The role of nutrition and effects on the cytokine milieu in allogeneic hematopoietic stem cell transplantation

Nutritional deficiency is very common after allogeneic stem cell transplantation (HSCT) despite careful assessment and nutritional supplementation (total parenteral or oral nutrition). The importance of nutrition in the immune system has been well defined during the past several years, as it has modulatory effects on the immune system. One of the most frequent questions in nutrition is whether nutritionally at-risk hosts have a defect in their immune system and whether such defects can be corrected by nutritional supplementation. Addressing nutritional supplementation starting from early post-transplantation might decrease the risk of infectious complication and GVHD after HSCT via the immunomodulatory role of a variety of nutrients and supplements. Given the well-established link between nutrition and immunomodulation, we hypothesize that timely nutritional supplementation can potentially play a direct or indirect role in decreasing non-relapse morbidity and mortality after HSCT. In this article, we discuss the possible link between nutritional deficiency and its effects on the cytokine milieu after HSCT.     

Maternal environment and the reproductive function of the offspring

Fetal programming of metabolic diseases is now a well established concept. The scope of the Developmental Origins of Health and Disease has, however, widened and led to the identification of new targets of fetal programming, notably effects on reproductive function. Epidemiologic studies about maternal nutrition and effects on offspring's fertility are rare, but a link between impaired fetal growth, possibly caused by maternal malnutrition, and reproductive function, has been established. The methodologic limitations inherent to human epidemiologic studies can be complemented through the use of animal models, which enable experimental studies on maternal environment and its effect on reproductive functions of the offspring. Altogether, an interaction between inappropriate maternal nutrition (excess or reduced nutritional intake, micronutrient unbalance, or alcohol intake) and reproductive maturation of the offspring has been shown in a majority of experiments as summarized in this review. The exact processes through which maternal nutrition or maternal environment affect reproductive function in the offspring remain unclear but epigenetic modifications are a clear link. Further studies are needed to better understand the mechanisms involved, identify the crucial critical periods, and prevent or treat the adverse effects.     

Intensive Metabolic Support : Evolution and Revolution

ObjectiveTo describe a new aspect of critical care termed intensive metabolic support.MethodsWe performed a MEDLINE search of the English-language literature published between 1995 and 2008 for studies regarding the metabolic stages of critical illness, intensive insulin treatment, and intensive metabolic support in the intensive care unit, and we summarize the clinical data.ResultsIntensive metabolic support is a 3-component model involving metabolic control and intensive insulin therapy, early nutrition support, and nutritional pharmacology aimed at preventing allostatic overload and the development of chronic critical illness. To improve clinical outcome and prevent mortality, intensive metabolic support should start on arrival to the intensive care unit and should end only when patients are in the recovery phase of their illness.ConclusionsIntensive metabolic support should be an essential part of the daily treatment strategy in critical care medicine. This will involve a newfound and extensive collaboration between the endocrinologist and the intensivist. We call for well-designed future studies involving implementation of this protocol to decrease the burden of chronic critical illness. (Endocr Pract. 2008;14:1047-1054)     

Nutritional status of the Indian population

High prevalence of low birth weight, high morbidity and mortality in children and poor maternal nutrition of the mother continue to be major nutritional concerns in India. Although nationwide intervention programmes are in operation over two decades, the situation has not changed greatly. In addition, the Indian population is passing through a nutritional transition and is expected to witness higher prevalences of adult non-communicable diseases such as diabetes, hypertension and coronary heart disease according to the theory of ‘fetal origin of adult disease’. Clearly, there is a need for examining several issues of nutritional significance for effective planning of interventions. In particular, maternal nutrition and fetal growth relationship, long term effects of early life undernutrition, interactions of prenatal nutritional experiences and postnatal undernutrition are some of the major issues that have been discussed in the present paper with the help of prospective data from various community nutrition studies carried out in the department.     

Nutritional support of children in the intensive care unit.

Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional support, including enteral, peripheral, and central parenteral nutrition are discussed in detail. Appropriate formulas are given for different age groups. Electrolyte, vitamin, and mineral supplements are discussed. Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team.     

Effect of nutrition on reproduction in llamas and alpacas

The role of nutrition, especially the role of energy and protein status, on reproductive performance of production animals has been well documented. Comparatively, there is a true paucity of literature regarding nutritional mediation of reproductive performance in llamas and alpacas. Following seasonal patterns of feed availability in South America, adverse effects of nutritional deprivation on reproductive performance are well recognized, suggesting similar nutrition-reproduction interrelationships. Camelids, with their unique metabolism, may have some peculiar interrelationships between reproduction and protein and phosphorus nutrition. This presentation will review basic issues of energy and protein nutrition relative to reproductive performance in llamas and alpacas, based primarily on hypotheses and extrapolation from other species. Opportunities for research on this topic will be discussed, including preliminary data from current research.     

Nutritional effects on oocyte and embryo development in mammals: implications for reproductive efficiency and environmental sustainability

The environment in which a breeding female lives prior to conception and during the early stages of her pregnancy has striking effects on oocytes developing in the ovarian follicle and on early embryos in the reproductive tract. Of the various environmental factors known to affect oocyte and embryo development, altered nutrition during this critical period has been particularly well studied. Alterations in the quantity of food consumed or the composition of the diet imposed solely during the pre-mating period affect oocyte maturity, blastocyst yield, prenatal survival and the number of offspring born alive. Importantly, nutrition at this time also affects the quality of embryos and resultant offspring, with increasing evidence from a variety of species showing that peri-conception nutrition can alter behaviour, cardiovascular function and reproductive function throughout post-natal life. In livestock species, it is important to devise nutritional strategies that improve reproductive efficiency and the quality of offspring but that do not add to the environmental footprint of the production system and which recognize likely changes in feedstuff availability arising from predicted changes in climate.     

The thrifty phenotype hypothesis: thrifty offspring or thrifty mother?

Medical research is increasingly focusing on the contribution of nutritional programming to disease in later life. Programming is a process whereby a stimulus during a critical window of time permanently affects subsequent structure, function or developmental schedule of the organism. The thrifty phenotype hypothesis is widely used to interpret such studies, with early growth restriction seen as adaptation to environmental deprivation. However, such permanent adjustment is less beneficial than maintaining flexibility so as to recover from early growth deficits if the environment improves. Thus, the existing thrifty phenotype hypothesis fails to explain why plasticity is lost so early in development in species with extended growth. One explanation is that the developing organism simply cannot maintain phenotypic plasticity throughout the period of organ growth. This article adds a life history perspective, arguing that programming of the offspring may in some species benefit maternal fitness more than it does that of individual offspring. Closing the critical window early in development allows the preservation of maternal strategy in offspring phenotype, which in humans benefits the mother by constraining offspring demand after weaning. The offspring gains by being buffered against environmental fluctuations during the most sensitive period of development, allowing coherent adaptation of organ growth to the state of the environment. The critical window is predicted to close when offspring physiology becomes independent of maternal physiology, the timing of which depends on offspring trait. Because placental nutrition and lactation buffer against short-term environmental fluctuations, maternal strategy is predicted to derive from long-term experience, encapsulated in maternal size and nutritional status. Such an approach implies that public health programmes for improving birth weight may be more effective if they target maternal development rather than nutrition during pregnancy. Equally, aggressive nutritional management of infants born small or pre-term may induce the very environmental fluctuations that are naturally softened by maternal nutrition.     

The challenges for molecular nutrition research 4: the “nutritional systems biology level”

Nutritional systems biology may be defined as the ultimate goal of molecular nutrition research, where all relevant aspects of regulation of metabolism in health and disease states at all levels of its complexity are taken into account to describe the molecular physiology of nutritional processes. The complexity spans from intracellular to inter-organ dynamics, and involves iterations between mathematical modelling and analysis employing all profiling methods and other biological read-outs. On the basis of such dynamic models we should be enabled to better understand how the nutritional status and nutritional challenges affect human metabolism and health. Although the achievement of this proposition may currently sound unrealistic, many initiatives in theoretical biology and biomedical sciences work on parts of the solution. This review provides examples and some recommendations for the molecular nutrition research arena to move onto the systems level.     

Child nutrition in the transition from nomadic pastoralism to settled lifestyles: individual, household, and community-level factors

The research reported here examines child nutrition in a population that is currently experiencing a transition in subsistence, shifting from nomadic pastoralism to a variety of settled lifestyles. We investigate the range of nutritional consequences of settlement both within and between communities by examining individual, household, and community-level predictors of child nutritional status. Data are drawn from the Rendille Demographic and Health Survey, which contains anthropometric data from 1,088 children ages 6 months to 10 years, as well as socioeconomic data from 640 households drawn from one nomadic and four economically and ecologically diverse settled communities. Comparisons allow us to test the widely held assumption that settlement results in nutritional improvements. The examination of individual and household-level factors highlights several important influences on child nutrition. We find a complex interaction between gender and birthorder, whereby firstborn sons have significantly higher weight-for-height scores than other children, potentially reflecting preference under a system of primogeniture. We also find a complex interaction between defacto female-headed households, where males are absent for over half of the year, and economic status. Young children from poor female-headed households have significantly lower weight-for-height than other children, possibly due to the fact that these households are amongst the poorest in the entire community. However, young children from economically sufficient female-headed households actually fare better than their counterparts in male headed households, suggesting that in households with any discretionary resources, female heads prioritize food acquisition relative to other concerns. Finally, our comparison of child nutritional status across communities, while controlling for individual and household-level variation, does not support the contention that settlement is associated with nutritional improvements. Rather, the effect of community, and its associated changes in subsistence and lifestyle, results in either no nutritional changes, or in the case of young children in the lowland desert community of Korr, diminished nutritional status. Our results underscore the importance of considering variation in sample composition and socioeconomic status when performing community comparisons, and highlight the central role of women in influencing the nutritional welfare of their families.     

Phenotypic flexibility as a measure of health: the optimal nutritional stress response test

Nutrition research is struggling to demonstrate beneficial health effects, since nutritional effects are often subtle and long term. Health has been redefined as the ability of our body to cope with daily-life challenges. Physiology acts as a well-orchestrated machinery to adapt to the continuously changing environment. We term this adaptive capacity “phenotypic flexibility.” The phenotypic flexibility concept implies that health can be measured by the ability to adapt to conditions of temporary stress, such as physical exercise, infections or mental stress, in a healthy manner. This may offer a more sensitive way to assess changes in health status of healthy subjects. Here, we performed a systematic review of 61 studies applying different nutritional stress tests to quantify health and nutritional health effects, with the objective to define an optimal nutritional stress test that has the potential to be adopted as the golden standard in nutrition research. To acknowledge the multi-target role of nutrition, a relevant subset of 50 processes that govern optimal health, with high relevance to diet, was used to define phenotypic flexibility. Subsequently, we assessed the response of biomarkers related to this subset of processes to the different challenge tests. Based on the obtained insights, we propose a nutritional stress test composed of a high-fat, high-caloric drink, containing 60 g palm olein, 75 g glucose and 20 g dairy protein in a total volume of 400 ml. The use of such a standardized nutritional challenge test in intervention studies is expected to demonstrate subtle improvements of phenotypic flexibility, thereby enabling substantiation of nutritional health effects.

Electronic supplementary material

The online version of this article (doi:10.1007/s12263-015-0459-1) contains supplementary material, which is available to authorized users.     

Food-Pharma Convergence in Medical Nutrition– Best of Both Worlds?

At present, industries within the health and life science sector are moving towards one another resulting in new industries such as the medical nutrition industry. Medical nutrition products are specific nutritional compositions for intervention in disease progression and symptom alleviation. Industry convergence, described as the blurring of boundaries between industries, plays a crucial role in the shaping of new markets and industries. Assuming that the medical nutrition industry has emerged from the convergence between the food and pharma industries, it is crucial to research how and which distinct industry domains have contributed to establish this relatively new industry. The first two stages of industry convergence (knowledge diffusion and consolidation) are measured by means of patent analysis. First, the extent of knowledge diffusion within the medical nutrition industry is graphed in a patent citation interrelations network. Subsequently the consolidation based on technological convergence is determined by means of patent co-classification. Furthermore, the medical nutrition core domain and technology interrelations are measured by means of a cross impact analysis. This study proves that the medical nutrition industry is a result of food and pharma convergence. It is therefore crucial for medical nutrition companies to effectively monitor technological developments within as well as across industry boundaries. This study further reveals that although the medical nutrition industry’s core technology domain is food, technological development is mainly driven by pharmaceutical/pharmacological technologies Additionally, the results indicate that the industry has surpassed the knowledge diffusion stage of convergence, and is currently in the consolidation phase of industry convergence. Nevertheless, while the medical nutrition can be classified as an industry in an advanced phase of convergence, one cannot predict that the pharma and food industry segments will completely converge or whether the medical industry will become an individual successful industry.     

Current perspectives in avian nutrition: domestic animal models and their role in conservation management

As biodiversity declines, wildlife conservation focuses on in situ and ex situ management strategies. Zoo-based breeding programmes are often designed to contribute to the conservation of species that are threatened in the wild. Diet contributes to the reproductive success, disease status and longevity of all animals. It is near-impossible to replicate a species' diet in captivity using only the species they consume in the wild, but the nutritional composition of a wild diet, if known, can be closely matched using commercially available foods for which the nutritional composition has been calculated. Ecological research has identified food items of importance in the diet of many species. However, the nutritional composition of these food items is rarely evaluated, even though the composition of wild food items is important in understanding the dietary adaptations and requirements of wildlife. In contrast, the nutritional requirements of domestic species are well researched and can be used to predict a range of plausible nutrient requirements of some wild species, especially those with similar life histories. Access to wild populations provides further opportunities for nutritional science to determine the requirements of individual species. Small-scale dietary experimentation undertaken at conservation institutions may show positive effects on health and welfare but is rarely published in the scientific literature. This review describes current standards in nutritional management of birds and recommends pathways for filling knowledge gaps. Research on mammals has dominated the nutrition literature, so there is a relative lack of nutritional management information for birds. We combine concepts of domestic animal nutrition with recent findings on the nutritional requirements of birds to provide a foundation for further studies of avian nutrition. We call for the broader zoological community to share data and collaborate on nutritional research to support conservation institutions in nutritional management of wild birds.     

The injured mind in the UK Armed Forces

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.     

Nutritional value of algae: a critical control on the stability of Daphnia-algal systems

In Daphnia–algal systems, the effect of nutrient enrichmenton stability is an important ecological issue. Here I considera system of Daphnia and two potential prey; one prey termedprimary algae, which are preferentially consumed, and the othersecondary algae, which yield less nutrition and are more resistantto the grazer. The presence of secondary algae is a key to thestability, but their nutritional value has not been clearlydefined in the previous theory and the actual value varies.Here I use a simple mathematical model defining explicitly thenutritional values of algae and examine the stability of thesystems as a function of phosphorus enrichment. Whether or notall three species can stably coexist depended on the combinationof the algal species used for simulation. In systems where allthe species coexist in a stable manner, in which enrichmentdoes not necessarily lead to destabilization, there is alwaysa critical nutritional value of the secondary algae. Empiricalwork supports the possibility that the unknown nutritional valueof secondary algae takes a value close to the critical one.Furthermore, at the critical nutritional value, the populationresponse in the systems to enrichment is consistent with theobserved trend in natural systems. This suggests that Daphnia–algalsystems in nature can maintain stability in the face of enrichment,without requiring specific assumptions such as spatial heterogeneity.     

Effects of protein malnutrition and ascorbic acid levels on drug metabolism

The duration of action of drugs (or other environmental chemicals) is dependent on their rate of metabolic deactivation and elimination from the body. Termination of activity is achieved either through excretion of the drug via the kidney and bile or, more commonly, through metabolic deactivation by enzymes of the liver and other tissues. In recent years, it has become increasingly obvious that nutritional status is one of the major factors capable of modifying the pharmacological effect of drugs. Numerous studies have indicated that the process of drug metabolism may be affected by acute starvation, undernutrition, protein nutrition, and deficiencies of minerals, vitamins, and lipids. Although most of the evidence concerning the effects of nutrition on the metabolism of drugs has been derived from studies on experimental animals, there is significant fragmentary human data to show that the same effects may occur in man. This paper will discuss the influence of nutritional status with particular references to protein and ascorbic acid on the metabolism of foreign compounds including drugs. The interrelationships of nutrition and the metabolism of drugs are an important consideration in view of the widespread recurrence of primary malnutrition in the developing countries, and of secondary malnutrition in more affluent societies, especially in debilitated chronically ill patients, in postoperative patients, and in those whose dietary manipulations are carried out in weight-reducing regimens. The effects of nutrition on drug metabolism may be viewed as an extension of the search for one of the environmental factors that modify drug action.     

Improved nutrition cues switch from efficiency to luxury phenotypes for a long‐lived ungulate

Cervid phenotype can be categorized as efficiency, which promotes survival but not extravagant growth, or luxury which promotes growth of large weaponry and body size. Although nutritional variation greatly influences these phenotypic forms, the potential for subspecies‐linked genetic or founder effects from restocking efforts of harvested species has not been eliminated. We measured intergenerational phenotypic change of males in response to improved nutrition in three captive‐reared populations of white‐tailed deer. Study animals were offspring of females captured from three regions displaying variation in antler and body size as well as nutritional variation. We fed all animals a high‐quality diet and measured antler and body size for two generations. We predicted that improved long‐term nutrition would cue a switch from efficiency to luxury phenotype for all populations and that regional compensation of antler and body size would occur. Improved nutrition positively influenced all measures of antler and body size; however, changes varied in magnitude. Antler size was more responsive than body size. Improved nutrition also facilitated regional compensation of antler size and partial compensation of body size. Our results show that improved long‐term nutrition cues a shift from efficiency to luxury phenotype in a long‐lived cervid with weaponry being more responsive than body size. Compensation of antler size suggests that weaponry is greatly influenced by nutrition and is not restricted by subspecies‐linked genetic or founder effects from restocking efforts related to our regional populations. Therefore, strategies to improve cervid antler and body size should include habitat management that elevates long‐term diet quality.     

Link between intestinal immunity and practical approaches to swine nutrition

Gaining a deeper understanding into the underlying mechanisms associated with intestinal function and immunity during the weaning transition is critical to help shed new light into applied nutrition approaches to improve piglet performance and health during this critical life-stage transition. The transient anorexia triggered at weaning leads to compromised intestinal barrier function and a localized inflammatory response. Considering barrier function, specific nutrient fractions appear to have a significant impact on the development and function of the immune and microbial systems around weaning. Understanding the specific impact of nutrients in the small intestine and hindgut is important for helping to bring more focus and consistency to nutritional approaches to support health and immunity during the weaning transition period. The challenge continues to be how to translate these modes of action into practical and scalable approaches for swine nutrition. We will focus specifically on practical nutritional approaches to influence intestinal immunity through lipid, protein and antioxidant nutrition.     

Effect of nutrition on endocrine parameters, ovarian physiology, and oocyte and embryo development

Reproductive efficiency in high yielding dairy cows has decreased over the past 50 years, despite significant gains in genetic selection for increased milk output. One possible reason for this decline has been a change in the nutritional intake to meet the increased energy and protein demands for higher milk production. Excess energy intake in sheep will lead to significant reductions in progesterone concentrations; the effects in cattle are not so clear. Nutrition, unless radically changed, will have little effect on gonadotropin concentrations in ruminants, and this is in contrast to the situation for pigs and for primates, where very short-term nutritional changes manifest themselves in altered gonadotropin secretion. Cattle with reduced energy intake have smaller dominant follicles and more three-wave cycles, compared with animals on higher feed intakes. One of the main areas where nutrition influences reproductive efficiency is at the level of embryo production. Several studies indicate that excess energy intake reduces the response to superovulation and also decrease the yield of embryos and alters expression of some gene constructs within the developing embryo. The mechanism of this effect is not clear but indications are that the quality of the oocytes may be compromised. Indeed recent data indicate that nutritional changes around the time of mating may have detrimental effects on the establishment of pregnancy in heifers. Thus, nutritional balancing is critical for high-yielding dairy cows, in particular. The challenge remains to modify nutritional and management strategies in such cows to maintain the levels of production made possible by genetic selection and still maintain an acceptable level of fertility.     

Nutrition and the healthy heart with an exercise boost

In this era of potent medications and major cardiovascular (CV) procedures, the value of nutrition can be forgotten. A healthy diet is essential, regardless of CV risk. Caloric balance is inherent to a good diet. Despite patients who say they eat little, ideal weight can be maintained if calories are burned. Composition is another component of a healthy diet. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets provide proof of CV benefit from their specific content. Metabolic syndrome (MS) is associated with poor diet and obesity. A healthy diet with good nutrition benefits the MS patient and associated conditions such as obesity and diabetes. Exercise, in conjunction with a healthy diet and good nutrition, helps maintain optimal weight and provides CV benefit such as decreased inflammation and increased vasodilatation. Whether vitamins or other nutritional supplements are important in a healthy diet is unproven. Nevertheless, the most promising data of added benefit to a healthy diet is with vitamin D. Some dietary supplements also have promise. Alcohol, in moderation, especially red wine, has nutritional and heart protective benefits. Antioxidants, endogenous or exogenous, have received increased interest and appear to play a favorable nutritional role. CV health starts with good nutrition.