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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Treatment comprises a search for and correction of any precipitating factors. Lactulose given in a dose to produce at least two soft bowel motions a day should be given and, if encephalopathy persists, rifaximin 550 mg twice daily is effective in some. A low-protein diet is sometimes indicated but the impact on nutrition usually outweighs the benefit. Unproven treatments include bromocriptine and flumazenil (benzodiazepine antagonist).
Diabetes and the Microcirculation
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
Dietary protein restriction is of known benefit in preventing the progression of nondiabetic renal failure, although whether it has similar effects in diabetic nephropathy remains controversial.74 In any case, only moderate protein restriction is practical, however, as most patients find a low protein diet unacceptable. Once end-stage renal failure is reached, renal transplantation is the preferred choice of renal replacement therapy, with long-term transplantation results now approaching those in nondiabetic subjects. As transplantation is currently a limited option due to inadequate donor numbers, most patients with end-stage renal failure are treated with renal dialysis, at least for a period. Continuous ambulatory peritoneal dialysis is preferred to hemodialysis, as the latter is difficult in diabetic patients due to problems with vascular access, postural hypotension, and glycemic control. In addition, hemodialysis in elderly patients is associated with a higher mortality than other forms of renal replacement therapy.75
Treating the Dysmetabolism Underlying Osteoporosis
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Protein-calorie malnutrition (PCM) occurs as a result of many chronic diseases and left uncorrected, results in MBD. Protein intake helps provide the structural matrix of bone, optimize levels of IGF-1, an important hormone in bone metabolism, and also is reported to increase urinary calcium and intestinal calcium absorption [77]. In the NHANES 1 study, hip fractures were associated with low energy intake, low serum albumin, and decreased muscle strength; all reflecting protein and caloric deficit [78]. A 10% decrease in body weight typically results in a 1%–2% bone loss, and more severe weight loss and malnutrition are considered risk factors for osteoporosis which is likely due to low protein intake [79]. Although high‑protein diets have been shown to increase urinary calcium losses, there have been mixed study findings on the long-term effects on BMD [77]. Conversely, a low protein diet has been found to be related to low bone mass and increased fracture risk [77]. In two interventional trials examining graded levels of protein intake on calcium homeostasis, decreased calcium absorption and an acute rise in PTH were noted by day four of the 0.7 and 0.8 g/kg diets but not during the 0.9 or 1.0 g/kg diets [80, 81].
Associations of low-carbohydrate with mortality in chronic kidney disease
Published in Renal Failure, 2023
Qidong Ren, Yangzhong Zhou, Huiting Luo, Gang Chen, Yan Han, Ke Zheng, Yan Qin, Xuemei Li
A low protein diet is recommended for CKD stage 3–5 patients according to the current guideline. Thus, CKD population was further divided into sub-populations by eGFR (0-59 mL/min·1.73m2) and ACR (> =30 mg/g). The same estimation of the non-linear relation between the HR and the macronutrients of interest was performed in these CKD sub-populations. Unless indicated, the same set of covariates was adjusted in the model. The eGFR and ACR were excluded from the model in subgroup analysis, respectively. Sensitivity analysis was performed in two different ways using the same multivariable Cox proportional hazard models. One by excluding participants who died within 12 months’ follow-up period, the other by including participants who self-reported the 24h-recall dietary data was different from the usual diet. All statistical analysis was performed using R (version 4.0.5), with the package survey (version 4.0).
Clinical features of anemia in membranous nephropathy patients: a Chinese cohort study
Published in Renal Failure, 2023
Zhe Li, Weibo Le, Haitao Zhang, Dacheng Chen, Wencui Chen, Shuhua Zhu, Ke Zuo
A low-protein diet can delay the deterioration of renal function in CKD patients [16], but malnutrition caused by strict diet control is also a risk factor for increased mortality in hemodialysis patients [17]. In this study, low total protein levels, low Chol levels, hypokalemia and hypophosphatemia were found to be independent risk factors for anemia in MN patients. If there was no significant difference in urinary protein levels between the two groups, the total protein, Alb, Glb and prealbumin levels in the anemia group were all low, suggesting that some MN patients may have overcontrolled their protein intake, resulting in malnutrition and insufficient hematopoietic substances. Analysis of patients whose anemia treatment failed to reach the standard found that the proportion of microcytic hypochromic anemia was high, suggesting that malnutrition would also affect the therapeutic effect of anemia in MN patients.
Maternal protein restriction affects cardiovascular, but not respiratory response to L-glutamate microinjection into the NTS of conscious rats
Published in Nutritional Neuroscience, 2021
D. S. Alves, D. F. S. Barbosa, V. O. Nogueira, Y. Tourneur, D. A. F. Fontes, J. L. Brito-Alves, J. H. Costa-Silva
Virgin female albino Wistar rats (Rattus novergicus) were maintained at room temperature (22 ± 1°C) with a controlled light–dark cycle (dark 18:00–06:00 hours). Laboratory chow (52% carbohydrate, 21% protein, and 4% lipids – Presence®, São Paulo, Brazil) and water were given ad libitum up to the 3-month, when rats were mated (two females for one male). The day on which spermatozoa was identified in a vaginal smear was considered as the day of conception, and then pregnant dams were transferred to individual cages. Pregnant dams were fed on a 17% protein diet (normal protein group, NP, n = 5) or 8% protein diet (low protein group, LP, n = 5). Both diets were isoenergetic (Table 1) and were offered ad libitum throughout pregnancy and lactation. Diets were elaborated according to the American Institute of Nutrition – AIN-93 [13]. The low protein diet differed from the normal protein diet in the content of carbohydrate and protein (Table 1). Furthermore, analysis of the diet preparations measured 85 g of protein for each 100 g of casein.