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Mahmoud MA Abulmeaty,1,2 Ghadeer S Aljuraiban,1 Thuraya A Alaidarous,3 Noura M Alkahtani4 1Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Medical Physiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 3Clinical Nutrition Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Endocrinology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaCorrespondence: Mahmoud MA AbulmeatyDepartment of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi ArabiaTel +966 548155983Fax +966 114693715Email dr.abulmeaty@gmail.comPurpose: Data about body compositional changes throughout the course of type 2 diabetes (T2D) are limited and inconsistent. We investigated the roles of the disease duration and glycemic control in T2D-associated changes of body composition and the components of metabolic syndrome (MetS).Patients and Methods: A total of 25 non-diabetic controls and 92 individuals aged 20– 60 years with T2D were included in a case–control study conducted at King Faisal Specialist Hospital, Saudi Arabia. Based on disease duration (newly diagnosed: within the first year and long duration: ≥ 5 years) and glycemic control (glycated hemoglobin [HbA1C] level ≤ 7%), the patients were divided into the following groups: newly diagnosed and controlled (N&C, n=25), newly diagnosed and uncontrolled (N&U, n=17), old and controlled (O&C, n=25), and old and uncontrolled (O&U, n=25). Blood samples were collected to assess fasting blood glucose level, HbA1C level, and lipid profile. Anthropometric data were evaluated, and body composition was assessed using a bio-impedancemetry analyzer. Nonparametric tests and multivariable logistic regression analyses were performed.Results: Compared to the control group, the fat mass (FM) was significantly higher in all groups; furthermore, the fat mass/fat-free mass (FM/FFM) ratio was significantly higher in the N&C. The N&U and O&U groups showed significantly higher percentages of all components of MetS. Among all selected independent factors, only age increased the likelihood of MetS diagnosis by 7% (OR: 1.07; 95% CI: 1.004– 1.149; P< 0.05). Besides, age, gender, adherence to diet regimen, and T2D duration showed lower odds of increased FM/FFM ratio.Conclusion: This study provided evidence about the impact of T2D on body composition and the other components of MetS. Thus, further characterization of T2D contributes to defining the etiology of the disease to detect and treat poor cardiometabolic health.Keywords: type 2 diabetes, metabolic syndrome, disease duration, HbA1C, FM/FFM ratio, HOMA-IR

Background: Women with binge eating disorder (BED) and bulimia nervosa (BN) usually consume high-calorie meals with variable macro- and micronutrient compositions and have a disturbed perception of gastric fullness. The association of dietary intake with gastric interoception and gastric myoelectric activity (GMA) is poorly studied. This study examined the link between GMA/interoception and dietary intake in women with eating disorders (ED) compared to age/body mass index (BMI)-matched controls., Methods: A total of 18 women diagnosed with BED (n = 9) or BN (n = 9) and 18 age/BMI-matched controls (MC) group were enrolled in this study. Interoception was measured by measuring the volume of ingested water until the feeling of maximal fullness within 5 minutes (5 min water load test; 5 min WL). GMA was measured using transcutaneous electrogastrography (EGG) before and after water ingestion. Dietary intake was recorded using the multipath 24-hour recall of the two proceeding days. Then, food processor software was used to analyze the macro- and micronutrient composition of their diets. The volume of water load (WL) and the EGG's average dominant frequency (ADF) were correlated with macro- and micronutrient intakes., Results: Compared to the matched controls, women with ED had a significantly higher consumption of total calories, fat, saturated fat, carbohydrate (CHO), fibers, and sugar, with further higher intakes of total calories and trans-fat in the BED compared to the BN subgroup (p < 0.05). Moreover, the BED group showed higher vitamin B1, copper, and iron intakes than the MC group (p-values were <0.05). The volume of 5 min WL was higher in the BN group than in the control group (697.50 ± 186.45 vs. 466.67 ± 120.44 mL; p < 0.05) and the BED group (697.50 ± 186.45 vs. 488.75 ± 152.17 mL; p < 0.05). In the BED group, ADF showed a significant positive correlation with CHO, sugar, and vitamin B12 intakes (r = 0.700, 0.719, and 0.766, respectively; p < 0.05). Additionally, the 5 min WL volume was negatively correlated with the fiber and sodium intake in the BN group (r = -0.710 and -0.724, respectively; p < 0.05)., Conclusion: Specific dietary approaches might be effective for women with BN and BED. Women with BN may benefit from diets that are higher in fiber and sodium. In contrast, those with BED may find diets rich in simple carbohydrates and vitamin B12 helpful for regulating their eating habits and gastric mobility. Future research is encouraged to test this finding prospectively.

Background: The effectiveness of telehealth in managing obesity in Saudi patients is still under investigation. This study compared the effectiveness of telehealth and in-person obesity management programs for adults., Methods: This clinical trial involved 62 adults, 29 receiving in-person intervention at the clinic and 33 receiving telehealth via videoconference calls. Anthropometric measurements, biochemical parameters, and dietary and lifestyle habits were assessed at baseline and after 12 weeks. Patients have been educated about goal-setting, healthy eating behaviors, personalized meal plans, and increasing physical activity levels., Results: It showed that 45% and 49% of the in-person and telehealth groups lost more than 5% of their initial body weight. Weight, % body fat, and waist circumference were significantly reduced in the in-person and telehealth groups ( p < 0.001). No significant differences between the groups were found in the parameters mentioned above. Within-group analysis showed that light physical activity levels improved in both groups significantly ( p < 0.001), and the moderate physical activity level improved significantly among the telehealth group ( p < 0.039). No significant differences were observed between the groups regarding physical activity level, blood pressure measurement, and biochemical markers, except for the RBC blood level ( p = 0.026). The telehealth group had significantly higher attendance rates for counseling sessions (97% vs. 75% for the in-person group, p < 0.01). Participants' dropout rates were higher for the in-person group 21%, compared to the telehealth group 13%. Telehealth participants' satisfaction regarding the benefits of the obesity management program in losing weight was higher at 87% compared to the in-person group at 76%., Conclusions: In conclusion, applying a telehealth obesity management program can support patients struggling with obesity who may have limited access to traditional healthcare services, while ensuring that telehealth care replicates the quality of in-person care.

Profoundly hearing-impaired individuals lack health-promotion education on healthy lifestyles, and this may be due to communication barriers and limited awareness of available resources. Therefore, providing understandable healthy eating knowledge and a proper education evaluation via a questionnaire is vital. The present study aimed to translate, culturally adapt, and validate the content of a Saudi sign language version of the General Nutrition Knowledge Questionnaire (GNKQ). The study followed the World Health Organization guidelines for the translation and cultural adaptation of the GNKQ, using two-phase translation (from English into Arabic and then from Arabic into Saudi sign language), including forward-translation, back-translation, and pilot testing among profoundly hearing-impaired individuals. A total of 48 videos were recorded to present the GNKQ in Saudi sign language. The scale-level content validity index (S-CVI) value was equal to 0.96, and the item-level content validity index (I-CVI) value for all questions was between 1 and 0.9, except for question 6 in section 1, which was 0.6; this discrepancy was due to religious, social, and cultural traditions. The translation, cultural adaptation, and content validity of the Saudi sign language version of the GNKQ were satisfactory. Further studies are needed to validate other measurement properties of the present translated version of this questionnaire.

Ultrasound (US) is a promising tool for skeletal muscle assessment; however, US studies have scarcely focused on Arabic populations. This study examined the association of handheld US indicators and bioelectrical impedance analysis (BIA) parameters in healthy Arabic females. A cross-sectional study was conducted on 60 healthy Arabic females whose muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris (RF) were measured alongside their MT and pennation angle (PA) of the medial gastrocnemius (MG) muscle (both muscles on the dominant side). Anthropometric and body composition analyses quantified fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM). Muscle strength was assessed using a handgrip dynamometer, and physical activity levels were recorded with the Global Physical Activity Questionnaire (GPAQ). The CSA of the RF and the MT of both the RF and MG correlated significantly with FFM and ASMM. The PA of MG showed no significant correlations with ASMM, FFM, or handgrip strength. The CSA of RF was significantly correlated with handgrip strength ( r = 0.313, p = 0.015), while the PA of MG correlated positively with GPAQ score ( r = 0.346, p = 0.007). The CSA of RF significantly predicted both ASMM (β = 0.883, p = 0.0002) and FFM (β = 1.935, p = 0.0001). In conclusion, handheld US parameters, especially the RF's CSA, correlate with and can predict BIA-based FFM and ASMM in healthy females.

Active athletes frequently develop low energy (LEA) and protein availabilities (LPA) with consequent changes in the vital metabolic processes, especially resting metabolic rate (RMR) and substrate utilization. This study investigated the association of energy and protein intakes with RMR and substrate utilization in male and female athletes and those with LEA and LPA. Sixty athletes (35% female, 26.83 ± 7.12 y) were enrolled in this study. Anthropometric measurements and body composition analysis were reported to estimate fat-free mass (eFFM). Dietary intakes were recorded by two-day multiple-pass 24 h recall records and three-day food records and then analyzed by food processor software to calculate protein intake (PI) and energy intake (EI). Indirect calorimetry was used to measure RMR and percentages of substrate utilization. Activity-energy expenditure (AEE) was assessed by using an Actighrphy sensor for three days. Energy availability was calculated using the following formula (EA = EI - AEE/eFFM). The correlation of EI and PI with RMR and substrate utilization was tested with Pearson correlation. In the LEA group, both EI and PI correlated positively with RMR (r = 0.308, 0.355, respectively, p < 0.05). In addition, EI showed a positive correlation with the percentage of fat utilization. In the male and sufficient-PA groups, PI correlated positively with the RMR and negatively with the percentage of protein utilization. In conclusion, the percentage of LEA is markedly prevalent in our sample, with a higher prevalence among males. Athletes with LEA had lower fat utilization and lower RMR, while those with sufficient PA showed lower protein utilization with excessive PI. These findings may explain the metabolic responses in the cases of LEA and LPA.

Objective: To investigate the response of nutritional supplement (LNS-PLW) on appetite score, energy intake, insulin and glucose levels in preeclamptic women., Design & Participants: Sixty under-weight preeclamptic primigravida were divided into two groups randomly and provided LNS-PLW/Placebo in the fasted state. Blood samples were collected at fasting state, after 30mins of supplementation, "ad libitum buffet" breakfast and lunch for glucose and insulin levels., Results: Total energy intake was higher significantly in the LNS-PLW group, although during breakfast it was significantly reduced. The insulin and glucose concentration was significantly increased after 30min of supplementation in the LNS-PLW group., Conclusion: Intake of the LNS-PLW by pre-eclamptic women had short-term suppression on subsequent meal but improved total energy intake during trial., (Copyright 2024 The Author(s).)

Being the most stable component of energy expenditure, resting metabolic rate (RMR) is usually used in the calculation of energy requirements for athletes. An adequate energy prescription is essential in supporting athlete development. This work aims to develop and validate an equation for calculating energy requirements for Arabic Saudi athletes. This cross-sectional study included 171 active athletes aged 18 to 45 years. The sample was divided into a development group (n = 127) and a validation group (n = 44). Anthropometry, indirect calorimetry, and body composition analysis via bioelectric impedance analysis were performed on all participants. The novel predictive equations were created by using stepwise linear regression analyses. The accuracy of the novel equations was compared with 10 equations, and Bland and Altman plots were used to estimate the limits of agreement between measured RMR and novel equations. The first novel equation used a set of basic measures, including weight, gender, and age, was [RMR = 1137.094 + (Wt × 14.560)-(Age × 18.162) + (G × 174.917)] (R = 0.753, and R2 = 0.567, wt = weight, G = gender; for male use 1 and female 0). The second equation used fat-free mass, age, and weight [RMR = 952.828 + (fat-free mass × 10.970)-(Age × 18.648) + (Wt × 10.297)] (R = 0.760 and R2 = 0.577). Validation of the second novel equation increased the prediction of measured RMR to 72.7% and reduced the amount of bias to 138.82 ± 133.18 Kcal. Finally, the new set of equations was designed to fit available resources in clubs and showed up to 72.73% accurate prediction and good agreement with measured RMR by Bland and Altman plots., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Unpredictable chronic mild stress (UCMS) leads to variable metabolic effects. Oxidative stress (OS) of adipose tissue (AT) and mitochondrial energy homeostasis is little investigated. This work studied the effects of UCMS on OS and the antioxidant/redox status in AT and mitochondrial energy homeostasis in rats. Twenty-four male Wistar rats (180-220 g) were divided into two equal groups; the normal control (NC) group and the UCMS group which were exposed to various stresses for 28 days. An indirect calorimetry machine was used to measure volumes of respiratory gases (VO 2 & VCO 2 ), total energy expenditure (TEE), and food intake (FI). The AT depots were collected, weighed, and used for measuring activities and gene expression of key antioxidant enzymes (GPx1, SOD, CAT, GR, GCL, and GS), OS marker levels including superoxide anion (SA), peroxynitrite radical (PON), nitric oxide (NO), hydrogen peroxide (H 2 O 2 ), lipid peroxides (LPO), t-protein carbonyl content (PCC), and reduced/oxidized glutathione levels (GSH, GSSG). Additionally, AT mitochondrial fractions were used to determine the activities of the tricarboxylic acid cycle (TCA) cycle enzymes (CS, α-KGDH, ICDH, SDH, MDH), respiratory chain complexes I-III, II-III, IV, the nicotinamide coenzymes NAD + , NADH, and ATP/ADP levels. Compared with the NC group, the UCMS group showed very significantly increased OS marker levels, lowered antioxidant enzyme activities and gene expression, as well as lowered TCA cycle and respiratory chain activity and NAD + , NADH, and ATP levels (p < .001 for all comparisons). Besides, the UCMS group had lowered TEE and insignificant FI and weight gain. In conclusion, AT of the UCMS-subjected rats showed a state of disturbed redox balance linked to disrupted energy homeostasis producing augmentation of AT., (© 2023 John Wiley & Sons Ltd.)

There is little research evaluating skeletal muscle strength, nutritional status, and quality of life in older Arab adults. This study examined the association of nutritional status with skeletal muscle strength and quality of life among older adults living in Saudi Arabia. A cross-sectional study was conducted among older adults ( n = 166 older adults; 57.8% females) who visited primary outpatient clinics at King Khalid University Hospital in Riyadh City. Sociodemographic data, Mini Nutritional Assessment short-form (MNA-SF), diet variety score (DVS), and health-related quality of life (HR-QoL) were assessed. Furthermore, handgrip strength (HGS) and knee extension strength (KES) were measured to evaluate skeletal muscle strength. Malnourishment and risk of malnutrition were found in 16.9% of our sample. Nutritional status was significantly associated with muscle strength and HR-QoL ( p < 0.05). The well-nourished group had higher HGS, KES, and total HR-QoL scores compared to the at risk of malnutrition or malnourished group. Moreover, there was a moderate positive correlation between MNA-SF and total HR-QoL scores (r = 0.40). The percentage of individuals in the well-nourished group categorized with a high or moderate DVS was significantly higher than those at risk of malnutrition or are malnourished; however, DVS was not associated with muscle strength and HR-QoL. The MNA-SF score had a significant positive correlation with HGS (r = 0.30) and KES (r = 0.23). An increase in the MNA-SF score was significantly associated with higher odds of being moderate/high (HGS and HR-QoL) in the crude and adjusted models. In conclusion, maintaining adequate nutritional status is beneficial for preserving skeletal muscle strength and promoting better HR-QoL among older individuals. Therefore, applications of appropriate nutritional and muscle strength assessments in geriatric care institutions are recommended.

Depression is a psychiatric disorder that negatively affects how a person feels, thinks, and acts. Several studies have reported a positive association between vitamin D (VD) deficiency and depression. Therefore, we aimed to examine the effects of intraperitoneal injection of VD3, fluoxetine (antidepressant), and a combination of VD3 + fluoxetine on a rat model of chronic unpredictable mild stress (CUMS). A total of 40 male Wistar rats (224-296 g) were divided into five groups ( n = 8 each) as follows: (1) the control group, (2) the CUMS group, (3) the CUMS group that received vitamin D (10 μg/kg), (4) the CUMS group that received fluoxetine (5 mg/kg), and (5) the CUMS group that received both vitamin D (10 μg/kg) and fluoxetine (5 mg/kg). The CUMS model was produced by exposing rats to frequent social and physical stressors for 21 days. In addition, blood samples were collected to determine corticosterone and serum VD levels. Also, behavioral tests were conducted, including the sucrose preference test (SPT), the forced swimming test (FST), the tail suspension test (TST), the open field test (OFT), and the elevated plus maze test (EPM). Our results show that VD3 had effects similar to fluoxetine on the depressive behavior of the rats when measured by three behavioral tests, namely SPT, FST, and OFT ( p < 0.001). Additionally, VD3 had a protective effect against depression similar to that of fluoxetine. Corticosterone levels were lower in the CUMS group that received vitamin D and the CUMS group that received both vitamin D and fluoxetine than in the CUMS group ( p < 0.000). In conclusion, VD3 has a protective effect against anxiety and depressive behaviors produced by CUMS in rats.

Women with eating disorders (EDs) often complain of abnormal gastric responses, which may impact their eating patterns and, consequently, their body composition. Binge eating disorder (BED) and bulimia nervosa (BN) have been shown to affect gastric myoelectric activity (GMA), which may provide a basis for the gastric response in this disease population. This study aimed to examine GMA and body composition in patients with an ED compared to age-body mass index (BMI) matched controls. This case-control study included 18 adults diagnosed with BED or BN compared to 19 age-gender-BMI-matched controls. The electrogastrography with water load test was used to measure GMA during fasting and after water loading to satiety. Body composition was measured using a bioelectric impedance analyzer. The results showed that the ED group had a significantly higher water load than the control group and increased percentages of tachygastria times. Comparing the BED and BN subgroups showed differences in body composition status between the subgroups in the form of less fat mass, muscle mass, and total body water in the BN subgroup. In the BN subgroup, fat mass was associated with the average dominant frequency in the EGG. Thus, measuring GMA may be a promising approach to understanding gastric abnormalities in patients with EDs. Therapies targeting improving body composition in women with BED and BN are recommended in future ED management strategies.

Exposure to long-term chronic unpredictable mild stress (CUMS) can cause redox imbalance and inflammation, which may affect the integrity of the gut barrier. The present study was conducted to investigate the effects of a probiotics bacterium mixture, including Clostridium butyricum (C. butyricum) and Bifidobacterium infantis (B. infantis) , on the intestinal homeostasis in rats exposed to multiple low-intensity stressors for 28 days. The mechanism of CUMS-induced altered intestinal homeostasis was evaluated by focusing on the nuclear factor-E2-related factor-2 (Nrf-2) pathway. In contrast to the CUMS group, probiotic mixture supplementation significantly ( p < 0.01) reversed the stress-induced elevated corticosterone level, protein and lipid oxidation, and increased enzymatic and non-enzymatic antioxidant levels, as well as upregulated Nrf-2/HO-1 pathway. Probiotics supplementation further significantly ( p < 0.01) decreased the CUMS-induced inflammation, altered T-lymphocyte levels, and suppressed the protein expression of nuclear factor kappa B (NF-κB) in rat intestines. Improvement in histological changes and intestinal barrier integrity further validate the beneficial effects of probiotic mixtures on CUMS-induced altered intestinal morphology. In conclusion, our results suggest that the combination of C. butyricum and B. infantis significantly attenuated CUMS-induced oxidative stress, inflammation, and T-lymphocyte modulation by upregulating Nrf-2/HO-1 signaling and inhibiting NF-κB expression in rat intestine.

Background and Objectives : Obesity is a chronic inflammatory condition and is considered a major risk factor for cardiovascular disease (CVD). The effects of obesity management via sleeve gastrectomy (SG) and lifestyle intervention (LS) on inflammatory cytokines, redox status, and CVD risk were studied in this work. Materials and Methods : A total of 92 participants (18 to 60 years old) with obesity (BMI ≥ 35 kg/m 2 were divided into two groups: the bariatric surgery (BS) group ( n = 30), and the LS group ( n = 62). According to the achievement of 7% weight loss after 6 months, the participants were allocated to either the BS group, the weight loss (WL) group, or the weight resistance (WR) group. Assessments were performed for body composition (by bioelectric impedance), inflammatory markers (by ELISA kits), oxidative stress (OS), antioxidants (by spectrophotometry), and CVD risk (by the Framingham risk score (FRS) and lifetime atherosclerotic cardiovascular disease risk (ASCVD)). Measurements were taken before and after six months of either SG or LS (500 kcal deficit balanced diet, physical activity, and behavioral modification). Results : At the final assessment, only 18 participants in the BS group, 14 participants in the WL group, and 24 participants in the WR group remained. The loss in fat mass (FM) and weight loss were greatest in the BS group ( p < 0.0001). Levels of IL-6, TNF-a, MCP-1, CRP, and OS indicators were significantly reduced in the BS and WL groups. The WR group had significant change only in MCP-1 and CRP. Significant reductions in the CVD risk in the WL and BS groups were detected only when using FRS rather than ASCVD. The FM loss correlated inversely with FRS-BMI and ASCVD in the BS group, whereas in the WL group, FM loss correlated only with ASCVD. Conclusions : BS produced superior weight and fat mass loss. However, both BS and LS produced a similar reduction in the inflammatory cytokines, relief of OS indicators, and enhancement of antioxidant capacity, and consequently reduced the CVD risk.

The capability of bariatric surgery (BS) and lifestyle intervention (LSI) in ameliorating obesity-associated altered gastric myoelectric activity (GMA) in relation to body composition is underinvestigated. This work studied GMA during weight loss via sleeve gastrectomy and multimodal lifestyle intervention. Seventy-nine participants with morbid obesity were assigned into three groups: bariatric surgery (BS group, n = 27), in which laparoscopic sleeve gastrectomy was performed; lifestyle intervention (LS group, n = 22), in which a calorie-deficit balanced diet with gradual physical activity and personalized behavioral modification were carried out; and waitlist control (C group, n = 30). For all participants, multichannel electrogastrography (EGG) with water-load testing and bioelectric impedance body composition analysis were done at baseline, after three months, and at six months. In the BS group, the water-load volume was decreased but without improvement in the bradygastria. In the LS group, preprandial bradygastria were reduced and some postprandial normogastria were increased throughout the study period. Except for fat-free mass and total body water, the parameters of body composition changes were superior in the BS group. In the LS group, the amount of fat-mass loss was negatively correlated with bradygastria times and positively correlated with preprandial and the early postprandial average dominant frequency (ADF). In addition, in the BS group, fat-mass loss was positively correlated with the ADF at late postprandial times. In conclusion, compared to BS, LS produced moderate normalization of GMA with the preservation of fat-free mass. The GMA changes were significantly associated with the amount of fat loss, regardless of the method of obesity management.

The Global Leadership Initiative on Malnutrition (GLIM) is a new approach established for the assessment of malnutrition. This study aimed to validate the GLIM for the diagnosis of malnutrition in patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia, using the Subjective Global Assessment (SGA) as a reference. In addition, the association between the GLIM criteria and vascular complications in those patients was examined. A cross-sectional study was conducted on 101 patients with T2DM. The level of agreement between the GLIM and SGA tools was calculated using the kappa coefficient (κ). A receiver operating characteristic curve was used to determine the sensitivity and specificity of the GLIM. In addition, binary logistic regression was performed to investigate the association between each GLIM criterion and T2DM vascular complications. According to both the GLIM and the SGA, malnutrition was found in 15.8% and 17.8% of patients, respectively. The GLIM criteria achieved a very good level of accuracy (AUC = 0.877). The agreement between the tools was substantial (κ = 0.778). The 'disease/inflammation' criterion of the GLIM was significantly associated with macrovascular complications. To conclude, the GLIM criteria for diagnosis of malnutrition presented satisfactory levels of validity, and as such are acceptable for assessing the nutritional status of patients with T2DM.

The energy homeostasis-associated (Enho) gene, the transcript for the Adropin peptide, is usually linked to energy homeostasis, adiposity, glycemia, and insulin resistance. Studies on Enho expression in stressful conditions are lacking. This work aimed to investigate Enho mRNA expression and energy homeostasis in acute stress (AS) versus chronic unpredictable mild stress (CUMS) rat models. A total of thirty male Wistar rats (180-220 g) were fed a balanced diet with free access to water. Rats were divided into three equal groups ( n = 10): (a) the normal control (NC) group; (b) the AS group, where one episode of stress for 2 h was applied; and (c) the CUMS group, in which rats were exposed to a variable program of mild stressors for 4 weeks. Energy homeostasis was analyzed by the PhenoMaster system for the automatic measuring of food intake (FI), respiratory O 2 volume (VO 2 ), CO 2 volume (VCO 2 ), respiratory quotient (RQ), and total energy expenditure (TEE). Finally, liver, whole brain, and adipose (WAT) tissue samples were collected, total RNA was prepared, and RT-PCR analysis of the Enho gene was performed. The CUMS group showed higher VO 2 consumption and VCO 2 production, and a higher RQ than the AS group. Furthermore, the TEE and FI were higher in the CUMS group compared to the AS group. Enho gene expression in the liver, brain, and WAT was significantly higher in the CUMS group than in the AS and NC groups. We can conclude that in the chew-fed AS rats, hypophagia was evident, with a shift in the RQ toward fat utilization, with no changes in body weight despite the increase in Enho mRNA expression in all studied tissues. In the CUMS group, the marked rise in Enho mRNA expression may have contributed to weight loss despite increased FI and TEE.

Obesity can modulate gastric myoelectric activity (GMA); however, the relationship of GMA with nutrient intakes and substrate utilization in adults with obesity is lacking. We examined the association of dietary intakes, energy expenditure, and substrate utilization with the GMA. Participants (n = 115, 18−60 y) were divided into healthy weight (HW, n = 24), overweight (OW, n = 29), obese (OB, n = 41) and morbidly obese (MO, n = 21). Two-day multi-pass 24 h recalls were conducted. The GMA was measured by multichannel electrogastrography (EGG) with water-load (WL) testing. Resting metabolic rate (RMR) and percentages of substrate utilization were measured by indirect calorimetry. In the HW, protein intake was directly correlated with average dominant frequency (ADF) and with WL volume, while in obese participants and the MO subgroup, WL volume correlated with carbohydrate intake. In participants with obesity, ADF was positively correlated with fiber intake. In participants with obesity and the OB subgroup, RMR was positively correlated with water-load volume (r = 0.39 and 0.37, p < 0.05). The ADF showed negative correlations with percent of fat utilization and positive correlations with percent of CHO utilization in non-obese groups. However, protein utilization showed inverse correlation in all obese groups. In conclusion, these distinctive associations suggest that certain dietary compositions and dieting regimens impact GMA patterns.

Several studies have found a correlation between inflammatory markers and sarcopenia; however, limited research has been conducted on the Arabic population. Therefore, this study aimed to investigate the value of inflammatory parameters in Saudi elderly women with sarcopenia. In this cross-sectional study, 76 elderly Saudi women (>65 years) were stratified according to the presence (n = 26) or absence (n = 50) of sarcopenia, using the operational definition of the Asian Working Group for Sarcopenia (AWGS). Demographics and clinical data were collected. Muscle mass, muscle strength, and physical performance were assessed using bioelectrical impedance, hand grip and timed-up-and-go (TUG) tests, respectively. Inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) were assessed using commercially available assays. Muscle mass and strength indicators were lower in the sarcopenia group (p-value < 0.05). Moreover, interleukin 6 (IL-6) was positively correlated with TUG (r = 0.48, p-value < 0.05), while CRP showed an inverse correlation with the right leg muscle (R-Leg-M) and a positive correlation with triceps skinfold (TSF) (r = −0.41, r = 0.42, respectively, p-values < 0.05). Additionally, TSF and R-Leg-M were independent predictors of CRP variation (R2 = 0.35; p < 0.01). Lastly, participants with a TNF-α > 71.2 were five times more likely to have sarcopenia [(OR = 5.85), 95% CI: 1.07−32.08; p = 0.04]. In conclusion, elevated levels of TNF-α are significantly associated with the risk of sarcopenia, while variations perceived in circulating CRP can be explained by changes in the muscle mass indices only among individuals with sarcopenia. The present findings, while promising, need further investigations on a larger scale to determine whether inflammatory markers hold any diagnostic value in assessing sarcopenia among elderly Arab women.

Sarcopenia is the loss of skeletal muscle mass, and is most common in older people. The present multi-center cross-sectional study aimed to determine the prevalence of sarcopenia and possible risk factors among Arab elderly females. A total of 131 ambulatory Saudi elderly females aged 60-85 years (mean age 65.9 ± 5.5 years) were recruited to participate. A general questionnaire with questions related to sociodemographic factors, medical history, diet, physical activity, and lifestyle was administered. Anthropometrics and muscle assessments were done. Fasting blood glucose and lipids were measured routinely. Circulating 25(OH)D and irisin levels were measured using commercially available assays. Sarcopenia was assessed using the criteria of the Asian Working Group for Sarcopenia (AWGS). Over-all prevalence of sarcopenia was 19.8% (26 out of 131 participants). Novel measures such as abdominal volume index (AVI), dietary fiber, and irisin were found to be significantly lower in the sarcopenia group than those without sarcopenia, independent of age. No associations were found with physical activity or dietary and lifestyle habits. In conclusion, sarcopenia is relatively common among Arab elderly females. Longitudinal studies are needed to determine whether lifestyle modifications can decrease the incidence of sarcopenia in this population. Irisin maybe a promising biomarker for sarcopenia but needs to be confirmed using larger sample sizes.

Background and Objective: Functional disturbances of gastric myoelectrical activity (GMA) might exist in obesity. However, studies on its association with the gastric hormones in obesity phenotypes are lacking. The objective was to study the association of GMA with the serum levels of key gastric hormones in different obesity phenotypes. Methods: A total of 139 adults (31.00 ± 11.12 years) were classified into different metabolic phenotypes of obesity: 1) normal weight-lean (NWL group): BMI <25 kg/m 2 and the fat-mass index (FMI) ≤9.7 kg/m 2 in females and ≤6.3 kg/m 2 in males; 2) metabolically obese normal weight (MONW group): BMI <25 kg/m 2 and FMI >9.7 kg/m 2 in females and >6.3 kg/m 2 in males; 3) metabolically healthy obese (MHO group): BMI ≥25 and FMI ≤9.7 kg/m 2 in females and ≤6.3 kg/m 2 in males; and 4) metabolically unhealthy obese (MUO group): BMI ≥25 and FMI >9.7 kg/m 2 in females and >6.3 kg/m 2 in males. The GMA was measured at the baseline and post-prandial state using a multichannel electrogastrography with a water load satiety test. The average power distribution by the frequency region and the average dominant frequency were used for analysis. Anthropometric measurements and bioelectric impedance analysis were performed to calculate the FMI and fat-free mass index (FFMI). Serum levels of ghrelin, gastrin, and irisin were measured by ELISA kits according to the manufacturer's protocol. Results: Compared to the NWL group, gastrin and ghrelin levels were significantly low in the MUO participants, while irisin was significantly high. The EGG showed significantly lower baseline and 20-min normogastria frequencies in the MHO and MUO groups. In the MHO group, baseline duodenal frequency was positively correlated with the gastrin level, while normogastria times were positively associated with the irisin level and negatively associated with the ghrelin level. In the MUO group, percentages of bradygastria frequencies at 10, 20, and 30 min were positively correlated with the BMI and FFMI. This bradygastria was correlated positively with the irisin level and negatively with the ghrelin level. Conclusion: The EGG patterns might be associated with obesity-related gastric hormones in different obesity phenotypes. EGG may be a promising clinical tool in obesity assessment. The association of the EGG patterns with hormonal levels needs further investigation for potential practical uses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abulmeaty, Aldisi, Aljuraiban, Almajwal, El Shorbagy, Almuhtadi, Albaran, Aldossari, Alsager, Razak, Berika and Al Zaben.)

Coronavirus disease 2019 (COVID-19) is a rapidly growing pandemic that requires urgent therapeutic intervention. Finding potential anti COVID-19 drugs aside from approved vaccines is progressively going on. The chemically diverse natural products represent valuable sources for drug leads. In this study, we aimed to find out safe and effective COVID-19 protease inhibitors from a library of natural products which share the main nucleus/skeleton of FDA-approved drugs that were employed in COVID-19 treatment guidelines or repurposed by previous studies. Our library was subjected to virtual screening against SARS-CoV Main protease (Mpro) using Molecular Operating Environment (MOE) software. Twenty-two out of those natural candidates showed higher binding scores compared to their analogues. We repurpose these natural products including alkaloids, glucosinolates, and phenolics as potential platforms for the development of anti-SARS-CoV-2 therapeutics. This study paves the way towards discovering a lead used in the treatment of COVID-19 from natural sources and introduces phytomedicines with dual therapeutic effects against COVID-19 besides their original pharmacological effects. We recommend further in vitro evaluation of their anti-COVID-19 activity and future clinical studies., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The use of bioelectrical impedance analysis (BIA) in clinical settings is common. However, the value of BIA-based parameters in diagnosing metabolic syndrome (MetS) in children is under-investigated. Herein, we aimed to study the usefulness of BIA-indices in the diagnoses of MetS in 6-10-year-old girls. Therefore, a diagnostic accuracy case-control study was conducted, which included 75 girls aged 10-16 years, divided into three age-matched groups (normal, None-MetS, and MetS). Anthropometric indices, BIA parameters (including fat-free mass (FFM), body fat percent (BFP), and total body water (TBW)), blood pressure (BP), and blood samples were collected. Our main findings show that for girls in None-MetS and MetS groups, the waist circumference (WC) correlated positively with waist-hip ratio and mid-arm circumference (r = 0.58, 0.47, respectively), but not with BFP based on skinfold thickness (SFT), or mid-arm muscle area. WC was positively correlated with FFM and TBW, while high-density lipoprotein was inversely correlated with FFM. However, fasting blood glucose, triglycerides and BP showed no association with anthropometric measurements and BIA components. WC was the best indicator of MetS (AUC = 0.88, cut-off = 81.5 cm), followed by BMI (AUC = 0.84, cut-off = 26.9 kg/m 2 ), while BFP based on SFT was the least sensitive (62.5%). In conclusion, apart from the FM index, anthropometric parameters such as WC are more valuable in diagnosing MetS in young adolescent girls.

Vitamin D (VD) deficiency is frequently reported in heart transplant (HT) recipients and routinely supplemented. However, the efficacy of VD supplementation on bone mineral density (BMD) and its association with all-cause mortality is underinvestigated. The VD levels and BMD were studied for two years, and the association of VD and BMD with all-cause mortality risk was investigated. Ninety-six HT patients (38.18 ± 12.10 years old; 74% men) were followed up during VD, Ca, and Mg supplementation. Anthropometric measurements, BMD by Dual-energy X-ray absorptiometry (DEXA) scan, VD concentrations, and related biochemical parameters were analyzed before, 1 year, and 2 years after HT. Despite significant improvement of VD 3 and 25-hydroxy VD (25OHVD) levels especially in the men, BMD parameters were insignificantly changed. After 2 years, the all-cause mortality rate was 15.6%. High pretransplant levels of 25OHVD failed to improve the survival probability. Cox's regression showed a 32.7% increased hazard ratio for each unit increase in body mass index (95% CI: 1.015-1.733, p = 0.038), in the VD-deficient group rather than in the VD-sufficient one. In conclusion, VD supplementation improves the biochemical status, especially in VD-deficient HT. However, its impact on the BMD and mortality was not as usually expected. Further investigation of the disturbed VD metabolism in HT is warranted.

Candesartan cilexetil (CC) is an antihypertensive drug. It has low solubility and faces hepatic first-pass metabolism after oral ingestion. We formulated bioadhesive buccal films and studied the respective drug pharmacokinetics. Different bioadhesive films were prepared (40, 80, 120, 160, 200, and 240 mg CC per film) by using the solvent casting method. The drug concentrations used affect the drug entrapment mechanism, which was reflected in the film physicochemical properties like thickness, weight, drug content, bioadhesion, and drug release. Low drug concentration (F2, 40 mg per film) led to minute drug crystal dispersion while increasing the drug concentration (F7, 240 mg per film) showed drug crystal encapsulation, which affects the drug release. The drug pharmacokinetic from the prepared films was studied compared to the oral form by serial blood sampling via an inserted catheter in the carotid of rats. High-Performance Liquid Chromatography assay was used to measure the plasma concentration of CC in different forms. Compared to other films, the F2 showed the highest maximal concentration (Cmax) and the lowest elimination half-life (t 1/2 ). Bioadhesion buccal film of CC has better bioavailability, especially at low concentrations. The ease, robustness, and ruggedness of the preparation suggests the same procedure for drugs like CC.

Acrylamide (AA) is a hazardous chemical that is widely used in industrial practices. Spirulina platensis (SP) is a blue green alga that is rich in bioactive compounds with many medicinal benefits. The aim of the present study was to evaluate the ameliorative effect of SP against AA toxicity in rats. Animals were divided into six groups: Group (1) was normal rats, groups (2) and (3) received SP at 500 and 1000 mg/kg BW orally respectively for 21 days, group (4) was administered 20 mg/kg BW AA daily for 14 days, while groups (5) and (6) were given orally SP at the same doses of groups (2) and (3), then AA at similar dose of group (4). Rats that received AA alone displayed markedly increased serum levels of liver enzymes (ALT, AST, and ALP), kidney function parameters (urea and creatinine), DNA damage marker (8-OHdG), and proinflammatory cytokines (IL-1β, IL-6, and TNF-α), compared to control rats. Furthermore, tissue analysis revealed marked increases in hepatic, renal, and brain MDA and NO, as well as marked reductions in the antioxidant biomarkers (GSH, GSH-Px, SOD, and CAT) in acrylamide-intoxicated rats. Spirulina ameliorated the alterations in serum biochemical parameters and reduced MDA and NO, as well as improved antioxidant biomarkers in AA-intoxicated rats in a dose-dependent manner. Our results show that SP has a powerful protective effect on serum biochemistry and liver, kidney, and brain antioxidant machinery in AA-intoxicated rats.

Modulation of cytokine production using immunonutrition is a relatively novel concept to improve outcomes among patients with SARS-CoV-2 infection and is now hypothesized to help manage COVID-19, however, clinical evidence is lacking. This prospective, double-blinded, randomized parallel-controlled interventional clinical trial investigated the effect of antioxidant supplements on inflammatory cytokines and disease progression in non-critically ill patients. A total of 87 hospitalized COVID-19 patients were randomized using computer-generated-randomization into the supplement group ( n = 18) and the placebo group ( n = 16) for 10 days. Baseline and final nutritional screening via nutrition risk screening (NRS-2002) and subjective global assessment (SGA), as well as the recording of anthropometric, clinical, biochemical, and functional parameters, were done. Serum ferritin level, cytokine storm parameters such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein 1(MCP-1), C-reactive protein, total leukocyte count, lymphocytic count, and neutrophil-to-lymphocyte ratio were measured. Anthropometric and clinical parameters showed nonsignificant differences between groups. The hematology profile showed improvement in lymphocyte count in the supplement group. However, levels of alkaline phosphatase, IL-6, TNF-α, and MCP-1 were significantly lower in the supplement group. In conclusion, antioxidant oral supplementation significantly reduced the cytokine storm and led to partial improvements in clinical parameters among patients with non-critical COVID-19.

Long-term continuous light exposure (CL) and western diet (WD) effects on Adropin expression, RORα, and Rev-erb-α nuclear receptors and energy homeostasis were studied in rats. Thirty-two male Wistar rats (250-290 g) were enrolled for 3 months in the following groups ( n = 8/group): (a) Normal control group (NC), (b) CL group, (c) WD group, and (d) CL + WD group. Then, indirect calorimetry and food intake (FI) were measured. Finally, Adropin, hormone-sensitive lipase (HSL), adipocyte triglyceride lipase (ATGL), and free fatty acids (FFA) were measured. Additionally, the histopathology and gene expression of Enho, RORα, and Rev-erb-α genes were done. The CL alone elevated the Adropin plasma level and gene expression, increased RORα expression, and decreased the Rev-erb-α nuclear receptor expression mainly in the liver and kidney. Besides, CL increased the total energy expenditure (TEE) and decreased the respiratory quotient. WD alone or in combination with the CL reversed gene expression of Enho, RORα, and Rev-erb-α. Combined CL and WD increased the TEE, reduced the food intake, increased the ATGL, and reduced the Adropin level in addition to widespread degenerative changes in the liver, spleen, and renal tissues. The deleterious effects of CL and WD on energy homeostasis may include Adropin with the involvement of the RORα and Rev-erb-α nuclear receptors.

This study evaluated the Nutrition Care Process documentation used by dietitians for obese pediatric patients diagnosed with metabolic syndrome (MetS) and/or non-alcoholic fatty liver disease (NAFLD) and its impact on the achievement of nutritional goals. This retrospective cohort study utilized data retrieved from three tertiary care hospitals in Riyadh. A total of 142 obese pediatric patients aged 8-18 years diagnosed with NAFLD and/or MetS were evaluated. Data on weight, height, blood pressure (BP), lipid profile, and liver enzymes were collected. A validated audit was used to assess the documentation quality. Twenty-seven (46.6%) dietitian notes received a high score, 21 (36.2%) received a medium score, and 10 (17.2%) received a low score. There was no significant effect of dietitian audit scores on nutritional outcomes, however, the change in body mass index from 6 to 12 months follow-up period was inversely correlated with the audit score ( r = -0.761, p = 0.007), and alkaline phosphatase was inversely correlated with the audit score (r = -0.819, p = 0.013). In conclusion, there was a clear variation in the quality of dietitians' documentation and the impact of documentation scores on nutritional outcomes.

Green synthesis of metal nanoparticles using plant extracts as capping and reducing agents for the biomedical applications has received considerable attention. Moreover, emergence and spread of multidrug resistance among bacterial pathogens has become a major health concern and lookout for novel alternative effective drugs has gained momentum. In current study, we synthesized gold nanoparticles using the seed extract of Trachyspermum ammi (TA-AuNPs), assessed its efficacy against drug resistant biofilms of Listeria monocytogenes and Serratia marcescens , and evaluated its anticancer potential against HepG2 cancer cell lines. Microwave-assisted green synthesis of gold nanoparticles was carried out and characterization was done using UV-vis spectroscopy, X-ray diffraction (XRD), transmission electron microscopy (TEM), and dynamic light scattering (DLS). Most nanoparticles were observed as spherical and spheroidal with few anisotropies with an average crystalline size of 16.63 nm. Synthesized TA-AuNPs demonstrated significant biofilm inhibitory activity against L. monocytogenes (73%) as well as S. marcescens (81%). Exopolysaccharide (EPS), motility, and CSH, key elements that facilitate the formation and maintenance of biofilm were also inhibited significantly at the tested sub-minimum inhibitory concentrations (sub-MICs). Further, TA-AuNPs effectively obliterated preformed mature biofilms of S. marcescens and L. monocytogenes by 64% and 58%, respectively. Induction of intracellular ROS production in TA-AuNPs treated bacterial cells could be the plausible mechanism for the reduced biofilm formation in test pathogens. Administration of TA-AuNPs resulted in the arrest of cellular proliferation in a concentration-dependent manner. TA-AuNPs decrease the intracellular GSH in HepG2 cancer cell lines, cells become more prone to ROS generation, hence induce apoptosis. Thus, this work proposes a new eco-friendly and rapid approach for fabricating NPs which can be exploited for multifarious biomedical applications.

Malnutrition among heart-transplant patients may affect survival. The aim was to investigate the survival and nutrition status among male and female heart transplant patients who underwent transplantation, before and 1 year after surgery based on the nutritional risk index (NRI). The medical records of ninety heart-transplant patients (2009-2014) from the King Faisal Specialist Hospital, Riyadh, were reviewed. The assessment included demographic data, anthropometric measurements, and NRI calculation. Moreover, postoperative data included the length of stay and survival. Paired t -test and survival analysis by Kaplan-Meier (KM) curves were used. A total of 90 patients (males 77.78%) were included. The prevalence of malnutrition in the preoperative phase by NRI was 60% (7.78% as severe; 40% as moderate, and 12.22% mild NRI scores). After 1 year, body mass index (BMI) and NRI increased significantly ( p < 0.001). Furthermore, NRI was significantly different between men and women ( p < 0.01), while KM survival curves were insignificantly different ( p = 0.67). Recipients with postoperative moderate or severe nutritional risk (NRI < 97.5) had significantly shorter survival in the first-year post-transplantation (HR = 0.82; 95% CI, 0.75-0.89; p < 0.001). Our findings indicate that the NRI after 1 year of transplant correlated significantly with mortality. Besides, there was no significant gender difference regarding survival; however, malnutrition and low survival were more prominent among women.

Purpose: The effects of caffeine on drowsiness and reaction time in patients with narcolepsy are unclear. We aimed to assess the effects of caffeine as add-on therapy in narcolepsy patients., Methods: A randomized, double-blind, placebo-control clinical pilot trial was conducted with a parallel, two-arm trial allocation ratio of 1:1. Participants attended two study visits 7 days apart. The drug was administered orally in a single opaque capsule containing 200 mg caffeine/placebo daily in the morning for 1 week. Sleepiness was assessed objectively using infrared reflectance oculography to measure the percentage of long eye closure (LEC%) and subjectively using two sleepiness scales, the Stanford Sleepiness Scale (SSS) and Karolinska Sleepiness Scale (KSS). Parameters were measured at baseline (BL) prior to taking the drug, after taking the first dose (FD), and after 1 week (WD) of daily caffeine., Results: Sixteen participants with narcolepsy were included. No significant differences between groups in baseline measurements were observed. LEC% was significantly decreased after the FD and WD compared with baseline levels (BL 1.4 ± 2.1 vs. FD 0.06 ± 0.0.6 and WD 0.03 ± 0.04). Significant improvements in alertness were observed using the KSS when comparing BL with FD and WD (6.3 ± 1.6, 4.9 ± 1.7, and 4.7 ± 1.7, respectively; p = 0.01). No changes in reaction time or SSS scores were noted., Conclusion: Our findings suggest that a small dose of caffeine has positive effects on alertness in patients with narcolepsy. However, larger trials are required to confirm these findings., Trial Registration No: ClinicalTrial.gov NCT02832336.

Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes.

A pro-inflammatory diet may have an adverse influence on stress and inflammatory biomarker levels among college students. The dietary inflammatory index (DII ® ) is a tool used to assess the inflammatory potential of a diet. However, evidence for the association between DII and stress is limited. We examined the association between energy-adjusted DII (E-DII TM ), high sensitivity-C-reactive protein [hs-CRP], and stress among female college students. This cross-sectional study included 401 randomly selected female students, aged 19-35 years. Data collection included blood, anthropometric measurements, a healthy-history questionnaire, the perceived stress scale (PSS-10), the Saudi food frequency questionnaire (FFQ), and E-DII. Multiple linear regression analyses were used to examine the association between FFQ-derived E-DII score, hs-CRP, and PSS. A higher E-DII score per 1SD (1.8) was associated with a 2.4-times higher PSS score (95% CI: 1.8, 3.1). Higher hs-CRP per 1SD (3.3 mg/L) was associated with a 0.9 (95% CI: 0.7-1.1) times higher PSS score, independent of lifestyle and dietary factors. Our findings indicate that pro-inflammatory diets were highly prevalent among Saudi college students and were associated with higher stress levels. Consideration of the role of stress and focusing on anti-inflammatory foods may be key for healthier dietary habits.

This case-control study compared the body composition, resting metabolic rate (RMR), and respiratory quotient (RQ) of narcolepsy patients with those of body mass index (BMI)- gender and age-matched controls. This study included 14 male patients with narcolepsy and 14 matched controls. The narcolepsy patients were subdivided into two subgroups (n = 7/each): those with cataplexy (NT1) and those without cataplexy (NT2). Anthropometric measurements, bioelectric impedance analysis, and indirect calorimetry were used in addition to the calculation of common body-composition indices (conicity index, abdominal volume index, and body adiposity index). Our results showed no significant difference in fat percentage, fat mass, fat-free mass, and TBW among NT1, NT2, and controls (p > 0.05). Compared to matched controls, there was a reduction of muscle mass in both NT1 and NT2 subgroups. The RMR was similar in all groups, while patients in the NT1/NT2 subgroups had a lower RQ, used more fat and fewer carbohydrates during the fasting period. These findings give an insight into the distinctive state of altered metabolism in patients with narcolepsy, especially the resting metabolic rate, which was not altered in NT1 vs. NT2 compared to the controls when matched for BMI, age, and gender.

Background and Aims: To investigate the impact of glycemic control and T2D duration on vitamin D status and cardiovascular disease (CVD) risk among Saudi patients., Methods: This case-control study was conducted in King Faisal Specialist Hospital, Saudi Arabia. A total of 25 nondiabetic controls and 92 patients with confirmed T2D, aged 20-60 years, were included. Patients with T2D were divided into the following groups based on disease duration (newly diagnosed: ≈6 months and long duration: ≥5 years) and glycemic control based on their glycated hemoglobin (HbA 1C ) level with a threshold of ≤0.053 mol/mol: newly diagnosed controlled (NC, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU, n = 25), newly diagnosed uncontrolled (NU., Results: Our study showed that T2D duration was an independent predictor of vitamin D deficiency. The longer disease duration, the lower odds of being vitamin D deficient (odds ratio (OR) = 0.05, 95% CI: 0.01-0.29, p < 0.05). No significant association was observed between vitamin D and HbA 1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D ( r = 0.53, p < 0.05). No significant association was observed between vitamin D and HbA 1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D ( r = 0.53, p < 0.05). No significant association was observed between vitamin D and HbA 1C levels. In the NU group, CVD risk scores were directly correlated with serum 25(OH)D (., Conclusion: Duration of diabetes rather than glycemic control is associated with vitamin D deficiency. Glycemic uncontrol may augment vitamin D deficiency-associated CVD risk in both newly diagnosed and old patients with type 2 diabetes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Thuraya A. Alaidarous et al.)

Background and Objective: Previous studies have identified the role of irisin and vitamin D in energy homeostasis. However, the effect of irisin and vitamin D on energy regulation has not been thoroughly investigated. Therefore, in this study, the effects of a vitamin D-deficient diet and irisin on total energy expenditure (TEE), food intake, and blood metabolites were investigated in rats., Methods: Sixteen healthy weaned male albino rats were randomly divided into two groups: a group fed a normal balanced growth diet (group A: n = 8) and a group fed a normocalcemic diet that is vitamin D deficient with limited ultraviolet (UV) light exposure (group B, n = 8). After 6 weeks, the volumes of respiratory gases were measured by open-circuit indirect calorimetry. Serum irisin, 25-OHVD 3 , calcium, insulin, and glucose levels were measured using ELISA. The respiratory quotient (RQ), energy expenditure, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were calculated., Results: Rats with hypovitaminosis D were hypoirisinemic. Food intake, RQ (to the range of using endogenous fat), and glucose levels reduced significantly, while insulin levels increased. Body weight and TEE were non-significant changed. Additionally, irisin was strongly and positively correlated with body weight under normal conditions ( r = 0.905, p < 0.01), and a moderate negative correlation in group B ( r = -0.429, p < 0.05). TEE and irisin showed no significant correlation., Conclusion: This study demonstrated that the early changes in energy homeostasis and irisin levels during states of hypovitaminosis D are affected by long-term consumption of a vitamin D-deficient diet with limited UV exposure., (Copyright © 2020 Abulmeaty, Almajwal, Alam, Razak, ElSadek, Aljuraiban, Hussein and Malash.)

Background and Aims: The unique demographic and dietary characteristics of modern Arabic population require development of a new predictive equation for the estimation of resting energy expenditure (REE). This study presented new equations characteristic to Saudi population., Methods: A set of predictive equations for REE was derived for 427 healthy male and female subjects (aged 18-57 ± 14 years). REE was measured (REEm) by indirect calorimetry (IC) and predicted (REEp) using nine equations. REEp was compared with REEm to determine the predictive accuracy of these equations. Using IC and anthropometrics for stepwise linear regression analysis, a new set of equations to predict REE of men and women was developed. Accuracy of the new main equations was further tested in an external sample of 48 subjects (men = 50%)., Results: Using a number of parameters (bias, underprediction, overprediction, and % accurate prediction), our results suggested that almost all (9/9 in men and 7/9 in women) equations either underpredicted or overpredicted (2/9) REE. None of the already existing equations showed an acceptable REEp/REEm difference as low as 5% and an accurate prediction (∼55%) at the individual level. Based on these findings, a new prediction equation (hereafter referred to as the Almajwal-Abulmeaty (AA) equation) was developed using this study's data, after a rigorous stepwise regression analysis using the following formula: REE = 3832.955 + AdjWt (kg) × 48.037 - Ht (cm) × 30.642 + gender × 141.268 - age (years) × 4.525 [AdjWt is Adjusted body weight = (Wt - IBW)/4 + IBW. IBW is Ideal body weight; for men IBW = (Ht(cm) - 152.4) × 1.0714) + 45.36 and for women IBW = (Ht(cm)-152.4) × 0.8928) + 45.36]. The regression model accounted for approximately 70% of the variance in REEm ( R 2  = 0.702)., Conclusion: Previous equations likely over- or underpredicted REE. Therefore, the new predictive AA equations developed in this study are recommended for the estimation of REE in young to middle-aged Saudi men and women with different body mass indexes. Future research is also required for further clinical and cross-validation of these new equations., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Ali M. Almajwal and Mahmoud M. A. Abulmeaty.)

Background: Data on 25-OH VD concentrations and the associated factors in colorectal cancer (CRC) patients are scarce and need to be investigated. Methods: A total of 200 CRC patients participated in this cross-sectional study conducted in Pakistan. Socio-demographic and other health data were collected in a pretested questionnaire. Serum measurements of Vitamin D (1, 25(OH) 2 D 3 ) levels and hormones were performed. Association of age, sex, primary site, effects of hormone therapy and stage of disease and selected reproductive health indicators on vitamin D status were primarily scrutinized by univariate analysis. Results: Mean age of the population was 55.3 years (±15.6; Range: 20-90 years). Estradiol concentration was considerably elevated in young females compared to young male patients ( p < 0.001). The concentrations of FSH, LH testosterone and estradiol were significantly lower in post-menopausal female CRC patients as compared to their male counterparts of old age ( p , for all trends < 0.05). Both LH and FSH showed significant gender difference but only in older patients. Level of estrogen was markedly decreased in older post-menopausal CRC patients compared to premenopausal CRC patients, which might be associated with CRC progression. In the group of women, who "ever used hormone therapy" had differences of statistical significance ( p , for all trends < 0.05) in their mean serum 25-OH VD concentrations, while in the group of women who "never used hormone therapy" had non-significant differences in their mean serum 25-OH VD concentrations ( p , for all trends > 0.05). High 25-OH VD concentrations were observed in women who had their menarche at the age of 15 years or more. Nulliparous women had the highest mean 25-OH VD concentrations as compared to unparious or multiparious women. In addition, women having their menopause at 40-44 years of age had the highest 25-OH VD concentrations, although the difference was not significant ( p = 0.08). Women who "never used any oral contraceptive" had higher 25-OH VD concentrations as compared to those "whoever used oral contraceptives." Conclusion: Our findings suggest that vitamin D has a positive effect on the development of CRC through the mediation of hormones. Other health and reproductive traits that affect hormone levels may have an indirect effect on the development of CRC. Further potential studies that directly evaluate levels of circulating hormones and hormone therapy in women in association to 25-OH VD concentrations, as well as their possible role in colorectal cancer risk, would be vastly edifying.

Micronutrient delivery formulations based on nanoemulsions can enhance the absorption of nutrients and bioactives, and thus, are of great potential for food fortification and supplementation strategies. The aim was to evaluate the bioefficacy of vitamin D (VitD) encapsulated in nanoemulsions developed by sonication and pH-shifting of pea protein isolate (PPI) in restoring VitD status in VitD-deficient rats. Weaned male albino rats ( n = 35) were fed either normal diet AIN-93G (VitD 1000 IU/kg) (control group; n = 7) or a VitD-deficient diet (<50 IU/kg) for six weeks (VitD-deficient group; n = 28). VitD-deficient rats were divided into four subgroups ( n = 7/group). Nano-VitD and Oil-VitD groups received a dose of VitD (81 µg) dispersed in either PPI-nanoemulsions or in canola oil, respectively, every other day for one week. Their control groups, Nano-control and Oil-control, received the respective delivery vehicles without VitD. Serum 25-hydroxyvitamin D [25(OH)VitD], parathyroid hormone (PTH), Ca, P, and alkaline phosphatase (ALP) activity were measured. After one week of treatment, the VitD-deficient rats consuming Nano-VitD recovered from Vitamin D deficiency (VDD) as compared against baseline and had serum 25(OH)VitD higher than the Nano-control. Enhancement in VitD status was followed with expected changes in serum PTH, Ca, P, and ALP levels, as compared against the controls. Stabilization of VitD within PPI-based nanoemulsions enhances its absorption and restores its status and biomarkers of bone resorption in VitD-deficient rats.