Do patients with lymphoedema cholestasis syndrome 1/Aagenaes syndrome need dietary counselling outside cholestatic episodes?

Do patients with lymphoedema cholestasis syndrome 1/Aagenaes syndrome need dietary counselling outside cholestatic episodes?

Aug 2010

Drivdal M, Løken EB, Hagve TA, Bergstad I, Aagenaes Ø.

Source

Regional Department of Eating Disorders, Division of Psychiatry, Building 37A, Oslo University Hospital, Ullevaal, N-0407 Oslo, Norway. ildr@uus.no

Abstract

Keywords:  Intrahepatic cholestasis, Lymphoedema, Nutrition assessment, Nutrient intake, Syndrome

BACKGROUND & AIMS: Patients with lymphoedema cholestasis syndrome 1/Aagenaes Syndrome need a fat reduced diet when cholestatic. We wanted to assess the need for dietary counselling outside cholestatic episodes, and hypothetized that no counselling was needed.

METHODS:

Fifteen patients above 10 years of age without symptoms of cholestasis were compared with a sex and age matched control group. Diet from a four-day weighed record and blood samples were compared between the two groups and with general Norwegian recommendations.

RESULTS:

The patients had a similar diet to the healthy controls, except for statistically significant lower intake of energy from total fat (p=0.04) and saturated fat (0.02), and fish (0.05). The patients met the dietary recommendations for macronutrients, except for saturated fat, monounsaturated fat, refined sugar and fibre. Supplements were needed to meet the micronutrient recommendations. Patients had a significantly lower serum level of alpha-tocopherol (0.01) compared with the control group, and the serum 25-OH D level was below reference ranges.

CONCLUSIONS:

The patients would benefit from counselling on fat quality, carbohydrates including fibre intake, and individual needs for vitamins D and E. To secure serum 25-OH D and alpha-tocopherol levels within reference ranges, regular examinations to determine the need for supplementary vitamins D and E are recommended.

Elsevier

How prevalent is vitamin B(12) deficiency among vegetarians?

Feb 2013

Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, Lucus D.

Source

Department of Nutrition Science, East Carolina University, North Carolina, USA.

Abstract

Vegetarians are at risk for vitamin B(12) (B12) deficiency due to suboptimal intake. The goal of the present literature review was to assess the rate of B12 depletion and deficiency among vegetarians and vegans. Using a PubMed search to identify relevant publications, 18 articles were found that reported B12 deficiency rates from studies that identified deficiency by measuring methylmalonic acid, holo-transcobalamin II, or both. The deficiency rates reported for specific populations were as follows: 62% among pregnant women, between 25% and almost 86% among children, 21-41% among adolescents, and 11-90% among the elderly. Higher rates of deficiency were reported among vegans compared with vegetarians and among individuals who had adhered to a vegetarian diet since birth compared with those who had adopted such a diet later in life. The main finding of this review is that vegetarians develop B12 depletion or deficiency regardless of demographic characteristics, place of residency, age, or type of vegetarian diet. Vegetarians should thus take preventive measures to ensure adequate intake of this vitamin, including regular consumption of supplements containing B12.

Wiley

Global nutrition epidemiology and trends.

2012 

Bhutta ZA, Salam RA.

Source

Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.

Abstract

In the year 2011, 6.9 million children under the age of 5 years died worldwide, one third of them related to increased susceptibility to illnesses due to under nutrition. An estimated 178 million children under 5 years are stunted, 55 million are wasted, and 19 million of these are severely affected and are at a higher risk of premature death, the vast majority being from sub-Saharan Africa and South-Central Asia. Globally, over 2 billion people are at risk for vitamin A, iodine, and/or irondeficiency. Other micronutrient deficiencies of public health concern include zinc, folate, and the B vitamins. 

The risk factors for undernutrition include low birth weight, inadequate breastfeeding, improper complementary feeding, and recurrent infections. Infectious diseases often coexist with micronutrient deficiencies and exhibit complex interactions leading to the vicious cycle of malnutrition and infections. Diarrhea along with the poor selection and intake of complementary food are the major contributors to undernutrition. 

Possible strategies to combat malnutrition include promotion of breastfeeding, dietary supplementation of micronutrients, prevention of protein-energy malnutrition, and improvement in the standard of preparation and hygiene of available weaning foods. The universal coverage with the full package of these proven interventions at observed levels of program effectiveness could prevent about one quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one third. 

The median coverage rate of interventions along the continuum of care for Countdown countries has however beenlesws then 80 percent for vaccination and vitamin A supplementation. However, for several interventions, including early initiation and exclusive breastfeeding below 6 months of age and case management of childhood illnesses, the median coverage rate hovers at or below fifty percent. This suggests that interventions requiring strong health systems or behavior change appear to be stalled and need to be re-examined to find more effective ways of delivery.

Karger

Nutrition and Diet Page

Just a quickie note to pass on a link to another nutritional information page for lymphedema:

Nutrition and Diet

Step Up Speak Out

Cranberry Proanthocyanidins Improve Intestinal sIgA During Elemental Enteral Nutrition.

2013

Pierre JF, Heneghan AF, Feliciano RP, Shanmuganayagam D, Krueger CG, Reed JD, Kudsk KA.

Source

Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Abstract

Background: 

Elemental enteral nutrition (EEN) decreases gut-associated lymphoid tissue (GALT) function, including fewer Peyer's patch lymphocytes and lower levels of the tissue T helper 2 (Th2) cytokines and mucosal transport protein polymeric immunoglobulin receptor (pIgR), leading to lower luminal secretory immunoglobulin A (sIgA) levels. Since we recently demonstrated that cranberry proanthocyanidins (PACs) maintain the Th2 cytokine interleukin (IL)-4 when added to EEN, we hypothesized the addition of PACs to EEN would normalize other GALT parameters and maintain luminal levels of sIgA. 

Methods: 

Institute of Cancer Research mice were randomized (12/group) to receive chow, EEN, or EEN + PACs (100 mg/kg body weight) for 5 days, starting 2 days after intragastric cannulation. Ileum tissue was collected to measure IL-4 by enzyme-linked immunosorbent assay, pIgR by Western blot, and phosphorylated STAT-6 by microarray. Intestinal wash fluid was collected to measure sIgA by Western blot. 

Results: 

Compared with chow, EEN significantly decreased tissue IL-4, phosphorylated STAT-6, and pIgR. The addition of PACs to EEN prevented these alterations. Compared with chow, EEN resulted in significantly lower levels of luminal sIgA. The addition of PACs to EEN increased luminal sIgA levels compared with EEN alone. 

Conclusions: 

This study suggests the addition of PACs to EEN may support GALT function and maintain intestinal sIgA levels compared with EEN administration alone

Full length article:

Journal of Parenteral & Enteral Nutrition

Nutrition and depression at the forefront of progress.

Dec 2012

Popa T, Ladea M.

Source

3rd Psychiatric Department, "Alexandru Obregia" Clinical Hospital of Psychiatry, Bucharest, Romania.

Abstract

Depression is a debilitating disorder estimated to become the second cause of morbidity worldwide by the year 2020. The limited efficacy of antidepressant therapy, as well as the major negative consequences of this disorder, has stimulated additional research in order to determine possible adjunctive treatments. There is mounting evidence linking dietary patterns to major depression development. This article presents some of the most significant findings concerning the role of nutrition in major depressive disorder. Although more focused and clear results are needed, the correlation between nutrition and mental health is gaining attention. Now, there is evidence supporting the importance of nutrition in maintaining good mental health. We emphasize multiple findings that support adherence to healthy dietary patterns, taking into account that the production of neurotransmitters need, among others, right amounts of nutrients, a lot of which can only be supplied through diet. Not only certain nutrients are needed for proper brain functioning, but also others can be harmful, promoting depression. The Mediterranean diet has been linked to a low prevalence of depression while fast-food consumption has been found to increase the risk of developing and aggravating this disorder, hence the need for nutritional interventions. From the perspective of discovering modifiable risk factors, the role of nutrition in psychiatry could be more important than it was initially considered.

PubMed

Vitamins can harm cancer patients: scientist

Jan 2013

Madeleine Heffernan, Julia Medew

LATE-stage cancer patients could be thwarting their own treatment by taking multi-vitamin pills containing antioxidants, the Nobel Prize-winning scientist James Watson has warned.

The benefits of supplements containing antioxidants such as vitamins A, C and E are the subject of fierce debate.

While some studies suggest that they could offer moderate protection against cancer, Professor Watson, who with Francis Crick discovered the ''double helix'' structure of DNA in 1953, argues that the pills could be doing more harm than good.

In a new paper, he claims that the reason late-stage cancers often become untreatable is that they produce high levels of antioxidants which stop treatments such as chemotherapy and radiotherapy from working.In healthy people, antioxidants can be helpful because they attack molecules known as ''free radicals'' which can damage DNA. But many cancer treatments use free radicals to kill tumour cells, meaning antioxidants could prevent them doing their job.

Professor Watson said studies should be carried out to test his theory, which he described as ''among my most important work since the double helix''.

Writing in the Royal Society's Open Biology journal, he said: ''For as long as I have been focused on the understanding and curing [of] cancer, well-intentioned individuals have been consuming antioxidative nutritional supplements as cancer preventatives if not actual therapies.

''In light of the recent data strongly hinting that much of late-stage cancer's untreatability may arise from its possession of too many antioxidants, the time has come to seriously ask whether antioxidant use much more likely causes, than prevents, cancer.

''Blueberries [which are high in antioxidants] had best be eaten because they taste good, not because their consumption will lead to less cancer.''

Professor Nic Jones, Cancer Research UK's chief scientist, said: ''We know from many large studies that, far from being potent cancer-fighters, antioxidant supplements seem to be ineffective for cancer prevention in healthy people, and some can even slightly increase the risk of cancer. This should give people good reason to think twice about relying on them.''

Steve Williamson, cancer spokesman for Britain's Royal Pharmaceutical Society, added: ''I always advise patients not to take antioxidants while they are having chemotherapy in case it counteracts it.''

Cancer Council Australia's chief executive Ian Olver said the comments ''had merit''.

''Multi-vitamins are something that may be helpful in prevention, but they may not be helpful for treatment,'' Professor Olver said.

With a study last year showing that more than 50 per cent of male cancer patients in Australia were using ''complementary and alternative medicines'' while receiving chemotherapy or radiotherapy, Professor Olver said patients and doctors should ensure that alternative medicine use is out in the open.

Telegraph, London

Read more: http://www.theage.com.au/national/health/vitamins-can-harm-cancer-patients-scientist-20130109-2cgrc.html#ixzz2IQwNrm7Z

Are alanine, cysteine, glycine and valine amino acids the cause of non-immune hydrops fetalis?

**Non-immune hydrops fetalis is a syndrome that presents with lymphedema**

2012

Kale A, Kale E.

Source

Department of Obstetrics and Gynecology, Adana Numune Research Hospital, Adana, Turkey. ebrukale@gmail.com

Abstract

Our objective was to measure amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with non immune hydrops fetalis in the second trimester of pregnancy. Twenty-three pregnant women who had fetuses with non immune hydrops fetalis detected by ultrasonography (non immune hydrops fetalis group) in the second trimester and 19 women who had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis. The chromosomal analysis of the study and control groups was normal. 

Levels of free amino acids were measured in amniotic fluid samples using EZ: fast kits (EZ: fast GC/FID free (physiological) amino acid kit) by gas chromatography (Focus GC Al 3000 Thermo Finnigan analyzer). The mean levels of alanine, cysteine, glycine and valineamino acids were found to be significantly higher in fetuses with non immune hydrops fetalis than in the control group (p<0.05). The detection of significantly higher amino acid concentrations in the amniotic fluid of fetuses with a non immune hydrops fetalis in healthy fetuses suggests loss of amino acids from the fetus through capillary permeability or/and the lymphatic system through the amniotic fluid may contribute to the etiology of non-immune hydrops fetalis.

PubMed

Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial.

Jan 2013

**Editor's note: Many ,many of those with lymphedema report severe knee problems as well.  This is due, most likely, to the effects of the massive edema and the strain and inflammation the body goes through in attempting to cope.**

McAlindon T, LaValley M, Schneider E, Nuite M, Lee JY, Price LL, Lo G, Dawson-Hughes B.

Source

Abstract

IMPORTANCE:

 Knee osteoarthritis (OA), a disorder of cartilage and periarticular bone, is a public health problem without effective medical treatments. Some studies have suggested that vitamin D may protect against structural progression.

OBJECTIVE:

 To determine whether vitamin D supplementation reduces symptom and structural progression of knee OA.

DESIGN, SETTING, AND PATIENTS:

 A 2-year randomized, placebo-controlled, double-blind, clinical trial involving 146 participants with symptomatic knee OA (mean age, 62.4 years [SD, 8.5]; 57 women [61%], 115 white race [79%]). Patients were enrolled at Tufts Medical Center in Boston between March 2006 and June 2009.

INTERVENTION:

 Participants were randomized to receive either placebo or oral cholecalciferol, 2000 IU/d, with dose escalation to elevate serum levels to more than 36 ng/mL.

MAIN OUTCOME MEASURES:

 Primary outcomes were knee pain severity (Western Ontario and McMaster Universities [WOMAC] pain scale, 0-20: 0, no pain; 20, extreme pain), and cartilage volume loss measured by magnetic resonance imaging. Secondary end points included physical function, knee function (WOMAC function scale, 0-68: 0, no difficulty; 68, extreme difficulty), cartilage thickness, bone marrow lesions, and radiographic joint space width.

RESULTS:

 Eighty-five percent of the participants completed the study. Serum 25-hydroxyvitamin D levels increased by a mean 16.1 ng/mL (95% CI, 13.7 to 18.6) in the treatment group and by a mean 2.1 mg/mL (95% CI, 0.5 to 3.7) (P < .001) in the placebo group. Baseline knee pain was slightly worse in the treatment group (mean, 6.9; 95% CI, 6.0 to 7.7) than in the placebo group (mean, 5.8; 95% CI, 5.0 to 6.6) (P = .08). Baseline knee function was significantly worse in the treatment group (mean, 22.7; 95% CI, 19.8 to 25.6) than in the placebo group (mean, 18.5; 95% CI, 15.8 to 21.2) (P = .04). Knee pain decreased in both groups by a mean -2.31 (95% CI, -3.24 to -1.38) in the treatment group and -1.46 (95% CI, -2.33 to -0.60) in the placebo group, with no significant differences at any time. The percentage of cartilage volume decreased by the same extent in both groups (mean, -4.30; 95% CI, -5.48 to -3.12 vs mean, -4.25; 95% CI, -6.12 to -2.39) (P = .96). There were no differences in any of the secondary clinical end points. 

CONCLUSION AND RELEVANCE:  Vitamin D supplementation for 2 years at a dose sufficient to elevate 25-hydroxyvitamin D plasma levels to higher than 36 ng/mL, when compared with placebo, did not reduce knee pain or cartilage volume loss in patients with symptomatic knee OA.

JAMA

Successful management of congenital chylous ascites with early octreotide and total parenteral nutrition in a newborn.

***Editor's note:  While this is no "special" diet for lymphedema patients, sometimes there are syndromes that present with lymphedema as a co morbidity.  These in fact, do have special dietary and nutritional needs as the one below does. Pat ***

2012

Olivieri C, Nanni L, Masini L, Pintus C.

Source

Pediatric Surgery Unit, Policlinico "A. Gemelli", Rome, Italy.

Abstract

Congenital chylous ascites (CCA) is a rare disease that results from maldevelopment of the intra-abdominal lymphatic system. Few cases have been described and no gold standard treatment has been defined so far. Octreotide, a somatostatin analogue, has been used for the treatment of CCA, but always after a failed conservative approach with fasting, total parenteral nutrition (TPN) or medium chain triglyceride (MCT) feeds. We report the case of a newborn with CCA treated by fasting, TPN and octreotide for a period of 15&emsp14;days until the abdominal distension was successfully reduced at which point treatment was switched to an MCT formula. On day 25 the patient was breastfed and was discharged on day 33. No recurrence of chylous ascites was noted. Our experience highlights the successful treatment with TPN and octreotide as the first step for the conservative approach of CCA in a newborn, reducing the length of treatment and hospitalisation.

BMJ