Periodic fasting, under a religious aspect, has been adopted by humans for centuries as a crucial pathway of spiritual purification. Caloric restriction, with or without exclusion of certain types of ...food, is often a key component. Fasting varies significantly among different populations according to cultural habits and local climate conditions. Religious fasting in terms of patterns (continuous versus intermittent) and duration can vary from 1 to 200 d; thus, the positive and negative impact on health can be considerable. Advantages of religious fasting are claimed by many but have been explored mainly by a limited number of studies conducted in Buddhist, Christian, or Muslim populations. These trials indicate that religious fasting has beneficial effects on body weight and glycemia, cardiometabolic risk markers, and oxidative stress parameters. Animals exposed to a diet mimicking fasting have demonstrated weight loss as well as lowered plasma levels of glucose, triacylglycerols, and insulin growth factor-1, although lean body mass remained stable. Diabetic mice on repeated intermittent fasting had less insulin resistance that mice fed ad libitum. The long-term significance of such changes on global health remains to be explored. This review summarizes the data available with regard to benefits of fasting followed for religious reasons on human health, body anthropometry, and cardio-metabolic risk markers; aims to bridge the current knowledge gap on available evidence and suggests considerations for the future research agenda. Future studies should explore every type of religious fasting, as well as their consequences in subpopulations such as children, pregnant women, and the elderly, or patients with chronic metabolic diseases.
•Religious fasting reflects dietary habits of millions of believers.•Health impact of religious fasting has been documented among Buddhists, Christians, and Muslims.•Energy and/or food item restrictions are key components of religious fasting.•Religious fasting has potential benefits on energy balance, dyslipidemia and oxidative stress.•Religious fasting could be integrated into health management for diseases prevention.
Population strategies to increase physical activity are an essential part of cardiovascular disease prevention. However, little data exist on lifestyle interventions that are easy to integrate into ...everyday life such as using stairs instead of elevators at the workplace.
Pre and postintervention study.
A 12-week promotional campaign for stair use consisting in posters and floor stickers at the point of choice between stairs and elevators at each hospital floor was organized in a university hospital building. In 77 selected employees with an inactive lifestyle, physical activity, aerobic fitness, anthropometrics, blood pressure, lipids, insulin sensitivity, and C-reactive protein were assessed at baseline, 12 weeks, and 6 months.
During the intervention median daily number of ascended and descended one-story staircase units was 20.6/day (14.2-28.1) compared with 4.5/day (1.8-7.2) at baseline (P<0.001). At 12 weeks, estimated maximal aerobic capacity had increased by 9.2±15.1% (P<0.001) corresponding with approximately 1 MET. There were significant declines in waist circumference (-1.7±2.9%), weight (-0.7±2.6%), fat mass (-1.5±8.4%), diastolic blood pressure (-1.8±8.9%), and low-density lipoprotein cholesterol (-3.0±13.5%). At 6 months, the median daily number of ascended and descended one-story staircase units had decreased to 7.2 (3.5-14.0). Benefits on estimated maximal aerobic capacity (+5.9±12.2%, P=0.001) and fat mass (-1.4±8.4%, P=0.038) persisted.
Encouraging stair use at work is effective for improving fitness, body composition, blood pressure, and lipid profile in asymptomatic individuals with an inactive lifestyle and thus may be a simple way to significantly reduce cardiovascular disease risk at the population level.
Background/Objectives: The association between the nutritional risk and mortality in Brazilians with COVID-19 is poorly documented. Therefore, this study, for the first time, aimed at investigating ...the length of stay in the ICU and the chance of dying in patients with suspected COVID-19, without and with nutritional risk. Subjects/Methods: This retrospective monocentric study enrolled adult, COVID-19-positive patients that were admitted to the ICU at a university hospital. Biochemical analysis and clinical data were collected from medical records and the nutritional risk was assessed according to the Modified-Nutrition Risk in the Critically Ill (mNUTRIC) score. The Cox model was used to assess the chance of mortality in the patients with and without nutritional risk. Results: Out of 71 patients, 63.3% were male and 52% were older (≥60 years). Although no differences were found between groups for the length of stay in ICU, C-reactive protein, alanine aminotransferase and aspartate aminotransferase concentrations, the mNUTRIC ≥ 5 group had higher D-dimer than the mNUTRIC < 5 group. Regarding ICU mortality, most patients (69.5%) in the mNUTRI ≥ 5 group died while in the mNUTRIC < 5 group 33.3% died (p = 0.0001). In addition, patients with mNUTRIC ≥ 5 had (HR: 2.04 95% CI: 1.02–4.09, p = 0.04) a more likely chance of dying than patients in the mNUTRIC < 5 group, even that adjusted by BMI and D-dimer concentrations (HR: 2.18 95% CI: 1.04–4.56, p = 0.03). Conclusion: In patients with COVID-19, an mNUTRIC ≥ 5 score at admission leads to a more likely chance of death even after controlling for confounding variables.
Body composition: Why, when and for who? Thibault, Ronan; Genton, Laurence; Pichard, Claude
Clinical nutrition (Edinburgh, Scotland),
08/2012, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Summary Body composition reflects nutritional intakes, losses and needs over time. Undernutrition, i.e. fat-free mass (FFM) loss, is associated with decreased survival, worse clinical outcome and ...quality of life, as well as increased therapy toxicity in cancer patients. In numerous clinical situations, such as sarcopenic obesity and chronic diseases, the measurement of body composition with available methods, such as dual-X ray absorptiometry, computerized tomography and bioelectrical impedance analysis, quantifies the loss of FFM, whereas body weight loss and body mass index only inconstantly reflect FFM loss. The measurement of body composition allows documenting the efficiency of nutrition support, tailoring the choice of disease-specific and nutritional therapies and evaluating their efficacy and putative toxicity. Easy-to-use body composition methods integrated to the routine of care allow sequential measurements for an initial nutritional assessment and objective patients follow-up. By allowing an earlier and objective management of undernutrition, body composition assessment could contribute to reduce undernutrition-induced morbidity, worsening of quality of life, and global health care costs by a timely nutrition intervention.
Abstract Vitamins and trace elements are essential to the body, however, deficiencies are frequently observed in the general population. Diet is mostly responsible for these deficiencies but drugs ...also may play a significant role by influencing their metabolism. These effects are rarely assessed in clinical practice, in part because of limited data available in the literature. Drug-induced micronutrient depletions, however, may be the origin of otherwise unexplained symptoms that might sometimes influence medication compliance. We present various examples of widely prescribed drugs that can precipitate micronutrient deficiencies. This review aims at sensitizing physicians on drug–micronutrient interactions. High-risk population groups also are presented and supplementation protocols are suggested.
OBJECTIVES:
Fat-free mass (FFM) and fat mass (FM) are important in the evaluation of nutritional status. Bioelectrical impedance analysis (BIA) is a simple, reproducible method used to determine FFM ...and FM. Because normal values for FFM and FM have not yet been established in adults aged 15 to 98 y, its use is limited in the evaluation of nutritional status. The aims of this study were to determine reference values for FFM, FM, and percentage of FM by BIA in a white population of healthy adults, observe their differences with age, and develop percentile distributions for these parameters between ages 15 and 98 y.
METHODS:
Whole-body resistance and reactance of 2735 healthy white men and 2490 healthy white women, aged 15 to 98 y, was determined by 50-kHz BIA, with four skin electrodes on the right hand and foot. FFM and FM were calculated by a previously validated, single BIA formula and analyzed for age decades.
RESULTS:
Mean FFM peaked in 35- to 44-y-old men and 45- to 54-y-old women and declined thereafter. Mean FFM was 8.9 kg or 14.8% lower in men older than 85 y than in men 35 to 44 y old and 6.2 kg or 14.3% lower in women older than 85 y than in women 45 to 54 y old. Mean FM and percentage of FM increased progressively in men and women between ages 15 and 98 y. The results suggested that the greater weight noted in older subjects is due to larger FM.
CONCLUSIONS:
The percentile data presented serve as reference to evaluate deviations from normal values of FFM and FM in healthy adult men and women at a given age.
Total parenteral nutrition was developed in the 1960s and has since been implemented commonly in the intensive care unit (ICU). Studies published in the 1980s and early 1990s indicate that the use of ...total parenteral nutrition is associated with increased mortality and infectious morbidity. These detrimental effects were related to hyperglycemia and overnutrition at a period when parenteral nutrition was not administered according to the all-in-one principle. Because of its beneficial effects on the gastrointestinal tract, enteral nutrition alone replaced parenteral nutrition as the gold standard of nutritional care in the ICU in the 1980s. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequent protein-energy deficit is correlated with a worse clinical outcome. Recent evidence suggests that all-in-one parenteral nutrition has no significant effect on mortality and infectious morbidity in patients in the ICU if a glycemic control is obtained and hyperalimentation avoided. Thus, the time has come to reconsider the use of parenteral nutrition in the ICU. Supplemental parenteral nutrition could prevent onset of nutritional deficiencies when enteral nutrition is insufficient in meeting energy requirements. Clinical studies are warranted to show that the combination of parenteral and enteral nutrition could improve the clinical outcome of patients in the ICU.
To determine the predictive factors of morbidity and mortality in patients with end-stage respiratory disease.
Prospective, multicenter cohort study.
Thirteen outpatient chest clinics within the ...Association Nationale de Traitement à Domicile de l'Insuffisance Respiratoire.
Stable adult patients with chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation (n = 446; 182 women and 264 men; aged 68.5 ± 12.1 years ± SD); Respiratory diseases were COPD in 42.8%, restrictive disorders in 36.3%, mixed respiratory failure in 13.5%, and bronchiectasis in 7.4%. Recruitment was performed during the yearly examination. Patients with neuromuscular diseases and sleeping apnea were excluded.
Hospitalization days and survival were recorded during a follow-up of 14.3 ± 5.6 months. Body mass index (BMI), serum albumin, and transthyretin levels were considered for their predictive value of outcome, together with demographic data, underlying respiratory disease, respiratory function, hemoglobin, C-reactive protein, smoking habits, oral corticosteroid use, and antibiotic treatment courses. Overall, 1.8 ± 1.7 hospitalizations (cumulative stay, 17.6 ± 27.1 days) were observed in 254 of 446 patients (57%). Independent predictors of hospitalization were oral corticosteroids, FEV1, and plasma C-reactive protein. One-year and 2-year cumulative survivals were 93% and 69%, respectively. Plasma C-reactive protein, BMI, Pao2 on room air, and oral corticosteroids independently predicted survival in multivariate analysis.
Besides established prognosis factors such as FEV1 and Pao2, nutritional depletion as assessed by BMI and overall systemic inflammation as estimated by C-reactive protein appear as major determinants of hospitalization and death risks whatever the end-stage respiratory disease. BMI and C-reactive protein should be included in the monitoring of chronic respiratory failure. Oral corticosteroids as maintenance treatment in patients with end-stage respiratory disease are an independent risk factor of death, and should be avoided in most cases.
This article will summarize the current findings on the effects of physical activity on human health and well-being.
Physical activity is associated with enhanced health and reduced risk of all-cause ...mortality such as cardiovascular disease, hypertension, type 2 diabetes, obesity, osteoporosis, sarcopenia, cognitive disorders, and some forms of cancer. Nevertheless, the effects of exercise with respect to potential health consequences are complex. When untrained or previously sedentary persons undertake vigorous exertion suddenly, the undesired side effects of injuries, dehydration or cardiac arrest are amplified.
It is reasonable to conclude that the risk exposure through physical activity is outweighed by its overall benefits, and health authorities strongly encourage participation in moderate intensity physical activity on a daily basis. In the future, the identification and characterization of particularly inactive sub-groups of the population may facilitate and optimize the planning of public health interventions.
Critical illness is characterised by nutritional and metabolic disorders, resulting in increased muscle catabolism, fat-free mass loss, and hyperglycaemia. The objective of the nutritional support is ...to limit fat-free mass loss, which has negative consequences on clinical outcome and recovery. Early enteral nutrition is recommended by current guidelines as the first choice feeding route in ICU patients. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequently energy deficit is correlated to worsened clinical outcome. Controlled trials have demonstrated that, in case of failure or contraindications to full enteral nutrition, parenteral nutrition administration on top of insufficient enteral nutrition within the first four days after admission could improve the clinical outcome, and may attenuate fat-free mass loss. Parenteral nutrition is cautious if all-in-one solutions are used, glycaemia controlled, and overnutrition avoided. Conversely, the systematic use of parenteral nutrition in the ICU patients without clear indication is not recommended during the first 48 hours. Specific methods, such as thigh ultra-sound imaging, 3rd lumbar vertebra-targeted computerised tomography and bioimpedance electrical analysis, may be helpful in the future to monitor fat-free mass during the ICU stay. Clinical studies are warranted to demonstrate whether an optimal nutritional management during the ICU stay promotes muscle mass and function, the recovery after critical illness and reduces the overall costs.
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