Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacoth...Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacotherapy for AP,however,apart from fluid resuscitation,analgesics,and organ support,nutrition plays an important role in the management of AP.Oral or enteral nutrition(EN)is the preferred route of nutrition in AP,however,in a subset of patients,parenteral nutrition is required.EN has various physiological benefits and decreases the risk of infection,intervention,and mortality.There is no proven role of probiotics,glutamine supplementation,antioxidants,and pancreatic enzyme replacement therapy in patients with AP.展开更多
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst form...Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.展开更多
Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinica...Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation,acute-onchronic liver failure,and even mortality.It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy.Many factors have been evaluated in different studies in patients with underlying CLD.Some of these factors include the severity of underlying chronic liver disease,comorbid conditions,age,and severity of COVID-19.Overall,the outcomes are not favorable in patients with cirrhosis as evidenced by data from various studies.The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification,prognostication,and appropriate clinical management.展开更多
AIM： To describe the prevalence of transfusiontransmitted virus （TTV） infection in association with hepatitis A-E viral infections in different forms of liver diseases in North India. METHODS： Sera from a total nu...AIM： To describe the prevalence of transfusiontransmitted virus （TTV） infection in association with hepatitis A-E viral infections in different forms of liver diseases in North India. METHODS： Sera from a total number of 137 patients, including 37 patients with acute viral hepatitis （AVH）, 37 patients with chronic viral hepatitis （CVH）, 31 patients with cirrhosis of liver and 32 patients with fulminant hepatic failure （FHF）, were analyzed both for TTV-DNA and hepatitis A-E viral markers. Presence of hepatitis B virus （HBV）, hepatitis C virus （HCV） and hepatitis E virus （HEV） infections was detected in different proportions in different groups. Moreover, rrV-DNA was simultaneously tested in 100 healthy blood donors also. RESULTS： None of the patients had hepatitis A virus （HAV） and hepatitis D virus （HDV） infections. Overall prevalence of TTV-DNA was detected in 27.1% cases with AVH, 18.9% cases with CVH, 48.4% cases with cirrhosis and 9.4% cases with FHF. TTV-DNA simultaneously tested in 100 healthy blood donors showed 27% positivity. On establishing a relation between TTV infection with other hepatitis viral infections, TTV demonstrated co-infection with HBV, HCV and HEV in these disease groups. Correlation of TTV with ALT level in sera did not demonstrate high ALT level in TTV-infected patients, suggesting that TI-V does not cause severe liver damage. CONCLUSION： TTV infection is prevalent both in patients and healthy individuals in India. However, it does not have any significant correlation with other hepatitis viral infections, nor does it produce an evidence of severe liver damage in patients with liver diseases.展开更多
AIM: To evaluate selected factors influencing resting energy expenditure(REE) in obese female subjects.METHODS: Seventy seven 61 obese Caucasian women [mean age of 52.93 ± 13.45 years, and mean body mass index(BM...AIM: To evaluate selected factors influencing resting energy expenditure(REE) in obese female subjects.METHODS: Seventy seven 61 obese Caucasian women [mean age of 52.93 ± 13.45 years, and mean body mass index(BMI) of 41.78 ± 11.54 kg/m2] were enrolled; measurements of resting metabolic rate(RMR) by a ventilated, open-circuit system, indirect calorimeter were performed after an overnight fast. Body composition as well as medications, physical parameters, blood samples, disease pattern, and smoking were considered. RESULTS: RMR was significantly associated with body weight(r = 0.732, P < 0.001), body height(r = 0.401,P = 0.008), BMI(r = 0.504, P < 0.001), waist circumference(r = 0.602, P < 0.001), mid-upper arm circumference(r = 0.417, P = 0.006), mid-upper arm muscle circumference(r = 0.344, P = 0.028), total body water(r = 0.339, P = 0.035), body temperature(r = 0.409, P = 0.007), smoking(P = 0.031), serum T4 levels(r = 0.331, P = 0.036), obstructive sleep apnoea syndrome(OSAS; P = 0.023), impaired glucose tolerance(IGT; P = 0.017) and impaired glycaemic status, including hyperinsulinism, IGT and diabetes mellitus(P = 0.003).CONCLUSION: Future research should be prompted to optimize the procedure of indirect calorimetry to achieve clinical benefits in obese subjects.展开更多
The significance of plasma ascorbic acid(AA)is underscored by its enzymatic and antioxidant properties as well as involvement in many aspects of health including the synthesis of biomolecules during acute illness,trau...The significance of plasma ascorbic acid(AA)is underscored by its enzymatic and antioxidant properties as well as involvement in many aspects of health including the synthesis of biomolecules during acute illness,trauma and chronic health conditions.Dietary intake supports maintenance of optimal levels with supplementation at higher doses more likely pursued.Transient increased intestinal paracellular permeability following high dose AA may be utilised to enhance delivery of other micronutrients across the intestinal lumen.The potential mechanism following dietary intake however needs further study but may provide an avenue to increase small intestinal nutrient co transport and absorption,including in acute and chronic illness.展开更多
An emerging evidence suggests that dietary calcium may play a role in the regulation of body weight in humans. This study examined the relationship of calcium intake with body mass index and body fatness in Thai child...An emerging evidence suggests that dietary calcium may play a role in the regulation of body weight in humans. This study examined the relationship of calcium intake with body mass index and body fatness in Thai children. Methods: A cross-sectional study in 1570, 6 - 12 year-old children were conducted in representative provinces of Thailand. Body weight, height, sitting height and 4 sites skinfolds thickness were measured as well as the dietary intake using a 24 h recall and a food frequency questionnaire (FFQ). General linear model (GLM) analysis was used to determine the effect of calcium intake on body mass index (BMI) and body fatness of children. Results: There were no differences in parental education and family’s socio-economic status between genders. Girls had significantly greater sitting height (p?= 0.035), sitting height to height ratio (p?= 0.014) and sum of four skinfold thickness (p?= 0.001) than boys. Mean calcium intake was lower in girls than in boys. GLM analysis demonstrated that lower calcium intake among children was associated with higher body weight, BMI and sum 4-skinfold thickness. Conclusion: Lower calcium intake is associated with higher BMI and body fatness of Thai children. Further studies need to determine the optimal calcium intake to prevent overweight and obesity in children.展开更多
Obesity and sarcopenia combination, appropriately defined as sarcopenic obesity (SO), due to disproportionally reduced/low lean body mass compared to excess fat mass, may lead to disability. Aims: The aim of our study...Obesity and sarcopenia combination, appropriately defined as sarcopenic obesity (SO), due to disproportionally reduced/low lean body mass compared to excess fat mass, may lead to disability. Aims: The aim of our study was to investigate the relationship among sarcopenic obesity, physical performance, disability, and quality of life in a rehabilitation setting. Methods: Participants were recruited among obese patients (BMI > 30 kg/m2) admitted to the rehabilitation facility at the Department of Experimental Medicine, Medical Physiopatology, Food Science and Endocrinology Section during a 1-year period. A multidimensional evaluation was performed through bioelectrical impedance analysis and anthropometry, handgrip strength test, Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT) and blood chemistry parameters. Psychological status (SCL-90 questionnaire), quality of life, and comorbidity (Charlson comorbidity index score) were also evaluated. Obesity was diagnosed as increased fat mass by 35% in women and by 25% in men. Sarcopenia was defined if lean body mass (LBM) was <90% of the subject’s ideal LBM. Results: 79 patients (48 women and 31 men;mean age: 60.1 ± 11.5 years, and 58.6 ± 10.8 years, respectively) were enrolled. Results showed a high prevalence of SO (54.4%) in our samples of obese subjects. Sarcopenia was present not only among older obese adults but also among younger obese subjects, and was related to reduced functional performance, to inflammatory status and to worse psychological status and quality of life.展开更多
Within a year of its emergence,coronavirus disease-2019(COVID-19)has evolved into a pandemic.What has emerged during the past 1 year is that,apart from its potentially fatal respiratory presentation from which the sev...Within a year of its emergence,coronavirus disease-2019(COVID-19)has evolved into a pandemic.What has emerged during the past 1 year is that,apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)derives its name,it presents with a myriad of gastrointestinal(GI)and liver manifestations.Expression of the angiotensinconverting enzyme-2(ACE-2)receptor throughout the GI tract and liver,which is the receptor for the SARS-CoV-2,may be responsible for the GI and liver manifestations.Besides acting directly via the ACE-2 receptor,the virus triggers a potent immune response,which might have a role in pathogenesis.The virus leads to derangement in liver function tests in close to 50%of the patients.The impact of these derangements in patients with a normal underlying liver seems to be innocuous.Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease,leading to high mortality.Evolving data suggests that,contrary to intuition,liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality.The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered.With newer variants of COVID-19,which can spread faster than the original strain,the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.展开更多
Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interven...Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interventions and the genetic effect of TCF7L2 rs7903146 on glycemic traits,body weight,or waist circumference in overweight or obese adults in several randomized controlled trials(RCTs).Methods.From October 2016 to May 2018,a large collaborative analysis was performed by pooling individualparticipant data from 7 RCTs.These RCTs reported changes in glycemic control and adiposity of the variant rs7903146 after dietary/lifestyle-related interventions in overweight or obese adults.Gene treatment interaction models which used the genetic effect encoded by the allele dose and common covariates were applicable to individual participant data in all studies.Results.In the joint analysis,a total of 7 eligible RCTs were included(n=4,114).Importantly,we observed a significant effect modification of diet/lifestyle-related interventions on the TCF7L2 variant rs7903146 and changes in fasting glucose.Compared with the control group,diet/lifestyle interventions were related to lower fasting glucose by-3.06(95%CI,-5.77 to-0.36)mg/dL(test for heterogeneity and overall effect:I^(2)=45:1%,p<0:05;z=2:20,p=0:028)per one copy of the TCF7L2 T risk allele.Furthermore,regardless of genetic risk,diet/lifestyle interventions were associated with lower waist circumference.However,there was no significant change for diet/lifestyle interventions in other glycemic control and adiposity traits per one copy of TCF7L2 risk allele.Conclusions.Our findings suggest that carrying the TCF7L2 T risk allele may have a modestly greater benefit for specific diet/lifestyle interventions to improve the control of fasting glucose in overweight or obese adults.展开更多
文摘Acute pancreatitis(AP)has varying severity,and moderately severe and severe AP has prolonged hospitalization and requires multiple interventions.These patients are at risk of malnutrition.There is no proven pharmacotherapy for AP,however,apart from fluid resuscitation,analgesics,and organ support,nutrition plays an important role in the management of AP.Oral or enteral nutrition(EN)is the preferred route of nutrition in AP,however,in a subset of patients,parenteral nutrition is required.EN has various physiological benefits and decreases the risk of infection,intervention,and mortality.There is no proven role of probiotics,glutamine supplementation,antioxidants,and pancreatic enzyme replacement therapy in patients with AP.
文摘Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas,resulting in recurrent abdominal pain,diabetes mellitus,and malnutrition.It may lead to various other complications such as pseudocyst formation,benign biliary stricture,gastric outlet obstruction;and vascular complications like venous thrombosis,variceal and pseudoaneurysmal bleed.Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy.Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration,or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations.Procedure-related bleed is usually venous and mostly managed conservatively.Procedure-related arterial bleed,however,may require radiological interventions.
文摘Coronavirus disease 2019(COVID-19)has affected patients with pre-existing chronic liver disease(CLD)in various ways.The maximum impact was seen on patients with underlying cirrhosis who have shown to have poor clinical outcomes in the form of increased risk of hepatic decompensation,acute-onchronic liver failure,and even mortality.It is of paramount importance to identify various factors which are associated with unfavorable outcomes for prognostication and making informed management strategy.Many factors have been evaluated in different studies in patients with underlying CLD.Some of these factors include the severity of underlying chronic liver disease,comorbid conditions,age,and severity of COVID-19.Overall,the outcomes are not favorable in patients with cirrhosis as evidenced by data from various studies.The main purpose of this review is to identify the predictors of adverse clinical outcomes including mortality in patients with CLD for risk stratification,prognostication,and appropriate clinical management.
基金Supported by financial grant from ICMR, New Delhi 110049
文摘AIM： To describe the prevalence of transfusiontransmitted virus （TTV） infection in association with hepatitis A-E viral infections in different forms of liver diseases in North India. METHODS： Sera from a total number of 137 patients, including 37 patients with acute viral hepatitis （AVH）, 37 patients with chronic viral hepatitis （CVH）, 31 patients with cirrhosis of liver and 32 patients with fulminant hepatic failure （FHF）, were analyzed both for TTV-DNA and hepatitis A-E viral markers. Presence of hepatitis B virus （HBV）, hepatitis C virus （HCV） and hepatitis E virus （HEV） infections was detected in different proportions in different groups. Moreover, rrV-DNA was simultaneously tested in 100 healthy blood donors also. RESULTS： None of the patients had hepatitis A virus （HAV） and hepatitis D virus （HDV） infections. Overall prevalence of TTV-DNA was detected in 27.1% cases with AVH, 18.9% cases with CVH, 48.4% cases with cirrhosis and 9.4% cases with FHF. TTV-DNA simultaneously tested in 100 healthy blood donors showed 27% positivity. On establishing a relation between TTV infection with other hepatitis viral infections, TTV demonstrated co-infection with HBV, HCV and HEV in these disease groups. Correlation of TTV with ALT level in sera did not demonstrate high ALT level in TTV-infected patients, suggesting that TI-V does not cause severe liver damage. CONCLUSION： TTV infection is prevalent both in patients and healthy individuals in India. However, it does not have any significant correlation with other hepatitis viral infections, nor does it produce an evidence of severe liver damage in patients with liver diseases.
文摘AIM: To evaluate selected factors influencing resting energy expenditure(REE) in obese female subjects.METHODS: Seventy seven 61 obese Caucasian women [mean age of 52.93 ± 13.45 years, and mean body mass index(BMI) of 41.78 ± 11.54 kg/m2] were enrolled; measurements of resting metabolic rate(RMR) by a ventilated, open-circuit system, indirect calorimeter were performed after an overnight fast. Body composition as well as medications, physical parameters, blood samples, disease pattern, and smoking were considered. RESULTS: RMR was significantly associated with body weight(r = 0.732, P < 0.001), body height(r = 0.401,P = 0.008), BMI(r = 0.504, P < 0.001), waist circumference(r = 0.602, P < 0.001), mid-upper arm circumference(r = 0.417, P = 0.006), mid-upper arm muscle circumference(r = 0.344, P = 0.028), total body water(r = 0.339, P = 0.035), body temperature(r = 0.409, P = 0.007), smoking(P = 0.031), serum T4 levels(r = 0.331, P = 0.036), obstructive sleep apnoea syndrome(OSAS; P = 0.023), impaired glucose tolerance(IGT; P = 0.017) and impaired glycaemic status, including hyperinsulinism, IGT and diabetes mellitus(P = 0.003).CONCLUSION: Future research should be prompted to optimize the procedure of indirect calorimetry to achieve clinical benefits in obese subjects.
文摘The significance of plasma ascorbic acid(AA)is underscored by its enzymatic and antioxidant properties as well as involvement in many aspects of health including the synthesis of biomolecules during acute illness,trauma and chronic health conditions.Dietary intake supports maintenance of optimal levels with supplementation at higher doses more likely pursued.Transient increased intestinal paracellular permeability following high dose AA may be utilised to enhance delivery of other micronutrients across the intestinal lumen.The potential mechanism following dietary intake however needs further study but may provide an avenue to increase small intestinal nutrient co transport and absorption,including in acute and chronic illness.
文摘An emerging evidence suggests that dietary calcium may play a role in the regulation of body weight in humans. This study examined the relationship of calcium intake with body mass index and body fatness in Thai children. Methods: A cross-sectional study in 1570, 6 - 12 year-old children were conducted in representative provinces of Thailand. Body weight, height, sitting height and 4 sites skinfolds thickness were measured as well as the dietary intake using a 24 h recall and a food frequency questionnaire (FFQ). General linear model (GLM) analysis was used to determine the effect of calcium intake on body mass index (BMI) and body fatness of children. Results: There were no differences in parental education and family’s socio-economic status between genders. Girls had significantly greater sitting height (p?= 0.035), sitting height to height ratio (p?= 0.014) and sum of four skinfold thickness (p?= 0.001) than boys. Mean calcium intake was lower in girls than in boys. GLM analysis demonstrated that lower calcium intake among children was associated with higher body weight, BMI and sum 4-skinfold thickness. Conclusion: Lower calcium intake is associated with higher BMI and body fatness of Thai children. Further studies need to determine the optimal calcium intake to prevent overweight and obesity in children.
文摘Obesity and sarcopenia combination, appropriately defined as sarcopenic obesity (SO), due to disproportionally reduced/low lean body mass compared to excess fat mass, may lead to disability. Aims: The aim of our study was to investigate the relationship among sarcopenic obesity, physical performance, disability, and quality of life in a rehabilitation setting. Methods: Participants were recruited among obese patients (BMI > 30 kg/m2) admitted to the rehabilitation facility at the Department of Experimental Medicine, Medical Physiopatology, Food Science and Endocrinology Section during a 1-year period. A multidimensional evaluation was performed through bioelectrical impedance analysis and anthropometry, handgrip strength test, Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT) and blood chemistry parameters. Psychological status (SCL-90 questionnaire), quality of life, and comorbidity (Charlson comorbidity index score) were also evaluated. Obesity was diagnosed as increased fat mass by 35% in women and by 25% in men. Sarcopenia was defined if lean body mass (LBM) was <90% of the subject’s ideal LBM. Results: 79 patients (48 women and 31 men;mean age: 60.1 ± 11.5 years, and 58.6 ± 10.8 years, respectively) were enrolled. Results showed a high prevalence of SO (54.4%) in our samples of obese subjects. Sarcopenia was present not only among older obese adults but also among younger obese subjects, and was related to reduced functional performance, to inflammatory status and to worse psychological status and quality of life.
文摘Within a year of its emergence,coronavirus disease-2019(COVID-19)has evolved into a pandemic.What has emerged during the past 1 year is that,apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)derives its name,it presents with a myriad of gastrointestinal(GI)and liver manifestations.Expression of the angiotensinconverting enzyme-2(ACE-2)receptor throughout the GI tract and liver,which is the receptor for the SARS-CoV-2,may be responsible for the GI and liver manifestations.Besides acting directly via the ACE-2 receptor,the virus triggers a potent immune response,which might have a role in pathogenesis.The virus leads to derangement in liver function tests in close to 50%of the patients.The impact of these derangements in patients with a normal underlying liver seems to be innocuous.Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease,leading to high mortality.Evolving data suggests that,contrary to intuition,liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality.The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered.With newer variants of COVID-19,which can spread faster than the original strain,the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.
文摘Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interventions and the genetic effect of TCF7L2 rs7903146 on glycemic traits,body weight,or waist circumference in overweight or obese adults in several randomized controlled trials(RCTs).Methods.From October 2016 to May 2018,a large collaborative analysis was performed by pooling individualparticipant data from 7 RCTs.These RCTs reported changes in glycemic control and adiposity of the variant rs7903146 after dietary/lifestyle-related interventions in overweight or obese adults.Gene treatment interaction models which used the genetic effect encoded by the allele dose and common covariates were applicable to individual participant data in all studies.Results.In the joint analysis,a total of 7 eligible RCTs were included(n=4,114).Importantly,we observed a significant effect modification of diet/lifestyle-related interventions on the TCF7L2 variant rs7903146 and changes in fasting glucose.Compared with the control group,diet/lifestyle interventions were related to lower fasting glucose by-3.06(95%CI,-5.77 to-0.36)mg/dL(test for heterogeneity and overall effect:I^(2)=45:1%,p<0:05;z=2:20,p=0:028)per one copy of the TCF7L2 T risk allele.Furthermore,regardless of genetic risk,diet/lifestyle interventions were associated with lower waist circumference.However,there was no significant change for diet/lifestyle interventions in other glycemic control and adiposity traits per one copy of TCF7L2 risk allele.Conclusions.Our findings suggest that carrying the TCF7L2 T risk allele may have a modestly greater benefit for specific diet/lifestyle interventions to improve the control of fasting glucose in overweight or obese adults.
