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Summary: Background & aim: Swallowing disturbances are associated with older age as well as with other subclinical disturbances of multifactorial origin in patients with Parkinson's disease (PD). This study assesses nutritional markers and whole-body impedance data to better understand swallowing disturbances in Parkinson's disease. Design and patients included: This cross-sectional study includes baseline data from a cohort of newly diagnosed patients identified in the New Parkinsonism in Umeå study (NYPUM) (n = 75). Methods: Swallowing disturbance was registered as a score of one or more on the Unified Parkinson's Disease Rating Scale (UPDRS) section II question number 7 on swallowing. The analysis used nutritional markers in plasma and anthropometry from bioimpedance. Results: Bivariate analysis revealed that swallowing disturbances were associated with low plasma phosphate levels for males (r = −0.428; p = 0.005) and for all patients with PD (r = −0.241; p = 0.037). In males but not in females, a negative association was found between age and albumin and amount of intra-cellular water (ICW, l). Plasma albumin was associated with plasma phosphate (r = 0.315; p = 0.006; n = 75, r = 0.361; p = 0.036; n = 34, r = 0.310; p = 0.049; n = 41). Another risk pattern indicating swallowing disturbance in females was revealed by an association with visceral adiposity index (VAI), plasma triglycerides (TG), and triglyceride/high density lipoprotein (TG/HDL) ratio. The adjusted logistic regression revealed that low phosphate in males and low magnesium in females were risk factors for swallowing disturbance. Conclusion: The age-related decline in plasma phosphate in males with PD may be an important nutritional marker for swallowing disturbances. Body composition measurements and nutritional markers provide information for the study of swallowing dysfunction as part of sarcopenia. Keywords: Anthropometry, Nutritional markers, Parkinson's disease, Sarcopenia, Swallowing disturbance, Phosphate

The associations between nutritional markers and heart rate variability (HRV) are poorly addressed. This study aimed to evaluate whether malnutrition is associated with the altered autonomic nervous system (ANS) function. This cross-sectional study was conducted enrolling 175 patients (100 women, mean age 65.1 ± 12.9 years) receiving chronic hemodialysis in a teaching hospital from June to August 2010. We performed HRV measurements before and during the index hemodialysis and compared these HRV values between two groups categorized by the individual nutritional marker. By using the multivariate generalized estimating equation with adjustment, we exhibited the independent associations between HRV and poor nutritional status defined by serum albumin &lt, 3.8 g/dL, total cholesterol &lt, 100 mg/dL, body mass index &lt, 23 kg/m2, bodyweight loss within six months &gt, 10%, bodyweight loss within three months &gt, 5%, and normalized protein catabolic rate &lt, 1.1 g/kg BW/day. The current study disclosed ANS impairment in hemodialysis patients with poor nutritional status. The impaired ANS function might be a potential mechanism linking malnutrition to subsequent adverse prognoses in hemodialysis patients. Further investigations are warranted to confirm these findings and clarify the causal association among this complex issue.

COSMOS is sponsored by the Bone and Mineral Research Unit (Hospital Universitario Central de Asturias), SAFIM (Sociedad Asturiana Fomento Investigaciones Óseas), the European Renal Association-European Dialysis and Transplant Association, the National Program of I+D+I 2008–2011 and Instituto de Salud Carlos III (ISCIII), the ISCIII Retic REDinREN (RD06/0016/1013 and RD12/0021/1023), the ISCIII (ICI14/00107 and PI17/00384), Fondo Europeo de Desarrollo Regional (FEDER), Plan Estatal de I+D+I 2013–2016, Plan de Ciencia, Tecnología e Innovación 2013–2017 del Principado de Asturias (GRUPIN14-028) and Fundación Renal Ínigo Álvarez de Toledo (FRIAT), Carrero, J.J., Cabezas-Rodríguez, I., Qureshi, A.R., Floege, J., Ketteler, M., London, G., Locatelli, F., Memmos, D., Goldsmith, D., Ferreira, A., Nagy, J., Teplan, V., Martínez-Salgado, C., Fernández-Martín, J.L., Zoccali, C., Cannata-Andia, J.B., on behalf of the COSMOS group

Background The early exposure to poor social and nutritional conditions may influence cognitive function during adult age. However, the relative impact of these factors has not yet been established and they can vary during the course of life. Methods Analysis of data from 12,997 participants (35-64 years) of the baseline exams (2008-2010) of the Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of Brazilian civil servants. Four cognitive tests were applied: learning, recall and word recognition; semantic and phonemic verbal fluency; trail-making test version B. The markers of early nutritional and social conditions were maternal educational level, birth weight, and length of trunk and leg. The presence of independent association between every early marker and the poor performance in each cognitive test was investigated by multiple logistic regression, after mutual adjustment and considering the effects of gender, age and participant’s schooling level. The cut off for poor performance was the worst age-specific percentile of the final score distribution for each test. Results After full adjustments, lower maternal education increased the chances of poor performance in all cognitive tests, with a dose-response gradient; low birth-weight was related to poor performance in the trail-making test B (OR = 1.63, 95% IC = 1.29-2.06); and greater trunk length decreased the chances of poor performance in the semantic and phonemic verbal fluency (OR = 0.96, 95% IC = 0.94-0.97) and in the trail-making test B (OR = 0.94, 95% IC = 0.92-0.95). Leg length was not associated with any of the tests examined. The associations found were not modified by the educational attainment of the participants. Conclusions Early exposure to adverse social and nutritional conditions appear detrimental to semantic memory, learning, concentration, executive control and language among adults, independent of adulthood educational achievement.

Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients.BackgroundCross-sectional studies have shown an inverse correlation between serum C-reactive protein (CRP) and serum albumin concentration in hemodialysis patients. The net effects of inflammation and dietary protein intake on nutritional markers over time are unknown.MethodsTo explore the effects of CRP and normalized protein catabolic rate (nPCR) on serum albumin and creatinine, we analyzed six consecutive months of laboratory data from 364 hemodialysis patients, using a multivariable Mixed model with conservative biases.ResultsThe overall trend over time in serum albumin was slightly positive (0.039 g/dL/month) and in serum creatinine slightly negative (-0.052 mg/dL/month). With increasing CRP, serum albumin declined significantly (-0.124 g/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes, and nPCR, P < 0.0001). Serum albumin increased with increasing nPCR (0.021 g/dL/month per 0.1 g/kg/day, P < 0.0001). The effect of CRP on albumin was attenuated in African Americans and at a higher nPCR. Corresponding values for creatinine mirrored those for albumin. With increasing CRP, creatinine declined significantly [-0.142 mg/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes (time since initiation of dialysis; vintage), Kt/V, and nPCR, P = 0.002]. Serum creatinine increased with increasing nPCR (0.183 mg/dL/month per g/kg/day, P < 0.0001).ConclusionsProxies of inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. These data provide a rationale for prospective testing of dietary protein supplementation in hemodialysis patients with biochemical evidence of ongoing inflammation and “malnutrition.”

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:17Z No. of bitstreams: 1 S1676-24442002000300004.pdf: 239603 bytes, checksum: 7908367e73bd2dab80cfc5640df512d4 (MD5) Made available in DSpace on 2013-08-22T18:43:17Z (GMT). No. of bitstreams: 1 S1676-24442002000300004.pdf: 239603 bytes, checksum: 7908367e73bd2dab80cfc5640df512d4 (MD5) Previous issue date: 2002-07-01 Made available in DSpace on 2013-09-30T18:17:50Z (GMT). No. of bitstreams: 2 S1676-24442002000300004.pdf: 239603 bytes, checksum: 7908367e73bd2dab80cfc5640df512d4 (MD5) S1676-24442002000300004.pdf.txt: 35717 bytes, checksum: a4883a1a3ba668a157706182dbbc5d79 (MD5) Previous issue date: 2002-07-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:43Z No. of bitstreams: 2 S1676-24442002000300004.pdf: 239603 bytes, checksum: 7908367e73bd2dab80cfc5640df512d4 (MD5) S1676-24442002000300004.pdf.txt: 35717 bytes, checksum: a4883a1a3ba668a157706182dbbc5d79 (MD5) Made available in DSpace on 2014-05-20T13:33:43Z (GMT). No. of bitstreams: 2 S1676-24442002000300004.pdf: 239603 bytes, checksum: 7908367e73bd2dab80cfc5640df512d4 (MD5) S1676-24442002000300004.pdf.txt: 35717 bytes, checksum: a4883a1a3ba668a157706182dbbc5d79 (MD5) Previous issue date: 2002-07-01 Objetivo: Simplificar o cálculo do índice prognóstico inflamatório nutricional (IPIN) empregando número menor de variáveis com conseqüente redução do custo da análise. Materiais e métodos: Foram estudados 54 pacientes e 12 indivíduos-controle com 48 ± 20 (média ± dp) anos de idade. As principais patologias dos pacientes eram: doença arterial periférica (22), pênfigo foliáceo (7), doença inflamatória intestinal (7), trauma (6) e pós-operatório de ortognatia (3). Foram obtidas amostras de sangue periférico, colhidas em jejum para dosagens de proteínas positivas (+) e negativas (-) de fase aguda (PFA) pelo método nefelométrico. Proteína C reativa (PCR), alfa-1-glicoproteína-ácida (alfa-1-GA), alfa-1-antitripsina (alfa-1-AT) e ceruloplasmina (CER) foram as PFA+ e albumina (Alb), transtiretina (TTR), transferrina (TF) e proteína ligadora do retinol (RBP) foram as representantes das PFA-. Esses valores foram analisados quanto à associação de correlação isolada ou associadamente na fórmula do índice prognóstico inflamatório e nutricional (IPIN = PCR + alfa-1-GA / Alb + TTR). de acordo com o índice prognóstico inflamatório e nutricional, os pacientes foram classificados em grupo-controle (G1); pacientes sem infecção/inflamação (IPIN < 1, G2) ou com risco de inflamação/infecção (IPIN > 1, G3). em seguida os pacientes do G3 foram subdivididos em baixo risco (G3A, n = 16); médio risco ( G3B, n = 10); alto risco (G3C, n = 6) e com risco de morte (G3D, n = 11). Os resultados foram correlacionados entre si (teste de Spearman) ou submetidos às comparações entre grupos (teste de Kruskall-Wallis). Resultados: Houve relação significativa entre as variáveis PCR ´ alfa-1-GA (r = 0,49), Alb ´ TTR (r = 0,60), Alb ´ RBP (r = 0,58), Alb ´ TF (r = 0,39), TTR ´ RBP (r = 0,56) e TTR´ TF (r = 0,43) e as melhores relações encontradas entre PFA+ e PFA- foram: PCR ´ Alb (r = - 0,71), PCR ´ TTR (r = - 0,54), PCR ´ TF (r = - 0,39) e alfa-1-GA ´ Alb (r = - 0,35). Os valores do IPIN mostraram a diferenciação G3 > (G1 = G2) e G3 > G3A. Entre todas as proteínas dosadas apenas PCR, Alb e TTR discriminaram os grupos: sendo G3 > (G1= G2) para PCR e G3< (G1= G2) para Alb e TTR. Apenas PCR, TTR e TF discriminaram a morbimortalidade com G3D > G3A (para PCR) e G3D < G3A (para TTR e TF). PCR/Alb e IPIN apresentaram concordância de valores para os riscos de complicações. Conclusão: Assim, conclui-se pela possibilidade de substituição do IPIN pela relação PCR/albumina, mais simples e de menor custo, mantendo-se o mesmo poder e sensibilidade para diagnóstico dos graus de risco de complicações. The inflammatory stress of hospitalyzed patients was quantified according to their plasma levels of acute-phase proteins (APP). The data from 54 adult (48 ± 20 yrs) patients were retrospectively (1994-1998) analysed along with other 12 healthy controls. The major pathologies were peripheral vascular disease (22) , penphigus pholiaceos (7), inflammatory bowel disease (7), trauma (6) and orthognatic post surgery (3). Samples of fasting venous blood were drawn and their plasma used for positive (+) and negative (-) APP by nephelometric assays. Among assayed APP+ were C-reactive protein (CRP), acid alpha-1-glycoprotein (AAG), alpha-1-antitrypsin (AAT) and ceruloplasmim (CER) while albumin (Alb), transthyretin (TTR), transferrin (TF) and retinol-binding protein (RBP) were the APP- representatives. A significant relationship (Spearman test) was found between the variables CRP ´ AAG (r = 0.49), Alb ´ TTR (r = 0.60), Alb ´ RBP (0.58), Alb ´ TF (r = 0.39), TTR ´ RBP (r = 0.56) and TTR ´TF (r = 0.43). The stronger relationships between APP+ ´ APP- were found for CRP ´ Alb (r = - 0.71), CRP ´ TTR (- 0.54), CRP ´ TF (r = - 0.39) and AAG ´ Alb (r = - 0.35). By assembling the APP according to the prognostic inflammatory nutritional index (PINI) proposed by Ingenbleek & Carpentier (Int. J. Vitam. Nutr. Res., 55: 91, 1985) the obtained data allowed a group distribution as healthy controls (G1), patients without (PINI < 1,G2) or with risk (PINI >1, G3). The later was split as lower (G3A, n =16) medium (G3B, n =10) and high (G3C, n = 6) risk and mortality-risk (G3D, n =11). The PINI values differentiated (non-parametric Kruskall-Wallis test) G3 > (G1= G2) and G3 > G3A. Among all assayed proteins only CRP, Alb and TTR discriminated groups as G3 > (G1= G2) for CRP or G3< (G1= G2) for Alb and TTR. Only CRP, TTR and TF discriminated the morbidity severity with G3D > G3A (for CRP) and G3D < G3A (for TTR and TF). The correlation coeficient allowed only APP-- substitutions at the PINI formula whereas CRP/Alb was the best PINI simplification form keeping its power of group discrimination. Centro de Metabolismo e Nutrição Unesp Faculdade de Medicina de Botucatu Clínica Médica Unesp Faculdade de Medicina pós-graduação em Patologia Unesp Faculdade de Medicina Hospital das Clínicas Unesp Instituto de Biociências Departamento de Bioestatística Unesp Faculdade de Medicina de Botucatu Clínica Médica Unesp Faculdade de Medicina pós-graduação em Patologia Unesp Faculdade de Medicina Hospital das Clínicas Unesp Instituto de Biociências Departamento de Bioestatística