1,721,001 research outputs found
Pathways to Obesity and Main Roads to Recovery
No full textThe chapter reviews the options for the currently available - or under study - antiobesity drugs, including those which have been removed from the market, being considered unsafe. The efficacy of different kinds of products is evaluated. Short term weight loss with drug treatment seems to be generally modest while maintenance in the long term is even more disappointing. Furthermore drug treatment cannot be prescribed without an associated reduction in energy intake, increased physical activity and lifestyle changes, otherwise weight loss will not be achieved and weight regain will annihilate the treatment effects. Drugs have shown wide ranging side effects and contraindication from a prolongued use. Orlistat, which reduces the absorption of fat from the gastrointestinal tract by lipase inhibition, is the most used drug in the present day context, while sibutramine or the endocannabinoids are not more available in most countries. Newer concepts in weight management are mainly hormonal and receptor based, in the effort to reduce adverse effects. Weight loss drugs in development, many of which are in phase II/III trials, include compounds which act at the central level to limit food intake such as neuropeptide Y, Agouty related protein, MCH1 receptor or Serotonin (5-HT) Receptor Ligands. Other compounds act as Gut Hormone Signaling, including Amylin Analogues or Cholecystokinin-1 or as (CCK) Agonists. Drugs such as metformin, topiramate, bupropion or naltrexone alone or as combination therapy are also used. Some pharmacological agents try to induce weight reduction by increasing energy expenditure or by reducing or redistributing adipose tissu
Clinical Nutrition
No full textThere is scientific evidence that nutritional treatment can prevent or delay the progression of CKD, control symptoms and prevent or reduce the development of complications such as protein energy malnutrition (PEM) and cardiovascular disease (CVD). PEM is a common clinical finding in renal disease and has a negative bearing on quality of life, morbidity and mortality and therefore it should be adequately prevented, diagnosed and treated. Nutritional prescriptions in renal patients are complex because nutritional goals are multiple, and at time conflicting, yet the prescribed diets should be as realistic and practical as possible. Nutritional support is needed when spontaneous food intake is inadequate to cover nutrient requirements. The main topics of the chapter are: the physiopathology of acute and chronic renal failure, a review of the literature on the role of different nutrients on progression of kidney disease, diagnosis and classification of protein energy malnutrition, which is steel controversial, dietary treatment according to the most recent guidelines, nutritional practical tips, nutrition in dialysis and transplant patients
La valutazione dello stato nutrizionale nella malnutrizione proteico energetica
No full textLa malnutrizione proteico energetica è una condizione di perdita di massa muscolare e adiposa associata, o meno, a modificazioni delle proteine viscerali, conseguente a patologie di tipo acuto e cronico e tale da influenzare la morbilità, la mortalità e la prognosi dei pazienti. Negli ultimo decennio la ricerca ha notevolmente approfondito i meccanismi fisiopatologici dei quadri di malnutrizione evidenziando in particolare il ruolo della risposta infiammatoria o dello stress ossidativo. Inoltre è emersa l’importanza di attuare uno screening nutrizionale sistematico precoce in tutti i pazienti al momento del ricovero e a cadenze determinate nel follow-up. Nei casi di screening positivo va attuata una valutazione diagnostica secondo criteri ben definiti. Il laboratorio clinico mantiene un ruolo centrale nella definizione dello stato nutrizionale attraverso la valutazione dii numerosi indicatori biochimici: dal bilancio dell’azoto, utile anche nella terapia di supporto nutrizionale, al dosaggio delle proteine sieriche e di metaboliti correlati alla massa muscolare. I markers di infiammazione e di stress ossidativo possono fornire informazioni sull’andamento del quadro clinico, sulla gravità della malnutrizione e sulla risposta alla terapia. In quest’ambito sono necessari ulteriori definizioni e messa a punto di metodiche sufficientemente sensibili e specifiche. Una valutazione dello stato dei micronutrienti, minerai e vitamine può essere necessaria in alcune situazioni
The Kidney
No full textDietary therapy has a role in renal disease to control the symptoms and the metabolic consequences of renal dysfunction. Protein and phosphate intake modification may decrease the rate of kidney failure patients. Protein-energy malnutrition is a common clinical finding in kidney patients from a number of cause, including iatrogenic factors from inadequate diets. Malnutrition may with a negative bearing in morbidity, mortality, quality of life and costs and also in the rate of progression of renal disease The indices to evaluate may be influenced by renal failure and may therefore not be as reliable as in subjects with normal renal function. The nutritional status of the patient needs to be monitored to prevent or treat malnutrition and regular follow up procedure are relevant. Acute and chronic kidney disease require specific nutritional treatments according the stage or the severity of renal failure, associated clinical conditions and the need of renal replacement therapy. In chronic patients personalized modified diets are prescribed after a careful assessment of the nutrient requirements. The compliance may be low and patient need to be educated and adequately informed. In some patients special substrates may be required . Finally kidney transplant subjects require special dietary treatment according to the different clinical stages and the type of medical treatment required by patients
The kidney
No full textThe purpose of the chapter is to offer a review of the physiopathology of kidney diseases related to multiple nutritional factors. These include not only protein and phosphate intake, but also dietary fats, excessive energy intake, nutrients related to hypertension, including sodium, alcohol and excess calories, bearing a negative impact and potassium, with a protective action. Metabolic disorders, such as dyslipidemia, obesity and a diabetes mellitus and low physical activity all have a role. Obesity is an independent risk factor for both chronic kidney and diabetic kidney diseases (obesity related glomerulopathy, ORG). Predialysis medical nutrition therapy has a role in delaying progression to stage 5 of kidney failure and in decreasing mortality after initiation of renal replacement therapy. Protein energy malnutrition and the inflammatory processes are frequent before and during dialysis. Kidney transplant is associated with metabolic complications. In the chapter current recommendations for screening, diagnosis, and treatment of clinically relevant nutritional problems are critically reviewed for application in clinical practice
Nutrition in Renal Disease
No full textNutrition has a fundamental role in the management of kidney patients, acute and chronic, on conservative or on substitutive dialysis treatment or after kidney transplantation. In chronic kidney disease (CKD), independently from the cause of the original renal damage there is a progressive and irreversible loss of nephrons and organ function leading to the final stages of kidney failure (ESRD) when dialysis treatment needs to be started. Some nutritional intervention may be useful to prevent or delay the development of kidney disease associated with some chronic conditions such as overweight (leading to Obesity-related glomerulopathy, ORG), diabetes mellitus. or hypertension or to delay the progression toward the end stages of kidney disease. In later stages of CKD, dietary modifications (protein, phosphate, calcium, potassium and sodium) are part of the management of some uremic complications. Since protein-energy malnutrition (PEM) is a common finding in CRF and its presence at the beginning of dialysis caries a bad prognosis, with higher mortality and complication rates, the nutritional status of the patient needs to be constantly monitored and every effort should be taken be prevented or to control malnutrition. In patients with CRF the rationale, the goals and the modalities of nutritional prescriptions change with the degree of loss of renal function, the etiology of kidney disease, the nutritional status of the subjects, the presence and the severity of clinical complications or co-morbidities and the need for dialysis treatment. When CRF patients start substitutive treatment the nutritional requirements change considerably. The big challenge for the nutritionist is to preserve the nutritional status, threatened by chronic nutrient losses and catabolism induced by dialysis, while at the same time controlling some of the symptoms not corrected by the dialysis sesions. Acute kidney failure(ARF) is associated with an acute type of PEM and nutritional interventions are generally similar to those for the acute hypercatabolic patients, with normal renal function.. In acute kidney patients however special substrates may be useful. Finally kidney transplant subjects require special care to counteract the effects on the nutritional status and nutrient requirements at first from the surgery and later from the post-transplant drug treatment
Disvitaminosi. In Trattato di Medicina Interna
No full textIl capitolo prende in esame i diversi aspetti delle vitamine e ha l’obiettivo di rivedere, alla luce della più recente letteratura, le modalità di classificazione, il metabolismo, le funzioni, i fabbisogni, in condizioni fisiologiche , nelle diverse età e nei due sessi, e nelle situazioni di disvitaminosi, oggi spesso subcliniche, ma comunque presenti e talora di difficile definizione, i quadri clinici di carenza, le più aggiornate indagini diagnostiche, le principali sorgenti alimentari e le interazioni tra farmaci e nutrienti. Le funzioni svolte delle vitamine si sono rivelate più complesse rispetto al passato, intervenendo nella regolazione della crescita dei tessuti, nella differenziazione cellulare, nella regolazione epigenetica dell’espressione genica, come antiossidanti, antiinfiammatori e regolatori del sistema immunitario, e nella patogenesi di diverse patologie. Il testo comprende anche una descrizione della tossicità di vitamine assunte in sovradosaggio, sostenuta da un diffuso e frequente ricorso a supplementi e integratori alimentari di vario tipo, assunti talora in modo indiscriminato o per funzioni non ancora confermate sul piano sperimentale
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