Ketogenic diet and cardiovascular risk - state of the art review

The ketogenic diet is based on extreme carbohydrate intake reduction and replacing the remaining with fat and has become a popular dietary pattern used for weight loss. The relationship between the ketogenic diet and cardiovascular risk is a controversial topic. This publication aimed to present evidence on the ketogenic diet and cardiovascular risk factors and mortality. The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure. Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations. In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet. Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.

The Impact of Education Level on Individual Lifestyle Behaviors among Dietetics Students and Professionals

Lifestyle and habits are acquired in the family environment and then shaped by the potential influence of the environment and received education. In recent years, there has been growing interest in understanding the relationship between sleep and dietary behaviors in various health professionals, including medical and dietetics professionals and students, as well as their self-perceived knowledge and attitudes. Despite the importance of this topic, there is a lack of research on the assessment of individual behaviors in dietetics students and professionals. The aim of this study was to assess the impact of education level on individual behaviors regarding nutrition, sleep, and physical activity in dietetics students and professionals. 71 dietetics students and professionals were enrolled in this study. Their overall knowledge, sleep, and nutritional behavior were assessed with a validated Questionnaire of Eating Behaviors at the beginning of their dietetics university education and then prospectively after a year. It was also compared to dieticians who already graduated. The analysis showed that the educational level did not correlate with sleep length or the physical activity level. However, the educational level was correlated with dietary knowledge and properly self-assessed by the participants. Significant differences were observed in both the prospective and comparative analyses. The educational level and knowledge were not correlated with eating behaviors. The self-assessment of nutritional behaviors also did not correlate with the objective assessment. Sleep length did not correlate with BMI, but it was inversely correlated with overall and healthy diet scores and knowledge levels. On the other hand, physical activity levels were positively correlated with healthy diet scores. Dietary education results in better nutritional knowledge; however, it does not significantly impact individual nutritional behaviors among dietetics students and professionals. Moreover, the inverse relationship between sleep length and nutritional knowledge and behaviors, as well as the positive relationship between physical activity level and dietary behaviors, shows that nutritional aspects of lifestyle are probably prioritized among dietetic students and professionals, with an acknowledgment of the role of physical activity and a neglect of sleep hygiene importance. Dietetics students should be advised to use their theoretical knowledge not only to guide their patients but also to implement it in their own lives.

Bioelectrical Impedance Analysis and Body Composition in Cardiovascular Diseases

Nutritional status and body composition in cardiovascular (CV) patients are important aspects of their performance. Bioelectrical impedance analysis (BIA) is a noninvasive method that provides reliable information about bioelectrical parameters which reflect nutritional status and body composition data. The aim of this paper was to describe BIA, its advantages, limitations, and clinical applications in CV patients. The PubMed database was searched for all papers showing the use of BIA in CV conditions until January 1, 2023. A total of 42 papers regarding BIA application in CV patients were identified. Phase angle, Z200/5 parameter, and membrane capacitance are the BIA parameters that can be used for nutritional status assessment in CV patients, mainly in heart failure and after myocardial infarction. Among secondary body composition parameters, fat mass can be used for obesity assessment which is a CV risk factor. Body cell mass can be used together which the direct BIA parameters for nutritional status assessment which is an important factor in treatment outcome, quality of life, and disease prognosis. Total body water can be used for hydration assessment in heart failure and during invasive procedures. To conclude, BIA is a noninvasive method that provides essential information about the general condition of the body which is the result of nutritional and hydration status in CV patients.

The Relationship between Knowledge, Dietary Supplementation, and Sleep Quality in Young Adults after the COVID-19 Pandemic

INTRODUCTION

Sleep is one of the most important factors affecting the quality of life. More than 50% of Polish adults have sleeping disorders, and young adults are the ones particularly vulnerable to this. This is why the analysis of the predictors of sleep quality, such as sleep hygiene knowledge and dietary knowledge, in young adults is a very important topic, especially after the COVID-19 pandemic, which may have affected sleeping habits.

MATERIAL AND METHODS

402 young adults (mean age 28.12 ± 6.08 years old) were enrolled in the study during the COVID-19 pandemic. Sleep quality was assessed with the Pittsburgh Sleep Quality Questionnaire, while dietary knowledge and sleep hygiene knowledge were assessed with dedicated questionnaires. The participants were also asked about the use of specific dietary supplements.

RESULTS

The analysis showed that sleep hygiene knowledge was significantly associated with sleep length (R = -0.17, p = 0.003) and overall sleep quality (R = -0.17, p = 0.005), while dietary knowledge significantly correlated with time to fall asleep (R = -0.12, p = 0.026). The regression analysis revealed that sleep hygiene knowledge was a significant negative predictor of sleep quality impairment (β = -0.13, p = 0.028). Significant results were also obtained for the use of supplements (β = -0.20; p = 0.001) and the use of medications (β = -0.32, p = 0.001), which were negative predictors of sleep quality impairment.

CONCLUSIONS

This study showed that increased sleep hygiene knowledge promoted improved sleep length and overall sleep quality. In addition, dietary knowledge significantly correlated with time to fall asleep. On the other hand, decreased sleep quality was observed in participants who used medications or dietary supplements.

Apple Peel Supplementation Potential in Metabolic Syndrome Prevention

(1) Introduction: Apples are a source of bioactive substances, e.g., anthocyanidins and flavonols, and dietary fiber. Their highest concentrations are observed in the skin. Metabolic syndrome (MetS) is a set of conditions originally associated with obesity. Excessive adipose tissue accompanying obesity leads to chronic inflammation and metabolic disorders, which result in the development of dyslipidemia, elevated blood pressure, and glucose levels. Thus, supplementation of apple peels, a source of antioxidant substances and fiber, could potentially be a method supporting the prevention of MetS. This paper summarizes the results of available research on the potential impact of apple peel supplementation on the components of MetS. (2) Results: The results from in vitro and animal model studies indicate a positive effect of apple peel supplementation on lipid profile, glucose levels, and blood pressure regulation mediators. Only one human study was performed, and it showed that the consumption of apple peels had an effect on endothelial function but not on other clinical parameters. At the moment, there are no results from observations on large groups of people available. (3) Conclusions: The results of in vitro and animal-model studies indicate the potential of apple peel supplementation in MetS prevention, but it has not been clinically confirmed in human studies. Conducting large human studies could allow a definite clarification of the role of apple peel supplementation in MetS prevention.

Nutritional Status of Coronary Artery Disease Patients-Preliminary Results

INTRODUCTION

Malnutrition is a condition that negatively impacts the clinical outcomes of numerous diseases. The aim of this study was to assess the nutritional status of coronary artery disease (CAD) patients and to investigate its relationship with the main clinical aspects of CAD.

MATERIAL AND METHODS

50 CAD patients undergoing coronary angiography were enrolled in this study. The nutritional status assessment was based on Nutritional Risk Score 2002 (NRS 2002), body mass index (BMI), and bioelectrical impedance analysis (BIA) measurements.

RESULTS

The analysis showed a moderate inverse correlation between NRS 2002 and BIA phase angle measured at 50 kHz (R: -0.31; p = 0.03) and Z200/5 parameter (R: 0.34; p = 0.02). The analysis of CAD clinical parameters showed a significant correlation between NRS 2002 and Canadian Cardiovascular Society (CCS) class (R: 0.37; p = 0.01). Left ventricle ejection fraction (LVEF) was correlated with BMI (R: 0.38; p = 0.02), however further BIA revealed hydration changes as LVEF was correlated to intracellular (ICF) and extracellular fluid (ECF) proportion: positively with ICF (R: 0.38; p = 0.02) and negatively with ECF (R: -0.39; p = 0.02).

CONCLUSIONS

NRS 2002 and BIA are valuable tools for nutritional status assessment in CAD patients. Malnutrition is related to the severity of CAD symptoms, particularly in women. Maintaining proper nutritional status can have a potentially important role in this group of patients.

The Relationship between Dietary Flavonols Intake and Metabolic Syndrome in Polish Adults

Metabolic syndrome (MetS) is a cluster of metabolic disorders primarily caused by central obesity, which results in chronic inflammation leading to hypertension, diabetes and atherogenic dyslipidemia. Inflammation underlying MetS could be the target for dietary flavonols as they present antioxidative properties. The aim of this paper was to analyze the differences in habitual intake of selected flavonols (quercetin, kaempferol, isorhamnetin and myricetin) between MetS patients and healthy participants, and its relationship with MetS advancement. Ninety participants were enrolled in this study. The one-year flavonol intake was assessed with a dedicated food frequency questionnaire. The patients with MetS consumed significantly less quercetin (p = 0.01), kaempferol (p = 0.04), isorhamnetin (p < 0.001), total flavonols (p = 0.01), tomatoes (p = 0.001) and wine (p = 0.01) daily. Further analysis revealed a moderate inverse correlation between quercetin (p = 0.001), kaempferol (p = 0.01), isorhamnetin (p < 0.001), total flavonols (p = 0.001) and tomato consumption (p = 0.004) and MetS stage. The analysis of laboratory parameters showed that dietary intake of flavonols was not correlated with lipid profile, glucose level or renal function. On the basis of this observation, a potential protective effect of dietary flavonols, mainly from tomatoes, against MetS could be suggested. However, when referring to MetS components, flavonols probably mainly impact central obesity and blood pressure, without a significant impact on conventional lipid-profile parameters and glucose level.

The Impact of Dietary Flavonols on Central Obesity Parameters in Polish Adults

Background: Central obesity is defined as the excessive fat tissue located in abdominal region accompanied by systemic inflammation, which drives to cardiovascular disease. Flavonols are antioxidative agents present in food. The aim of this study was investigating the relationship between dietary flavonols intake and central obesity. Methods and results: 80 participants (40 central obese and 40 healthy controls) were administered a food frequency questionnaire dedicated to flavonols intake assessment. Body composition was measured with bioelectrical impedance analysis. The analysis showed significant differences between central obese participants and healthy controls in total flavonol (p = 0.005), quercetin (p = 0.003), kaempferol (p = 0.04) and isorhamnetin (p < 0.001) habitual intake. Among central obese participants, there was a moderate inverse correlation between fat mass (FM) and total flavonol (R = −0.378; 95% CI: −0.620 to −0.071; p = 0.02), quercetin (R = −0.352; 95% CI: −0.601 to −0.041; p = 0.03), kaempferol (R = −0.425; 95% CI: −0.653 to −0.127; p = 0.01) and myricetin intake (R = −0.352; 95% CI: −0.601 to −0.041; p = 0.03). BMI was inversely correlated with total flavonol (R = −0.330; 95% CI: −0.584 to −0.016; p = 0.04) and quercetin intake (R = −0.336; 95% CI: −0.589 to −0.023; p = 0.04). Waist circumference was inversely correlated with total flavonol (R = −0.328; 95% CI: −0.586 to −0.009; p = 0.04), quercetin (R = −0.322; 95% CI: −0.582 to −0.002; p = 0.048) and myricetin intake (R = −0.367; 95% CI: −0.615 to −0.054; p = 0.02). Among flavonols’ dietary sources, there was an inverse correlation between black tea consumption and FM (R: −0.511; 95% CI: −0.712 to −0.233; p < 0.001) and between coffee and waist circumference (R: −0.352; 95% CI: −0.604 to −0.036; p = 0.03) in central obese participants. Conclusions: The higher flavonol intake could play a protective role in abdominal obesity development. What is more, total and selected flavonol dietary intakes are inversely correlated with the parameters used for obesity assessment in central obese participants. The habitual consumption of products rich in flavonols, mainly tea and coffee, could possibly have a preventive role in abdominal obesity development.

Dietary Isorhamnetin Intake Is Inversely Associated with Coronary Artery Disease Occurrence in Polish Adults

The role of antioxidative agents in coronary artery disease (CAD) has been investigated, but the analysis of specific flavonols intake in Polish adults requires validated tools. The aim of this study was to estimate the dietary intake of flavonols in CAD patients by creating a food frequency questionnaire (FFQ) dedicated for this purpose in Polish adults. The FFQ included 140 products from 12 food groups. The study involved 103 adult respondents (43 CAD patients and 60 healthy controls). Mean daily intakes of total flavonols, quercetin, kaempferol, myricetin and isorhamnetin were calculated as absolute values and quartiles. Mean daily intakes of 12 main food categories and 27 subcategories were calculated as portions and quartiles. The validity test revealed high correlation for total flavonols, kaempferol, myricetin and isorhamnetin and moderate for quercetin. In the reproducibility analysis, the correlation was high for total flavonols, quercetin, kaempferol and myricetin, moderate for isorhamnetin and high for all 12 categories and 25 out of 27 subcategories of the tested food groups. The application of the FFQ in healthy adults and CAD patients revealed that dietary intakes of total flavonols and proportional intakes of kaempferol and isorhamnetin in Polish adults and CAD patients are higher than in most other European countries, while the proportional intakes of quercetin and myricetin are lower than in most European countries. The comparison between CAD patients and the healthy controls revealed significant differences in dietary isorhamnetin intake (p = 0.002). The results suggest that dietary isorhamnetin could have a potential role in CAD prevention.

Cardiac Resynchronization Therapy Remote Monitoring - COVID-19 Pandemic Experiences and Future Perspectives

Cardiac resynchronization therapy (CRT) is a well-established form of the treatment for heart failure (HF) in patients with left ventricle contraction dyssynchrony. Apart from typical in-office management, remote monitoring enables constant surveillance on both the patient's and the device's condition. This way, in case of any problems, clinical decisions could be made earlier leading to better outcome of CRT patients. COVID-19 pandemic with following lockdowns in many countries resulted in getting more attention on remote monitoring systems. The aim of this paper was to gather and summarize worldwide experiences from CRT remote monitoring during COVID-19 pandemic and point out future possibilities for HF patients treated with CRT. Already published experiences from remote monitoring of CRT devices during COVID-19 restrictions confirmed previous advantages of telemedical approach, however, more publications in this area would be helpful.