT) conducted at three study centres. The CSS involved a survey administered to healthcare professionals to assess their knowledge, experience and willingness regarding IF and/or STF. In the RCT, brownies were randomly provided to healthcare staff attending a scientific meeting on restricting calories. Results 135 participants were included in the CSS and 64 participants joined the randomised experiment. We found that the randomisation had no statistically significant effect. Only 2 out of 64 were aware of the irony of the provided treatment. In the CSS, participants most often cited the expected beneficial effects on their short-term and long-term health as important reasons for adhering to IF and/or STF. Perceiving fasting as beneficial was mostly influenced by knowledge on the topic and previously adhering to a fasting diet. Discussion In this light-hearted, holiday-inspired exploratory study, we found that providing your audience with treats does not influence participants' opinion of you or your research, even when it focuses on the benefits of reducing calorie intake. The recipients of the treat will remain critical of presented findings, and due to prior experiences will be receptive to the counterintuitive topic of fasting.
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Affiliation(s)
- Christiaan Albert Johan Oudmaijer
- Erasmus MC Transplant Institute, department of Surgery, division of Hepatobiliary and Transplantation Surgery, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, Utrecht, The Netherlands
| | - Robert A Pol
- Department of Transplantation Surgery, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Robert C Minnee
- Erasmus MC Transplant Institute, department of Surgery, division of Hepatobiliary and Transplantation Surgery, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Wilbert Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, Utrecht, The Netherlands
- Oncode Institute, Utrecht, Utrecht, The Netherlands
| | - Jan N M Ijzermans
- Erasmus MC Transplant Institute, department of Surgery, division of Hepatobiliary and Transplantation Surgery, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
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Sergeeva E, Ruksha T, Fefelova Y. Effects of Obesity and Calorie Restriction on Cancer Development. Int J Mol Sci 2023; 24:ijms24119601. [PMID: 37298551 DOI: 10.3390/ijms24119601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The risk of malignant tumor development is increasing in the world. Obesity is an established risk factor for various malignancies. There are many metabolic alterations associated with obesity which promote cancerogenesis. Excessive body weight leads to increased levels of estrogens, chronic inflammation and hypoxia, which can play an important role in the development of malignancies. It is proved that calorie restriction can improve the state of patients with various diseases. Decreased calorie uptake influences lipid, carbohydrate and protein metabolism, hormone levels and cell processes. Many investigations have been devoted to the effects of calorie restriction on cancer development in vitro and in vivo. It was revealed that fasting can regulate the activity of the signal cascades including AMP-activated protein kinase (AMPK), mitogen-activated protein kinase (MAPK), p53, mTOR, insulin/ insulin-like growth factor 1 (IGF1) and JAK-STAT. Up- or down-regulation of the pathways results in the decrease of cancer cell proliferation, migration and survival and the increase of apoptosis and effects of chemotherapy. The aim of this review is to discuss the connection between obesity and cancer development and the mechanisms of calorie restriction influence on cancerogenesis that stress the importance of further research of calorie restriction effects for the inclusion of this approach in clinical practice.
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Affiliation(s)
- Ekaterina Sergeeva
- Department of Pathological Physiology, Krasnoyarsk State Medical University, No. 1 P. Zheleznyaka Str., 660022 Krasnoyarsk, Russia
| | - Tatiana Ruksha
- Department of Pathological Physiology, Krasnoyarsk State Medical University, No. 1 P. Zheleznyaka Str., 660022 Krasnoyarsk, Russia
| | - Yulia Fefelova
- Department of Pathological Physiology, Krasnoyarsk State Medical University, No. 1 P. Zheleznyaka Str., 660022 Krasnoyarsk, Russia
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Zhang H, Shi K, Yuan L, Guan X, Yin H, Zhao W, Zhou X, Chu A. Association Between Dietary Quality and Serum Cystatin C in Kidney Transplant Recipients Based on Chinese Diet Balance Index 2016 (DBI-16). Ann Transplant 2023; 28:e939149. [PMID: 36851833 PMCID: PMC9985305 DOI: 10.12659/aot.939149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Cystatin C (Cys) is considered to be a better marker than serum creatinine in assessing kidney function, predicting cardiovascular events, and all-cause mortality. It seems to be associated with nutritional status in the general population, but little is known about kidney transplant recipients (KTRs). This study aimed to explore the relationship between dietary balance index and serum Cys in KTRs. MATERIAL AND METHODS In a cross-sectional study, 215 KTRs completed an FFQ questionnaire and information on serum Cys. Dietary intake was assessed using the Food Frequency Questionnaire (FFQ). Dietary Balance Index 2016 (DBI-16) edition scores were calculated as an indicator of dietary quality. Data on the patient's serum Cys were obtained through the hospital information system. RESULTS The majority of KTRs were male (75.34%), 76.74% were aged 18-44 years, and 79.53% were abnormal serum Cys. Dairy (z=-2.161, P<0.05), meat (z=-2.578, P<0.05), and dietary diversity (z=-3.393, P<0.05) in the normal group were higher than those in the abnormal group, and the dietary quality distance (DQD) score (t=-2.264, P<0.05) was lower than that in the abnormal group. After adjusting for confounders, a low-quality diet was a risk factor for maintaining the normal level of serum Cys (OR 3.022, 95% CI 1.263-7.231, P<0.05). CONCLUSIONS The present study suggested that KTRs with a high dietary quality might be associated with normal serum Cys levels. Dairy, meat, and varied diet seems to impact the serum Cys levels of KTRs. Dietary imbalances were prevalent among KTRs.
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Affiliation(s)
- Hailing Zhang
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China,Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Ke Shi
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, PR China
| | - Li Yuan
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China,Department of General Surgery, The First Affiliated Hoaspital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Xiaohong Guan
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China,Department of Organ Transplantation, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Haihui Yin
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China,Blood Purification Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Wenjing Zhao
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, PR China
| | - Xinyi Zhou
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Aiqin Chu
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
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Tantisattamo E, Kalantar-Zadeh K. Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy. Curr Opin Nephrol Hypertens 2023; 32:67-75. [PMID: 36444664 DOI: 10.1097/MNH.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Living donor kidney transplantation potentially leads to long-term complications including chronic kidney disease, end-stage kidney disease, elevated blood pressure, and pregnancy-associated hypertension. Given living donors generally do not have underlying medical conditions, lifestyle modifications, particularly dietary interventions may prevent those complications and improve their health outcomes. RECENT FINDINGS Glomerular hyperfiltration occurs as physiologic adaptation during an initial postdonor nephrectomy period. In the long-term, these adaptations may become pathologic consequences resulting from hyperfiltration-mediated kidney injury and ultimately secondary focal segmental glomerulosclerosis in the solitary kidney. Dietary interventions to slow a decline in kidney function include low protein intake of <0.8 g/kg/day and low sodium consumption of 2-4 g/day as well as certain health dietary patterns. There is no evidence regarding the quantity and quality of protein that can be recommended for living kidney donors and the same for sodium. Plant Dominant (PLADO) diets, Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and vegetarian diets may be favorable for living kidney donors with solitary kidney but the evidence is still lacking. SUMMARY Although dietary interventions may provide benefits and kidney health for living kidney donors, further studies including clinical trials are required to incorporate them into clinical practice guidelines.
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Osterholt T, Gloistein C, Todorova P, Becker I, Arenskrieger K, Melka R, Koehler FC, Faust M, Wahlers T, Benzing T, Müller RU, Grundmann F, Burst V. Preoperative Short-Term Restriction of Sulfur-Containing Amino Acid Intake for Prevention of Acute Kidney Injury After Cardiac Surgery: A Randomized, Controlled, Double-Blind, Translational Trial. J Am Heart Assoc 2022; 11:e025229. [PMID: 36056721 PMCID: PMC9496445 DOI: 10.1161/jaha.121.025229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute kidney injury (AKI) is a major risk factor for chronic kidney disease and increased mortality. Until now, no compelling preventive or therapeutic strategies have been identified. Dietary interventions have been proven highly effective in organ protection from ischemia reperfusion injury in mice and restricting dietary intake of sulfur-containing amino acids (SAA) seems to be instrumental in this regard. The UNICORN trial aimed to evaluate the protective impact of restricting SAA intake before cardiac surgery on incidence of AKI. Methods and Results In this single-center, randomized, controlled, double-blind trial, 115 patients were assigned to a SAA-reduced formula diet (LowS group) or a regular formula diet (control group) in a 1:1 ratio for 7 days before scheduled cardiac surgery. The primary end point was incidence of AKI within 72 hours after surgery, secondary end points included increase of serum creatinine at 24, 48, and 72 hours as well as safety parameters. Quantitative variables were analyzed with nonparametric methods, while categorical variables were evaluated by means of Chi-square or Fisher test. SAA intake in the group with SAA reduced formula diet was successfully reduced by 77% (group with SAA reduced formula diet, 7.37[6.40-7.80] mg/kg per day versus control group, 32.33 [28.92-33.60] mg/kg per day, P<0.001) leading to significantly lower serum levels of methionine. No beneficial effects of SAA restriction on the rate of AKI after surgery could be observed (group with SAA reduced formula diet, 23% versus control group, 16%; P=0.38). Likewise, no differences were recorded with respect to secondary end points (AKI during hospitalization, creatinine at 24, 48, 72 hours after surgery) as well as in subgroup analysis focusing on age, sex, body mass index and diabetes. Conclusions SAA restriction was feasible in the clinical setting but was not associated with protective properties in AKI upon cardiac surgery. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03715868.
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Affiliation(s)
- Thomas Osterholt
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Claas Gloistein
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Polina Todorova
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Katja Arenskrieger
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Ramona Melka
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Felix C Koehler
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Michael Faust
- Polyclinic for Endocrinology Diabetes and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery University of Cologne, Faculty of Medicine and University Hospital Cologne Germany
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Franziska Grundmann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
| | - Volker Burst
- Department II of Internal Medicine and Center for Molecular Medicine Cologne University of Cologne, Faculty of Medicine and University Hospital Cologne Cologne Germany
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Oudmaijer CAJ, Minnee RC, Pol RA, van den Boogaard WMC, Komninos DSJ, van de Wetering J, van Heugten MH, Hoorn EJ, Sanders JSF, Hoeijmakers JHJ, Vermeij WP, IJzermans JNM. Fasting before living-kidney donation: effect on donor well-being and postoperative recovery: study protocol of a multicenter randomized controlled trial. Trials 2022; 23:18. [PMID: 34991694 PMCID: PMC8733810 DOI: 10.1186/s13063-021-05950-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the main effectors on the quality of life of living-kidney donors is postoperative fatigue. Caloric restriction (CR) and short-term fasting (STF) are associated with improved fitness and increased resistance to acute stress. CR/STF increases the expression of cytoprotective genes, increases immunomodulation via increased anti-inflammatory cytokine production, and decreases the expression of pro-inflammatory markers. As such, nutritional preconditioning by CR or STF represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and postoperative fatigue. To investigate whether preoperative STF contributes to a reduction in fatigue after living-kidney donation, a randomized clinical trial is indicated. METHODS We aim to determine whether 2.5 days of fasting reduces postoperative fatigue score in subjects undergoing living-kidney donation. In this randomized study, the intervention group will follow a preoperative fasting regime for 2.5 days with a low-dose laxative, while the control group will receive standard care. The main study endpoint is postoperative fatigue, 4 weeks after living-kidney donation. Secondary endpoints include the effect of preoperative fasting on postoperative hospital admission time, the feasibility of STF, and the postoperative recovery of donor and recipient kidney function. This study will provide us with knowledge of the feasibility of STF and confirm its effect on postoperative recovery. DISCUSSION Our study will provide clinically relevant information on the merits of caloric restriction for living-kidney donors and recipients. We expect to reduce the postoperative fatigue in living-kidney donors and improve the postoperative recovery of living-kidney recipients. It will provide evidence on the clinical merits and potential caveats of preoperative dietary interventions. TRIAL REGISTRATION Netherlands Trial Register NL9262 . EudraCT 2020-005445-16 . MEC Erasmus MC MEC-2020-0778. CCMO NL74623.078.21.
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Affiliation(s)
- C. A. J. Oudmaijer
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - R. C. Minnee
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
| | - R. A. Pol
- Department of Transplantation Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - W. M. C. van den Boogaard
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - D. S. J. Komninos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - J. van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M. H. van Heugten
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E. J. Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J. S. F. Sanders
- Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Groningen, Groningen, the Netherlands
| | - J. H. J. Hoeijmakers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
- Erasmus MC Cancer Institute, Department of Molecular Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
- Institute for Genome Stability in Ageing and Disease, Medical Faculty, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases (CECAD), Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - W. P. Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - J. N. M. IJzermans
- Erasmus MC Transplant Institute, Department of Surgery, Division of Hepatobiliary and Transplantation Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, RG-220, 3015 GD Rotterdam, the Netherlands
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Oudmaijer CAJ, van den Boogaard WMC, Komninos DSJ, Verwaaijen EJ, van Santen HM, Lilien MR, Hoeijmakers JHJ, Wijnen MHW, van den Heuvel-Eibrink MM, Vermeij WP. Fasting Intervention for Children With Unilateral Renal Tumors to Reduce Toxicity. Front Pediatr 2022; 10:828615. [PMID: 35155309 PMCID: PMC8829466 DOI: 10.3389/fped.2022.828615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Childhood renal tumors account for around 6% of all childhood cancers and 90% of these cases are Wilms tumor. In Europe, the SIOP-RTSG approach is considered standard of care and has resulted in five-year survival rates of over 90%. Efforts to decrease toxicity are now being pursued. Short-term fasting (STF), a short but strong reduction in calorie-intake, is associated with improved fitness, enhanced coping with acute physical stress and a lower risk of age-associated diseases. STF temporarily reduces growth to boost resilience, maintenance, and defense-mechanisms, by which toxic side-effects of (oxidative) damage and inflammation are largely prevented. Renal surgery for Wilms tumor carries a risk of acute kidney injury (AKI) and pediatric patients that had an episode of AKI are at increased risk for developing chronic renal disease. STF could mitigate surgery-induced stress and could further improve outcomes. We aim to investigate the effect of STF on renal function recovery after renal tumor surgery by conducting a single-center, prospective, randomized, non-blinded, intervention study. Children diagnosed with a unilateral renal tumor and opting for curative treatment are eligible for inclusion. The main study objective is to investigate the potential decrease in occurrence of AKI due to STF. Secondary objectives include renal function recovery, child's wellbeing, physical functioning, and feasibility of and adherence to STF in children with cancer.
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Affiliation(s)
- Christiaan A J Oudmaijer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Oncode Institute, Utrecht, Netherlands
| | | | - Daphne S J Komninos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Oncode Institute, Utrecht, Netherlands
| | | | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Endocrinology, University Medical Center Utrecht, Wilhelmina Childrens Hospital, Utrecht, Netherlands
| | - Marc R Lilien
- Department of Pediatric Nephrology, University Medical Center Utrecht, Wilhelmina Childrens Hospital, Utrecht, Netherlands
| | - Jan H J Hoeijmakers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Oncode Institute, Utrecht, Netherlands.,Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands.,Institute for Genome Stability in Aging and Disease, Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Marc H W Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Wilbert P Vermeij
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Oncode Institute, Utrecht, Netherlands
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Kip P, Sluiter TJ, Moore JK, Hart A, Ruske J, O’Leary J, Jung J, Tao M, MacArthur MR, Heindel P, de Jong A, de Vries MR, Burak MF, Mitchell SJ, Mitchell JR, Ozaki CK. Short-Term Pre-Operative Protein Caloric Restriction in Elective Vascular Surgery Patients: A Randomized Clinical Trial. Nutrients 2021; 13:nu13114024. [PMID: 34836280 PMCID: PMC8621550 DOI: 10.3390/nu13114024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/12/2023] Open
Abstract
(1) Background: Vascular surgery operations are hampered by high failure rates and frequent occurrence of peri-operative cardiovascular complications. In pre-clinical studies, pre-operative restriction of proteins and/or calories (PCR) has been shown to limit ischemia-reperfusion damage, slow intimal hyperplasia, and improve metabolic fitness. However, whether these dietary regimens are feasible and safe in the vascular surgery patient population remains unknown. (2) Methods: We performed a randomized controlled trial in patients scheduled for any elective open vascular procedure. Participants were randomized in a 3:2 ratio to either four days of outpatient pre-operative PCR (30% calorie, 70% protein restriction) or their regular ad-libitum diet. Blood was drawn at baseline, pre-operative, and post-operative day 1 timepoints. A leukocyte subset flow cytometry panel was performed at these timepoints. Subcutaneous/perivascular adipose tissue was sampled and analyzed. Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of whom 11 completed the study. No diet-related reasons for non-completion were reported, and there was no intervention group crossover. The PCR diet induced weight loss and BMI decrease without malnutrition. Insulin sensitivity was improved after four days of PCR (p = 0.05). Between diet groups, there were similar rates of re-intervention, wound infection, and cardiovascular complications. Leukocyte populations were maintained after four days of PCR. (4) Conclusions: Pre-operative PCR is safe and feasible in elective vascular surgery patients.
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Affiliation(s)
- Peter Kip
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Surgery, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands; (A.d.J.); (M.R.d.V.)
| | - Thijs J. Sluiter
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Surgery, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands; (A.d.J.); (M.R.d.V.)
| | - Jodene K. Moore
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA;
| | - Abby Hart
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
| | - Jack Ruske
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
| | - James O’Leary
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
| | - Jonathan Jung
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- School of Medicine, University of Glasgow, Glasgow G12 8QF, UK
| | - Ming Tao
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
| | - Michael R. MacArthur
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Patrick Heindel
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
| | - Alwin de Jong
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Surgery, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands; (A.d.J.); (M.R.d.V.)
| | - Margreet R. de Vries
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Surgery, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands; (A.d.J.); (M.R.d.V.)
| | - M. Furkan Burak
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
| | - Sarah J. Mitchell
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - James R. Mitchell
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.J.); (M.R.M.); (S.J.M.); (J.R.M.)
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - C. Keith Ozaki
- Department of Surgery and the Heart and Vascular Center, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (P.K.); (T.J.S.); (A.H.); (J.R.); (J.O.); (M.T.); (P.H.); (M.F.B.)
- Correspondence:
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11
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Veldscholte K, Cramer ABG, Joosten KFM, Verbruggen SCAT. Intermittent fasting in paediatric critical illness: The properties and potential beneficial effects of an overnight fast in the PICU. Clin Nutr 2021; 40:5122-5132. [PMID: 34461586 DOI: 10.1016/j.clnu.2021.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022]
Abstract
Although evidence for the superiority of continuous feeding over intermittent feeding is lacking, in most paediatric intensive care units (PICU) artificial feeding is administered continuously for 24 h per day. Until now, studies in PICU on intermittent feeding have primarily focused on surrogate endpoints such as nutritional intake and gastro-intestinal complaints and none have studied the effects of an extended fasting period. Intermittent fasting has been proven to have many health benefits in both animal and human studies. The observed beneficial effects are based on multiple metabolic and endocrine changes that are presumed crucial in critical illness as well. One key element is the transition to ketone body metabolism, which, among others, contributes to the stimulation of several cellular pathways involved in stress resistance (neuro)plasticity and mitochondrial biogenesis, and might help preserve brain function. Secondly, the fasting state stimulates the activation of autophagy, a process that is crucial for cellular function and integrity. Of the different intermittent fasting strategies investigated, time-restricted feeding with a daily extended fasting period appears most feasible in the PICU. Moreover, planning the fasting period overnight could help maintain the circadian rhythm. Although not investigated, such an overnight intermittent fasting strategy might improve the metabolic profile, feeding tolerance and perhaps even have beneficial effects on tissue repair, reperfusion injury, muscle weakness, and the immune response. Future studies should investigate practical implications in critically ill children and the optimal duration of the fasting periods, which might be affected by the severity of illness and by age.
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Affiliation(s)
- Karlien Veldscholte
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Arnout B G Cramer
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sascha C A T Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands.
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12
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Andrianova NV, Buyan MI, Bolikhova AK, Zorov DB, Plotnikov EY. Dietary Restriction for Kidney Protection: Decline in Nephroprotective Mechanisms During Aging. Front Physiol 2021; 12:699490. [PMID: 34295266 PMCID: PMC8291992 DOI: 10.3389/fphys.2021.699490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023] Open
Abstract
Dietary restriction (DR) is believed to be one of the most promising approaches to extend life span of different animal species and to delay deleterious age-related physiological alterations and diseases. Among others, DR was shown to ameliorate acute kidney injury (AKI) and chronic kidney disease (CKD). However, to date, a comprehensive analysis of the mechanisms of the protective effect of DR specifically in kidney pathologies has not been carried out. The protective properties of DR are mediated by a range of signaling pathways associated with adaptation to reduced nutrient intake. The adaptation is accompanied by a number of metabolic changes, such as autophagy activation, metabolic shifts toward lipid utilization and ketone bodies production, improvement of mitochondria functioning, and decreased oxidative stress. However, some studies indicated that with age, the gain of DR-mediated positive remodeling gradually decreases. This may be an obstacle if we seek to translate the DR approach into a clinic for the treatment of kidney diseases as most patients with AKI and CKD are elderly. It is well known that aging is accompanied by impairments in a huge variety of organs and systems, such as hormonal regulation, stress sensing, autophagy and proteasomal activity, gene expression, and epigenome profile, increased damage to macromolecules and organelles including mitochondria. All these age-associated changes might be the reasons for the reduced protective potential of the DR during aging. We summarized the available mechanisms of DR-mediated nephroprotection and described ways to improve the effectiveness of this approach for an aged kidney.
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Affiliation(s)
- Nadezda V Andrianova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia.,Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Marina I Buyan
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Anastasia K Bolikhova
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry B Zorov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia.,V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Egor Y Plotnikov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia.,V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia
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