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Pradeep Yarra

Citation: Eleni A, Panagiotis P. Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829-846. doi:10.1016/j.jhep.2017.05.016

Question 1:   Why is this study important?

Non-Alcoholic Fatty Liver Disease (NAFLD) has increased associated risk of progression to liver cirrhosis, liver cancer and cardiovascular effects. Prevalence of NAFLD varies largely from 20% to 30% and increases with age, with an annual incidence of around two new cases/100 patients/year. Patients with NAFLD are frequently obese and/or have diabetes, and insulin resistance is a key pathogenic trigger. Nutritional interventions are focused on weight loss in NAFLD due to associated obesity and DM. This study reviews role of total calories and type of weight loss diet, micro- and macronutrients, evidence-based benefits of physical activity and exercise and finally support these modifications through established behavioral change models and techniques for long-term maintenance of lifestyle modifications.

Identify one key finding of this study and describe how it relates to nutritional sciences

Primary take home points are from nutritional aspect:

1)     Mediterranean diet can reduce liver fat even without weight loss and is most recommended diet in NAFLD

2)     The traditional Mediterranean diet is characterized by a high intake of olive oil, which is rich in monounsaturated-fat [MUFA], nuts, fruits and legumes, vegetables, and fish and a low intake of red meat, processed meats, and sweets (wine in moderation). In contrast to the low-fat diet, which contains up-to 30% fat, 40% of the calories in the Mediterranean diet are derived from fats, mostly MUFA and omega-3 PUFA. MUFA has a favorable effect on lipid profile. Moreover, the Mediterranean diet plays a beneficial role in metabolic profile and has been shown to reduce the risk of cardiovascular disease and diabetes, two outcomes highly relevant in NAFLD patients.

3)     Gradual weight reduction achieved by caloric restriction, with or without increased physical activity, leads to an improvement in serum liver enzymes, liver fat, degree of hepatic inflammation and fibrosis.

4)      Role of micro nutrients is unclear, may be Vitamin D is beneficial.

What are the clinical implications of this study?

NAFLD is growing into a significant health burden with strong associations with risk of other metabolic conditions. dietary habits and physical activity, are and should be the first line of treatment in NAFLD and NASH. Weight reduction is the most established treatment for both NAFLD and NASH, with a clear dose-response association. Mediterranean diet with its effect on weight loss along with other system advantages is the recommended diet.

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Thomas, Tom R, et al. “Effects of Omega-3 Fatty Acid Supplementation and Exercise on Low-Density Lipoprotein and High-Density Lipoprotein Subfractions.” Metabolism, vol. 53, no. 6, 2004, pp. 749–754., doi:10.1016/j.metabol.2003.12.019.

For this last weekly wall, I chose to take a deeper look into omega 3 fatty acids effect on lipoprotein levels when supplemented with exercise. WE learned that exercise and a healthy diet are the first line of defense against a variety of health issues, this paper focuses primarily on hypertension and cardiovascular disease. This study is important because it takes a look past dietary intervention and looks at health benefits of consuming omega 3 fatty acids while supplementing with exercise. Participants involved in this study consumed 4g/day of omega 3 supplementation for 4 weeks and before and after supplementation they did an hour of treadmill exercise at about 60 of V02max (so fairly rigorous aerobic effort) at the end of the of exercise at each period before and after HDL and LDL levels were taken from blood draws. This is one drawback of this study, 2 blood draws per day for 4 weeks along with 2 hours of aerobic exercise that was more than likely past self-selected effort. A significant finding of this study was that omega 3 supplementation in addition to aerobic exercise increased HDL and subfraction levels in the serum of participants at the end of the study. Another thing that was found was that there was no effect on plasma LDL levels which is to be expected. I learned last semester in NS 601 that we haven’t found a way to decrease LDL levels yet, but in the same token we know that increasing HDL has profound effects on atherosclerosis and downstream heart issues. Clinically, this is important because we know how to increase HDL levels in patients that may be at risk for hypertension and atherosclerosis. We can educate and explain how fish oil has been shown to increase “good cholesterol” and promote a healthy RCT pathway. If we supplement this with aerobic exercise a few days per week we can promote these increases even further.

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Citation: Abe S, Ezaki O, Suzuki M. Medium-chain triglycerides (8:0 and 10:0) are promising nutrients for sarcopenia: a randomized controlled trial. Am J Clin Nutr. 2019 Sep 1;110(3):652-665. doi: 10.1093/ajcn/nqz138. PMID: 31334544.
The elderly population has increased for the decade, and it causes the performance of daily living, especially sarcopenia. Medium-chain triglycerides could increase exercise capacity, improving the gut environment. Leucine promotes protein synthesis. Therefore, the study would know the medium-chain triglycerides could improve sarcopenia, so it advances the nutrition and physical activities cooperation to prevent sarcopenia.

One of the critical findings is L-leucine and medium-chain triglycerides supplement the effect of muscle strength and function. Sixty-four participants took the supplements divided into three groups: L-leucine and medium-chain triglycerides supplement (LD+MCT), medium-chain triglycerides supplement (MCT), and long-chain triglycerides supplement (LCT) for three months. The participants take the LD+MCT or MCT supplements significantly change in right-hand grip strength, right knee extension time, and ten-second leg open and close test performance.

The study provides older adults fatty acid sources in their diet. Moreover, the clinicians could give efficient treatment for the patients with sarcopenia.

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Joseph J, Cole G, Head E, Ingram D. Nutrition, brain aging, and neurodegeneration. J Neurosci. 2009 Oct 14;29(41):12795-801. doi: 10.1523/JNEUROSCI.3520-09.2009. PMID: 19828791; PMCID: PMC6665319.

For my final weekly wall post, I decided to look at the impact of nutrition on the nervous system. The article that I chose summarized some nutritional modifications that could potentially be utilized in order to buffer the effects of neurodegeneration as the brain ages.

1.     Significance

This article was important because neurodegeneration is a component of aging. Neuronal death, chronic inflammation, protein aggregation are all common features of an aging brain due to cells becoming senescent. Looking at the issue on a broader level, the financial burden of aging is rapidly rising and costs will continue to rise as a greater proportion of the population become elderly.

2.     Key Finding

The incorporation of foods with anti-inflammatory properties (such as berry juices and curcumin) and those with healthy fat profiles, generally polyunsaturated fatty acids from plant based origins or fish oils, played different roles that worked together to protect the brain. A mixed diet was shown to help promote better cognition and memory performance and a decrease in inflammatory responses that damaged aged neurons

3.     Application

Clinically, emphasizing nutritional modifications over extended periods of time has been correlated with better neuronal aging in individuals. Utilizing these methods before neuronal damage may be a way to see better results in terms of cognition and memory.

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Dieli-Conwright, C. M., Courneya, K. S., Demark-Wahnefried, W., Sami, N., Lee, K., Sweeney, F. C., Stewart, C., Buchanan, T. A., Spicer, D., Tripathy, D., Bernstein, L., & Mortimer, J. E. (2018). Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast cancer research : BCR, 20(1), 124. https://doi.org/10.1186/s13058-018-1051-6

This study is important because it looks at how a physical activity intervention designed for metabolic syndrome impacts the fitness, bone health, and quality of life in overweight and obese breast cancer survivors who were less than six months post-treatment for cancer. One hundred breast cancer survivors were included in this randomized controlled trial. The women included in the study were randomly assigned to one of two groups. The first group was an exercise group which participated in a 16-week aerobic and resistance exercise intervention and the second group was a usual care group or control group. The women in the study were checked at three different intervals for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The first assessment was at baseline, the second was after the physical activity intervention, and the last assessment was after three months following the physical activity intervention.

One key finding in this study is that there was a significant difference in patient reported outcomes between the exercise intervention group and the usual care group. The patients in the exercise group reported improved quality of life and physical fitness compared to the usual care group. The exercise group also had superior muscle strength and bone health.

This study is important clinically because it shows that exercise can potentially improve quality of life for cancer patients. I did not know that exercise could improve quality of life for cancer survivors so I thought that this was an interesting study. I think this study could be beneficial when providing nutritional recommendations to cancer patients.

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Wendy Ramey                                     Chiu THT, Liu C-H, Chang C-C, Lin M-N, Lin C-L. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clinical Nutrition. Published online March 2019. doi:10.1016/j.clnu.2019.03.016    Since we did not look at gout and nutrition, and I see several patients a day with gout, I thought I would start with a diet studied in for gout risk. Diet is extremely important in preventing flares of gout and keeping uric acid levels in check. The low purine diet is fairly restrictive, and patient find it hard to maintain. This particular study looked at various vegetarian diets and incidence of gout in participants. This study found that lacto-ovo vegetarians had the lowest incidence of gout, followed by vegans and non-vegetarians. A diet high in meat and seafood is also high in purine which is metabolized to urate is recommended for patients with gout. But the list of foods to be avoided is daunting. Recommending a vegetarian diet that allows dairy and egg products would be an easier plan to maintain. Although many patients would be unhappy with a meatless diet, they may be more accepting of a plant-based diet that includes dairy and eggs and this study gives evidence for that recommendation.        

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Wendy Ramey                                     Chiu THT, Liu C-H, Chang C-C, Lin M-N, Lin C-L. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clinical Nutrition. Published online March 2019. doi:10.1016/j.clnu.2019.03.016    Since we did not look at gout and nutrition, and I see several patients a day with gout, I thought I would start with a diet studied in for gout risk. Diet is extremely important in preventing flares of gout and keeping uric acid levels in check. The low purine diet is fairly restrictive, and patient find it hard to maintain. This particular study looked at various vegetarian diets and incidence of gout in participants. This study found that lacto-ovo vegetarians had the lowest incidence of gout, followed by vegans and non-vegetarians. A diet high in meat and seafood is also high in purine which is metabolized to urate is recommended for patients with gout. But the list of foods to be avoided is daunting. Recommending a vegetarian diet that allows dairy and egg products would be an easier plan to maintain. Although many patients would be unhappy with a meatless diet, they may be more accepting of a plant-based diet that includes dairy and eggs and this study gives evidence for that recommendation.        

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Citation: Kang YS, Kim JC, Kim JS, Kim SH. Effects of Swimming Exercise on Serum Irisin and Bone FNDC5 in Rat Models of High-Fat Diet-Induced Osteoporosis. J Sports Sci Med. 2019;18(4):596-603. Published 2019 Nov 19.

Fat tissues play important role in energy balance regulation and homeostasis. Exercise is highly effective not only for preventing and treating obesity, but also for improving obesity-induced poor bone health. This study investigated effective methods to improve bone health in rats with high-fat diet (HFD) induced attenuation of bone accrual, particularly with the swimming exercise protocol. Body weight of the epididymal fat mass and BMD in femur and tibia were measure after 8 weeks of HFD to determine that HFD attenuate bone accrual.

After 8 weeks of HFD, BMD decreased with increasing body weight and epididymal fat mass. The results indicate that HFD attenuate bone accrual in BMD, microstructure, and metabolism, of growing rats. Swimming exercise was found to decrease body weight, body fat, and pro-inflammatory cytokines elevated due to obesity. The expression of inflammatory cytokines and induction of obesity from HFD adversely affect BMD as well as bone microstructure and bone remodeling. Swimming exercise improves bone accrual attenuation by reducing HFD induced inflammation and increasing expression of PGC-1/FNDC5 in the bone.

This study indicates that swimming can improve bone accrual, when attenuated by a HFD. The results verify that swimming, which has been perceived negatively so far, improves bone health and that it is safe and effective exercise program that decrease body fat and improve bone health for individuals who are obese and who cannot perform more vigorous or weight-bearing exercises.

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Wang, Lijun, Fan, Hongguang, He, Jingchun, Wang, Lifang, Tian, Zelong, & Wang, Chaoran. (2018). Protective effects of omega‐3 fatty acids against Alzheimer's disease in rat brain endothelial cells. Brain and Behavior, 8(11), E01037-N/a.

This study suggests the potential for omega-3 fatty acid's ability to modulate and provide therapeutic effect against symptoms of Alzheimer's disease. Many studies have correlated potential neuroprotective impact of omega-3 fatty acid. In this article, researchers investigated omega-3 fatty acid impacts on rat brain microvascular cells  (RBMVEC) in vitro. A variety of measures were taken by flow cytometry including to assess for the neuroprotective ability including: Lipid peroxidation rates, reactive oxygen species (ROS), glutathione peroxidase (Gpx), glutathione, superoxide dismutase (SOD), and catalase.

This study provides recent, murine-based evidence of this protective ability. This is evident in their results that indicate reduced lipid peroxidation and ROS generation. While the mechanism of action is still not fully understood, this provides more evidence of the potential use ability for supplementation of omega-3 fatty acids. They further demonstrated this by raising of levels of catalase, SOD, and Gpx-- key enzymes in the alleviation of oxidative stress.

Neural tissues are highly susceptible to lipid peroxidation for those with Alzheimers disease. This study suggests the potential to supplement those who may be at risk for AD. By providing potential evidence for this neuroprotective impact, we advance the field of neurobiology and give potential supplementation benefit to human populations who suffer from Alzheimers or alzheimers risk factors. Many people who have the disease will have another opportunity to combat the illness-- for which we have no known cure and limited treatment options.

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Kim H, Andrade FC. Diagnostic status of hypertension on the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. Prev Med Rep. 2016;4:525-531. Published 2016 Sep 28. doi:10.1016/j.pmedr.2016.09.009

This study concludes people with hypertension do not adhere healthy diets or lifestyle change. In this course, some classmates mentioned that patients with more than one chronic disease tend to ignore professional instruction. This is the exact same situation. This study is important because it suggests that physicians might be missing to emphasize the importance of dietary changes to their patients.

Hypertension is known as the silent killer and prevalent. Because it is caused by high sodium, saturated fat, total fat and protein, the DASH diet is recommended. Also, overweight, sedately lifestyle, smoking and alcohol are associated. This study used survey from the National Health and Nutrition Examination Survey (NHANES). Without doubt, highest rates are in age between 50 and 64, with obesity, diabetes and heart diseases. Surprising facts are that people with highest income level and with some college-level tend to ignore diet recommendation.

It reports that people who are diagnosed as hypertension are less likely to follow healthy diet than people with hypertension without diagnosis.

There are many points I couldn’t agree, but this study’s warning to professionals about treating patients with hypertension is very important. There is a lack of awareness in benefits of nutrition to lower BP, and physicians should recommend it more often with more information.

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Citation: Devasahayam, A.J.; Kelly, L.P.; Williams, J.B.; Moore, C.S.; Ploughman, M. Fitness Shifts the Balance of BDNF and IL-6 from Inflammation to Repair among People with Progressive Multiple Sclerosis. Biomolecules 2021, 11, 504. https://doi.org/10.3390/biom11040504

BNDF = regulates synaptic change and use-dependent brain plasticity.

For this last Weekly Wall, I wanted to revisit the topic of multiple sclerosis.

This study is important because it looks at exercise to shift an individual’s cytokine and growth-promoting protein levels to a ‘repair’ phenotype in diseases such as multiple sclerosis. Being sedentary is linked to elevated inflammatory markers such as Il-6 that increase brain inflammation and growth factors that decrease neuroplasticity. However, this can be inhibited by exercise.

In this study, individuals with MS that used walking aids and healthy controls matched for sex and age performed a graded exercise test (GXT). Blood levels of IL-6 and BDNF (brain-derived neurotrophic factor) were measured before and after the GXT. BDNF can be released in the blood, but it is dependent on intensity of exercise. Therefore, researchers found that, in the MS patients in this study, BDNF levels did not increase since they were in poor physical condition and could not complete the GXT at a high enough intensity. However, the MS patients had an increase of IL-6 levels post-GXT. Exercise-induced IL-6 levels have the potential to weaken the M1 phenotype in adipose tissue macrophages (mouse studies cited in this paper).

This research is clinically relevant because, MS patients that CAN achieve intense enough exercise to increase BDNF levels in their blood can benefit from the positive effects. Also, even patients who have a greater disability and cannot achieve the intensity can still possibly benefit from the increase of exercise-induced IL-6 levels.

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Citation: Alpízar-Rodríguez, D.; Finckh, A.; Gilbert, B. The Role of Nutritional Factors and Intestinal Microbiota in Rheumatoid Arthritis Development. Nutrients 2021, 13, 96. https://doi.org/10.3390/nu13010096

Why is this study important:  I selected this review because RA is a disease state that is interesting to me, but still one of the muddy points discussed during this semester. I went back to our Week 3 Wall as well to review the previous studies and I don’t believe that I saw this one so decided to post this review because I really feel like that it summarized my interest and confusion with this topic, but also positioned the discussion on nutrition and the development of RA, versus established RA.

It’s an important review because of the potential impact that individual foods as well as the health of our gut microbiota might have on the cause and / or prevention of this debilitating disease.

Key findings and nutritional science:

This review focusses on two potential RA influencers but then pulls these factors together, hypothesizing that the trigger for RA is a cascading event of one factor, causing another, which then causes RA.  The first focus is on dietary patterns and individual foods, and the second is on the role that the gut microbiota might play in RA.

A number of dietary patterns and associated studies were reviewed.  Of note, alcohol (low intake) has been shown to have some protective effects.  Other dietary patterns such as high salt consumption and sweetened beverages have been found to be ‘hazardous factors’.  Those still considered conflictive include the Mediterranean diet, meat and dairy consumption, vegan, fasting and elemental diets, PUFAs, coffee/ teas and vitamin D.

There is also considerable research on the influence of gut microbiota in RA development.  This review looks at a number of studies that focus on the intestinal barrier and factors influencing this barrier including a specific bacterial species, Prevotella, as well as other factors such as NSAIDs, hyperglycemia, acute stress, high fructose or fat diet and vitamin D deficiency.

Finally, the authors link these factors together with the hypotheses that it is many nutritional and dietary factors that disrupt the gut microbiota, causing a breach in the intestinal barrier which ultimately, through various immune regulating dysfunctions, causes RA in high risk individuals.

Clinical implications:  As with most of the disease states that we have studied this semester, the personal and economic impact can be devastating.  As this review noted, much of our research is on patients that already have RA, but if we can better isolate any nutritional factors that are causing or could prevent RA, we can have a greater impact on prevention of this disease. Continuing research, as well as education on the latest research, will help us to develop the most sound guidance regarding dietary patterns and behavior that can truly make a difference in disease prevention.

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Earl S Ford,
The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study,
Atherosclerosis,
Volume 173, Issue 2,
2004,
Pages 307-312,
ISSN 0021-9150,
https://doi.org/10.1016/j.atherosclerosis.2003.12.022.

I really enjoyed the material on cardiovascular disease. I also liked learning about metabolic syndrome. This study combines information from both of these conditions by examining associations between them and their relations to mortality. This study is important because it uses data from the National Health and Nutrition Examination Survey II Mortality Study and did not show an increase in mortality from CD alone, but the clearest risk was number of criterial for metabolic syndrome along with cardiovascular disease mortality. This is good information to understand and interpret. Knowing that metabolic syndrome associated with CD increases the risk for mortality can relate to nutritional sciences. The five traits of metabolic syndrome include a high triglyceride level, large waist, reduced HDL cholesterol, elevated fasting blood sugar, and increased blood pressure. Aggressive lifestyle changes in diet and exercise could help prevent or cure some of these issues to lessen effects and risks of mortality. Clinical implications include being understanding and compassionate about these topics. The provider should understand not all patients may have the same access or finances to partake in certain remedies. The provider should come up with the best situation and options for the patient to work toward bettering their health to decrease these risks in a feasible way for the patient.

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Hi Saniya, thank you for sharing the findings of this study. I'm curious to know what was the composition of the ketogenic diet, especially the amount and type of fat. Also, I would like to know more about the lab values before and after the introduction of the Keto Diet. Definitely, I'm going to read this paper. Alyaa Zagzoog

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Warris, L. T., van den Akker, E. L., Bierings, M. B., van den Bos, C., Zwaan, C. M., Sassen, S. D., Tissing, W. J., Veening, M. A., Pieters, R., & van den Heuvel-Eibrink, M. M. (2016). Acute Activation of Metabolic Syndrome Components in Pediatric Acute Lymphoblastic Leukemia Patients Treated with Dexamethasone. PloS one, 11(6), e0158225. https://doi.org/10.1371/journal.pone.0158225

Metabolic side effects occur in 10–45% of children treated with glucocorticoids and high doses of dexamethasone typically used in ALL treatment protocols often give rise to severe side effects.

The researchers of this study aimed measure the acute effects of dexamethasone on all components of metabolic syndrome (MetS), and to examine the correlation between serum dexamethasone levels and these components.

The main study findings were that dexamethasone treatment increased the following fasting blood levels: HDL, LDL, total cholesterol, and TG after four days of treatment. Also, dexamethasone treatment significantly increased both diastolic blood pressure and systolic blood pressure.

The clinical nutrition implication of this study is that RDs should appropriately apply the nutrition care process and prescribe an individualised diet plan to those patients to prevent and/ or eliminate  the nutrition related complications of dexamethasone, such metabolic syndrome.

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Citation:   Williams DGA, Villalta E, Aronson S, Murray S, Blitz J, Kosmos V, Wischmeyer PE; Duke Perioperative Enhancement Team (POET). Tutorial: Development and Implementation of a Multidisciplinary Preoperative Nutrition Optimization Clinic. JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1185-1196. doi: 10.1002/jpen.1824. Epub 2020 Mar 31. PMID: 32232882; PMCID: PMC7540666:

Importance:   This is an excellent publication  demonstrating implementation of a method to address perioperative nutrition.  This is an area that is  very frequently not addressed .  As documented here, there are many reasons , including funding, resources including space and  staff, but most importantly lack of initiation on the part of the surgical team.

Key finding;
The benefit of perioperative nutritional intervention is well documented.
Preoperative malnutrition is associated with significantly higher postoperative mortality, morbidity, length of stay (LOS), readmission rates, and hospital costs compared with well‐nourished patients. Analysis of US healthcare expenditure between 2009 and 2014 revealed annual costs of disease‐associated malnutrition to be >$15.5 billion. Approximately one‐third of that cost was attributed to patients aged 65 years and older.  Hospitalized patients with malnutrition incurred costs 30%–50% higher than did well‐nourished patients.  The average per‐patient cost of readmission associated with malnutrition has been estimated to be $16,900–$17,900 or 26%–34% increased when compared with that of patients without protein‐energy malnutrition.

Clinical importance:
This is  clinically relevant because it is an opportunity for improved outcomes for patients.  I am particularly interested in  implementation of a similar program in our department and potentially  for our surgical oncology clinics collectively.

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Citation: Włodarek D. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer's Disease and Parkinson's Disease). Nutrients. 2019;11(1):169. Published 2019 Jan 15. doi:10.3390/nu11010169

Study importance:

To assess the effectiveness of ketogenic diets (KD) on the therapy of neurodegenerative diseases. Ketogenic diets bring the body into a state of ketosis through a fasting-like effect, which for a long time has been used in drug-resistant epilepsy. Studies have shown a possible neuroprotective effect. However, one of the key concern has been maintaining adequate nutritional intake while on ketogenic diet given its propensity to reduce appetite and therefore, increase the risk of malnutrition in a population already at risk for it.

Key study finding:

The KD was found to reduce the volumes of solved amyloid-beta in homogenates of murine brains. It was also observed that a long-term administration of ketone body esters to mice improved their cognitive functions and reduced beta-amyloid and highly phosphorylated tau proteins in the brain. Animal and in vitro studies have demonstrated a beneficial effect of ketone bodies on the course of Parkinson disease.

Clinical implications:

The animal studies on the benefits of ketogenic diet have been positive, however we lack adequate studies in humans to validate these. The elderly are a special population where the application of KD may be restricted by the presence of pre existing malnutrition or other co-morbidities.

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Crowe W, Elliott CT, Green BD. A Review of the In Vivo Evidence Investigating the Role of Nitrite Exposure from Processed Meat Consumption in the Development of Colorectal Cancer. Nutrients. 2019; 11(11):2673. https://doi.org/10.3390/nu11112673

The AICR infographic that was provided in class indicates that processed meat should be limited.  In 2015 the WHO classified all processed meat as carcinogenic.  Sodium nitrate has long been used in processed meats as an anti-microbial agent, to extend shelf-life and enhance color in processed meats. Processed meats include items such as bacon, sausages and ham.  As I was researching dietary nitrates with regards to colorectal cancer I ran across the research article by Crowe et. al. The article suggests that processed meats should be further researched and categorized as to whether or not the processed meat contains nitrites or not because the researchers found in their meta-analysis that not all studies exploring the link between processed meats and colorectal cancer indicated a connection.  However, 2/3rds of the studies in the meta-analysis that specifically looked at processed meat containing nitrites found a link between nitrites and colorectal cancer.

What does this mean?  There are other preservatives, besides nitrates and nitrites, that are used in meat preservation and the authors of the study recommend that future research involve a distinction between those processed meats using nitrites and those that do not.  As not all preservatives used may have such a strong link to cancer.

I also found two articles that mentioned plant polyphenols and alpha-tocopherols as possible alternatives to synthetic nitrates and nitrites used in processed meats.  1) Cantwell M, Elliott C (2017) Nitrates, Nitrites and Nitrosamines from Processed Meat Intake and Colorectal Cancer Risk. J Clin Nutr Diet 3:27. doi: 10.4172/2472-1921.100062.  2) Ferysiuk, K., & Wójciak, K. M. (2020). Reduction of Nitrite in Meat Products through the Application of Various Plant-Based Ingredients. Antioxidants (Basel, Switzerland), 9(8), 711. https://doi.org/10.3390/antiox9080711.

What’s the application? It would be logical to conclude that processed meats (especially those containing synthetic nitrites such as sodium nitrite/nitrate) should be limited.  But it is also worth considing how the meat is cooked (grilled, smoked), what other foods the meat is consumed with, temperature of cooking, fat content of the meat and form of meat (beef, pork, turkey, chicken), sodium content of the meat, etc. Bottom line= I think it’s more complicated than just nitrate/nitrite content as there are other factors that have to be considered.  But would agree that based on the research by Crowe et.al that additional research is needed and that is would be a safe recommendation to limit intake of processed meats because in addition to any concerns regarding nitrates/nitrites these types of food also tend to be high in sodium and saturated fat.

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Christodoulou, C. C., Demetriou, C. A., & Zamba-Papanicolaou, E. (2020). Dietary Intake, Mediterranean Diet Adherence and Caloric Intake in Huntington’s Disease: A Review. Nutrients, 12(10), 2946.

1. Importance
I chose to look at the role of nutrition in Huntington’s Disease, a neurodegenerative disease known for its lethality. HD currently has no cure and was the focus of my master’s project. While most of the treatment that can be offered HD patients is symptom management, I wondered how nutrition would hit into this role as weightloss is a common symptom and dysphagia is a very common concern. This study looked to see if a high adherence to the Mediterranean Diet or other diets focusing on specific intake of macro- and micro-nutrients would slow cognitive decline and confer some level of neuroprotection to neurons degenerated due to HD. Any help or hope that could be given to HD patients is greatly needed.

2. One Key Finding
This study found that both cognitive and motor scores improved for HD patients who had a moderate and high adherence to either the Mediterranean Diet or other focused diets. This is hopeful news for HD patients. While there was no evidence of neuroprotection or significant cognitive protection/improvements, it’s still a step in the right direction that changing nutritional guidelines could improve what time patients do have.

3. Clinical Implications
HD has no cure, and healthcare can only manage symptoms and attempt to improve quality of life where possible. By adding in nutritional guidelines as a potential therapeutic option, this review shows that better nutrition may improve some cognitive and motor symptoms, improving the quality of life of HD patients. Nutrition could play a very significant role in Huntington’s Disease, and I think further research into this relationship could be very beneficial to Huntington’s patients.