Glycemic Indices of Multiple Oral Nutritional Supplements: A Randomized Cross-Over Study in Indian Adults

Background: A randomized cross-over study was conducted to assess the glycemic index (GI) of seven Oral Nutritional Supplements (ONSs). These ONSs are designed to support the nutritional requirements of different age-groups, physiological states, or health conditions among Indian adults. Methods: The study had two phases viz., phase1 (n = 18) studied two ONSs: A1 and B1 and phase 2 (n = 20) studied five ONSs: A2, B2, C2, D2 & E2. The subjects were healthy, non-diabetic adults, aged between 20 - 44 years with a mean Body Mass Index of 21.2 ± 1.52 kg/m2 (Phase 1) and 21.0 ± 1.45 kg/m2 (Phase 2). All these ONSs were compared with reference drinks (glucose). The carbohydrates in one serving of each ONS were matched to carbohydrates from 25 grams of glucose following ISO 2010 guidelines. Capillary blood was assessed for blood glucose response at baseline, 15, 30, 45, 60, 90 and 120 minutes. GI was calculated as the incremental area under the curve (iAUC) for the test drinks and expressed as a percentage of the average iAUC from glucose. Results: Phase 1 indicated that the high fiber diabetes-specific nutrition supplement A1 with higher protein (23% energy), higher fat (25% energy) and reduced carbohydrates (40% energy) had a significantly (p = 0.002) lower GI [34 (±6)] as compared to B1 [63 (±7)] (protein 19%, fat 7% and carbohydrates 60% energy) even with similar amount (22%) and type of fiber. Phase 2 reported that all test products [A2 (32 ± 5), B2 (37 ± 4), C2 (31 ± 5), D2 (31 ± 5) and E2 (55 ± 4)] had a low GI. As compared to phase 1, ONSs in phase 2 had lower fiber content (1.6% - 4.6% energy). Conclusion: The glycemic index of oral nutrition supplements is influenced not only by their fiber content, but also by the overall macronutrient composition including protein (≥17% energy), fat (≥10% - 27% energy) and carbohydrates (40% - 57.5% energy).

Efficacy of Alzer^®and Diamel, Nutritional Supplements, in the Prevention of Severe Diabetic Macular Edema

Introduction: Macular edema is the main cause of low vision in diabetic patients. Laser photocoagulation continues to be the treatment of choice in conjunction with the use of steroids and anti-angiogenics, but these treatments include possible ocular complications. The nutritional supplement Alzer (whose primary active ingredient is Ginkgo biloba, a powerful antioxidant that acts on vascular factors and oxidative damage, which are two of the mechanisms implicated in the pathogenesis of diabetic macular edema), which has been used on other non-diabetic macular conditions, along with the Diamel nutritional supplement has been shown to be effective on glycemic control and could represent a treatment alternative for mild to moderate macular edema by reducing the thickness of the macular retina and preventing the progression of other more advanced clinical presentations that are harder to treat. Objective: Identify the effect of Alzer along with Diamel in reduction of the thickness of the macular retina among patients with mild to moderate diabetic macular edema. Materials and Methods: A phase II double-blind clinical trial was conducted in 64 patients with non-severe diabetic macular edema over the course of non-proliferative diabetic retinopathy, who attended the ophthalmology service of the Institute of Endocrinology of Havana from January 2016 to December 2016. The treatment was randomly assigned to two groups: one received Alzer plus Diamel (n = 32) and the other group received Alzer placebo + Diamel placebo (n = 32). All patients were given an initial clinical evaluation, blood testing and ophthalmological evaluation at the start of treatment and after one year of follow-up. Results: There was a clinical improvement in the macular thickness upon the conclusion of the study in the patients treated with Alzer and Diamel. This decrease in thickness was statistically significant in the left eye. There was no decrease in visual acuity one year after treatment. Adverse events were mild and uncommon. Conclusions: Severe macular edema did not evolve in the Alzer and Diamel group. The clinical, but not statistically significant, success obtained in the experimental group proves the protocol hypothesis regarding the efficacy of the product being researched. The positive results in this small sample lead to the suggestion of performing larger-scale studies (Phase III). The clinical trial was registered in Clinical Trials.gov Identifier: NCT03533478.

Efficacy of a Diabetes Specific Nutritional Supplement (DSNS) on Glycemic Response in Prediabetic Adults: A Two-Armed, Open-Labelled Randomized Controlled Study

It is well known that Diabetes Specific Nutritional Supplements (DSNSs) are linked to improved glycemic control in individuals with diabetes. However, data on efficacy of DSNSs in prediabetics is limited. This was a two-armed, open-labelled, randomized controlled six-week study on 199 prediabetics [30 - 65 years;Glycosylated Hemoglobin (HbA1c) 5.7% - 6.4% and/or Fasting Blood Glucose (FBG) 100-125 mg/dl]. Two parallel phases were conducted: Acute Blood Glucose Response (ABGR) and Intervention phase. Prediabetic participants were randomized into test (n = 100) and control (n = 99). The primary objective was to assess the ABGR of DSNS versus an isocaloric snack, measured by incremental Area under the Curve (iAUC). Test and control received 60 g of DSNS and 56 g of isocaloric snack (cornflakes) respectively, both in 250 ml double-toned milk on visit days 1, 15, 29 and 43. Postprandial Blood Glucose (PPG) was estimated at 30, 60, 90, 120, 150 and 180 minutes. During the 4 weeks intervention phase, the test group received DSNS with lifestyle counselling (DSNS + LC) and was compared with the control receiving lifestyle counselling alone (LC alone). Impact was studied on FBG, HbA1C, anthropometry, body composition, blood pressure, nutrient intake, and physical activity. The impact of DSNS was also studied using CGM between two 14-day phases: CGM1 baseline (days 1 - 14) and CGM2 endline (days 28 - 42). DSNS showed significantly lower PPG versus isocaloric snack at 30 (p 12, and chromium were reported by DSNS + LC versus LC alone. No other significant changes were reported between groups. It may be concluded that DSNS may be considered as a snack for prediabetic or hyperglycemic individuals requiring nutritional support for improved glycemic control.

Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.

Urticaria Successfully Treated with Mindfulness and Nutraceutical Supplements

The study is to describe a patient with urticarial lesions which was successfully treated with mindfulness and nutraceuticals.A 20-year-old female patient with an unmarked past medical history presented with diffuse pruritic urticarial lesions associated with breathless and severe fatigue,lasting for 5 months.The lesions covered all body,except palms and plants.Hospitalized for three days,she received dexamethasone,promethazine,and subcutaneous adrenalin and discharged with fexofenadine,prednisone,and ranitidine.Mindfulness and relaxation practice were instructed and some nutraceuticals.After two months,she returned asymptomatic,without any new episodes of urticaria or fatigue.Most of the chronic urticaria patients are treated with antihistamines and/or steroids.This case illustrates an alternative holistic approach,combining mindfulness and relaxation practices with nutraceuticals.This alternative therapeutical strategy should be explored by back to back comparison to the conventional pharmaceutical approach.

Drug-Seeking Behavior Is Significantly Attenuated in Nutritionally Supplemented Cocaine Withdrawn Sprague-Dawley Rats

Aim: The effect of patented nutritional supplementation on drug-seeking behavior in cocaine addicted rats during acute drug withdrawal was investigated using a biased Conditioned Place Preference (CPP) paradigm. Method: Twenty-four (24) male Sprague-Dawley rats with pre-conditioned preference for the black chamber of the CPP box were randomly divided into Cocaine (COC) or Saline (SAL) treated groups. Rats (n = 12) treated with cocaine hydrochloride 20 mg/kg/ml, i.p. (COC group) were confined individually to the white chamber on days 1, 3, 5 and 7. On alternate days, they were given 1 ml saline vehicle, i.p. and confined to the black chamber. Control rats (SAL group, n = 12) received only vehicle on all 8 days and were confined on alternate days to the white or black chamber. Positive place preference was confirmed for COC rats, which subsequently received 6 increasing daily doses of cocaine. CPP performances of both COC and SAL rats were recorded following an acute 3-day withdrawal period. All animals were then randomly assigned to rats fed either chow reconstituted with the nutritional supplement (COC-S and SAL-S) or standard rat chow (COC-N and SAL-N) for 8 weeks, followed by final CPP performances. Results: Following supplementation, COC-S rats made significantly less entries and time spent in the white chamber (p < 0.05) compared with COC-N rats. COC-S rats exhibited significant place aversion to the white chamber similar to drug-naive animals;whereas COC-N continued to show positive place preference. Conclusion: Drug-seeking behavior that persisted during cocaine withdrawal was significantly diminished in the nutritionally supplemented.

Nutritional Therapy in Patients Undergoing Elective Colorectal Cancer Surgery

The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolerance of chemotherapy and radiotherapy.Therefore,the nutritional management of patients with colorectal cancer is important.The perioperative nutritional management of patients includes preoperative education,nutritional screening and evaluation,preoperative intestinal preparation,and postoperative nutritional management.This article summarizes the current status of perioperative nutritional therapy and bowel preparation for patients with colorectal cancer.

Antioxidant,nutritional and anti-nutritional composition of Garcinia kola and Chrysophyllum albidum from rainforest ecosystem of Ondo State,Nigeria

Tropical forests contain many tree species that have supplied edible fruits for centuries.These fruits have contributed to human diets due to their richness in nutrients,vitamins,minerals,antioxidants and their low antinutrients content.We investigated the antioxidant,nutritional and anti-nutritional composition of Garcinia kola and Chrysophyllum albidum fruit parts.The nutritional,anti-nutritional and antioxidant compositions differed depending on the fruit part.Irrespective of fruit part,moisture content was high（72–93 %）.While the edible part（fruit pulp） of C.albidum proved a better source of protein（4）,fibre（17 %） and fat（2 %）,the seed kernel was a better source of ash（2 %） and carbohydrate（15 %）.Carbohydrate（22 %）,protein（2 %）,fat（1 %） and fibre（3 %） were higher in G.kola seed kernel（edible part） than in the pulp and pod.Anti-nutrient content in G.kola and C.albidum fruits was low,indicating that their consumption would not pose nutritional or health problems.The antioxidant compositions（especially phenolic content（10–21 mg g-1） and DPPH（1,1-diphenyl–2 picrylhydrazyl）（26–55 %）） of C.albidum fruit pulp and G.kola seed kernel were high,implying that they could be good sources of natural antioxidants and could be used as supplements in food manufacturing.

Determination of Alpha-Lipoic Acid in a Nutritional Supplement Using High Performance Liquid Chromatography

Alpha lipoic acid has the ability to react and neutralize reactive oxygen species (ROS) such as superoxide radicals, simple oxygen, hydroxyl radicals, hypochlorous acid and peroxyl radicals. A rapid high-performance liquid chromatographic method for determination of lipoic acid in a nutritional supplement was developed. The method involved sample preparation and the mobile phase comprised of 50 mM disodium hydrogen phosphate buffer (pH 2.5 adjusted with 1 M H3PO4): acetonitrile in the ratio of 50:50. The separation was done using a C18 column (150 mm) and detection was carried out using UV detection at 201 nm. The assay was found to be linear in the range of 1.56 - 50 μg/mL with the correlation coefficient of 0.9997. Method precision was determined while LOD was 0.05 μg/mL and LOQ 0.15 μg/mL. The chromatographic peak LA retention time was 6 min.

Impact of Three-month Home Enteral Nutritional Supplementation on the Nutritional Status of Patients with Malignancy

Objective We analysed the impact of home nutritional interventions on the nutritional risk and the incidence and severity of malnutrition in patients with malignancy.Methods In this prospective interventional study,we recruited 60 patients with malignancy who were at nutritional risk(NRS 2002≥3 scores).These patients were given home enteral nutritional supplementation(HES)for 3 months.The HES included nutritional counselling,oral nutritional supplements(ONS)and tube feeding.The incidence and severity of nutritional risk and malnutrition,as well as the body composition and results of routine blood tests,were compared before and after the intervention.Results A total of 58 patients completed the study.After three months of home enteral nutritional intervention,the incidence and severity of nutritional risk and malnutrition were significantly reduced(the NRS 2002 score was reduced from 3 to 1,the PG-SGA score was reduced from 8.00 to 3.00,P<0.05).The patients’body mass index(BMI)and upper arm circumference increased(P<0.05),the muscle mass,appendicular skeletal muscle mass index(ASMI)and phase angle(PA)increased(P<0.05).The serum albumin,pre-albumin and haemoglobin levels increased significantly,while the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)decreased significantly(P<0.05).The incidence of hypoproteinaemia and anaemia also decreased significantly(P<0.05).Conclusion HES can effectively improve the nutritional status of patients and reduce the risk and severity of malnutrition.

Effect of perioperative branched chain amino acids supplementationin liver cancer patients undergoing surgical intervention: Asystematic review

performed independently by authors(Yap KY,Chi H,Ng S)identified 50 studies for full-text evaluation.Finally,12 prospective RCTs and 4 non-randomised studies(1 non-randomised trial and 3 observational studies)were included.A detailed PRISMA diagram is shown in Figure 1.The studies included were assessed for risk of bias,with a summary of the assessment shown in Figure 2 and Table 1 for trials and non-interventional studies,respectively.The PRISMA checklist is appended in Supplementary Figure 1.

L-Arginine Supplementation and Nitric Oxide Production:No Additional Effect When Associated to Exercise

L-arginine is an amino acid semiessencial considered a precursor of nitric oxide, a gas mainly produced in endothelial cells. Nutritional supplements based on the amino acid L-arginine have been broadly marketed in order to increase vasodilation and the blood supply to muscle in order to optimize metabolic responses induced by exercise. The main objective of this study was to evaluate the effect of L-arginine supplementation on nitric oxide production in response to exercise. Furthermore, the biochemical parameters of muscle fatigue were assessed. Fourteen trained runners were divided in two groups, supplemented with L-arginine (ARG) and placebo (PLA). Blood samples were collected before supplementation (T0), immediately after the first exercise session (T1), immediately after the second exercise session (T2), and after 20 minutes of rest (T3). Plasma cyclic guanosine monophosphate was assessed as a marker of nitric oxide production. The biochemical parameters of muscle fatigue analyzed were plasma lactate and ammonia. There was significant increase in plasma cyclic guanosine monophosphate in both groups in response to exercise: ARG (T0: 3.6 ± 1.4;T1: 17.9 ± 5.8;T2: 15.9 ± 5.3;T3: 7.3 ± 2.5 pmol/mL) and PLA (T0: 4.1 ± 1.1;T1: 18.8 ± 9.9;T2: 16.1 ± 3.5;T3: 9.3 ± 3.7 pmol/mL). A significant reduction in plasma lactate and ammonia were observed in the recovery period after exercise (T3). However, no significant difference was observed between groups in the variables studied. Therefore, L-arginine supplementation was unable to increase the effects of exercise on nitric oxide production and did not improve the metabolic responses to exercise in runners.

Efficient decolorization of dye-containing wastewater using mycelial pellets formed of marine-derived Aspergillus niger

In order to improve the efficient decolorization of dye-containing water by biosorbent and understand the biosorption mechanism, the self-immobilization mycelial pellets were prepared using a marine-derived fungus Aspergillus niger ZJUBE-1, and an azo dye, Congo red was chosen as a model dye to investigate batch decolorization efficiency by pellets. The pellets as biosorbent showed strong salt and acid tolerance in biosorption process. The results for dye adsorption showed that the biosorption process fitted well with models of pseudo-second-order kinetic and Langmuir isotherm, with a maximum adsorption capacity of 263.2 mg·g^(-1) mycelium. During 6 batches of continuous decolorization operation, the mycelial pellets could possess efficient decolorization abilities(>98.5%).The appearance of new peak in the UV–Vis spectral result indicated that the decolorization process may also contain biodegradation. The mechanism studies showed that efficient biosorption ability of pellets only relies on the active zone on the surface of the pellet, which can be enhanced by nutrition supplement or be shifted outward by a reculture process.

Antioxidant and immunomodulatory effects of Viusid in patients with chronic hepatitis C

AIM:To investigate the efficacy of Viusid,a nutritional supplement,as an antioxidant and an immunomodulator in patients with chronic hepatitis C.METHODS:Sixty patients with chronic hepatitis C who were non-responders to standard antiviral treatment were randomly assigned to receive Viusid(3 sachets daily,n=30) or placebo(n=30) for 24 wk.The primary outcome was the change in serum malondialdehyde and 4-hydroxyalkenals(lipid peroxidation products).Secondary outcomes were changes in serum tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ) and interleukin-10(IL-10).RESULTS:Statistically significant reductions in serum 4-hydroxyalkenals and malondialdehyde levels were observed in both groups in comparison with pretreatment values,but the patients who received Viusid showed a more marked reduction as compared with the control group(P=0.001).TNF-α levels significantly increased from 6.9 to 16.2 pg/mL(P< 0.01) in the patients who received placebo in comparison with almost unchanged levels,from 6.6 to 7.1 pg/mL(P=0.26),in the patients treated with Viusid(P=0.001).In addition,IL-10 levels were markedly increased in the patients treated with Viusid(from 2.6 to 8.3 pg/mL,P=0.04) in contrast to the patients assigned to placebo(from 2.8 to 4.1 pg/mL,P=0.09)(P=0.01).Likewise,the administration of Viusid markedly increased mean IFN-γ levels from 1.92 to 2.89 pg/mL(P< 0.001) in comparison with a reduction in mean levels from 1.80 to 1.68 pg/mL(P=0.70) in the placebo group(P< 0.0001).Viusid administration was well tolerated.CONCLUSION:Our results indicate that treatment with Viusid leads to a notable improvement of oxidative stress and immunological parameters in patients with chronic hepatitis C.

Pharmaceutical and nutraceutical potential of natural bioactive pigment:astaxanthin

Astaxanthin(3,3′-dihydroxy-β,β-carotene-4,4′-dione)is an orange-red,lipophilic keto-carotenoid pigment.It is majorly found in marine ecosystems particularly in aquatic animals such as salmon,shrimp,trout,krill,crayfish,and so on.It is also synthesized in microalgae Heamatococcus pluvialis,Chlorococcum,Chlorella zofingiensis,red yeast Phaffia rhodozyma and bacterium Paracoccus carotinifaciens.Some aquatic and terrestrial creatures regarded as a primary and secondary sources of the astaxanthin producing and accumulating it through their metabolic pathways.Astax-anthin is the powerful antioxidant,nutritional supplement as well as promising therapeutic compound,observed to have activities against different ravaging diseases and disorders.Researchers have reported remarkable bioactivities of astaxanthin against major non-communicable chronic diseases such as cardiovascular diseases,cancer,diabetes,neurodegenerative,and immune disorders.The current review discusses some structural aspects of astaxanthin.It fur-ther elaborates its multiple potencies such as antioxidant,anti-inflammatory,anti-proliferative,anti-cancer,anti-obese,anti-diabetic,anti-ageing,anti-TB,anti-viral,anti-COVID 19,neuro-protective,nephro-protective,and fertility-enhanc-ing properties.These potencies make it a more precious entity in the preventions as well as treatments of prevalent systematic diseases and/or disorders.Also,the review is acknowledging and documenting its powerful bioactivities in relation with the pharmaceutical as well as nutraceutical applicability.

Dietary supplementation in patients with alcoholic liver disease: a review on current evidence

BACKGROUND：Alcoholic liver disease（ALD）is one of the main causes of liver disease worldwide.Although the pathogenesis of ALD has not yet been well elucidated,the oxidative metabolites of ethanol such as acetaldehyde and reactive oxygen species play a pivotal role in the clinical and pathological spectrum of the disease.This review summarizes the existing evidences on dietary supplements considered to have antioxidant,and/or anti-inflammatory properties,and their role in the management of ALD and the proposed mechanisms.DATA SOURCES：The present study reviewed all studies published in Pub Med,Science Direct and Scopus,from 1959 to2015,indicating the role of different dietary supplementation in attenuation of many pathophysiological processes involved in development and progression of ALD.Full-texts of citations were used except for those that were published in languages other than English.RESULTS：Significant progress has been made to understand the key events and molecular players for the onset and progression of ALD from both experimental and clinical studies;however,there is no successful treatment currently available.The present review discussed the role of a variety of dietary supplements（e.g.vitamin A,carotenoids,vitamins B3,C and E,in addition to antioxidants and anti-inflammatory agents）in treating ALD.It has been shown that supplementation with some carotenoids,vitamin B3,vitamin C,silymarin,curcumin,probiotics,zinc,S-adenosylmethionine and garlic may havepotential beneficial effects in animal models of ALD;however,the number of clinical studies is very limited.In addition,supplementation should be accompanied with alcohol cessation.CONCLUSIONS：Since oxidative stress and inflammation are involved in the pathogenesis of ALD,dietary supplements that can modulate these pathologies could be useful in the treatment of ALD.In addition to alcohol cessation,these supplements have shown beneficial effects on animal models of ALD.Clinical trials are needed to validate the beneficiary role of these supplements in patients with ALD.

Factors Affecting Technology Adoption in Small Community Farmers in Relation to Reproductive Events in Tropical Cattle Raised under Dual Purpose Systems

The impact of technology adoption among farmers in developing countries has been an issue difficult to measure and interpret. Hence, research to improve production has been centered in technology that possible is not adequate for this region. The present review aims to utilize subjects such as Genetics, Reproduction, Nutrition, Management and Animal Health as examples of research endeavors illustrating the scarcely bond existing between research and adoption of technology. A final section is an attempt to illustrate the possible reasons why the transfer of technology is failing to be of any consequence at least under the conditions of developing countries.

Creatine supplementation in trained rats causes changes in myenteric neurons and intestinal wall morphometry

Creatine is widely used by athletes as an ergogenic resource.The aim of this study was to evaluate the infl uence of creatine supplementation on the duodenum of rats submitted to physical training.The number and myenteric neuronal cell bodies as well mucosal and muscular tunic morphometry were evaluated.Control animals received a standard chow for 8 weeks,and the treated ones received the standard chow for 4 weeks and were later fed with the same chow but added with 2%creatine.Animals were divided in groups:sedentary,sedentary supplemented with creatine,trained and trained supplemented with creatine.The training consisted in treadmill running for 8 weeks.Duodenal samples were either processed for whole mount preparations or for paraffi n embedding and hematoxylin-eosin staining for histological and morphometric studies of the mucosa,the muscular tunic and myenteric neurons.It was observed that neither creatine nor physical training alone promoted alterations in muscular tunic thickness,villus height or crypts depth,however,a reduction in these parameters was observed when both were associated.The number of myenteric neurons was unchanged,but the neuronal cell body area was reduced in trained animals but not when training and creatine was associated,suggesting a neuroprotector role of this substance.

Comprehensive interventions for adult cyclic vomiting syndrome complicated by superior mesenteric artery syndrome:A case report

BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.

Efficacy of a Diabetes Specific Nutrition Supplement on Glycemic, Anthropometric, Dietary and Gut Health Markers in Adults with Type 2 Diabetes: An RCT

With increasing incidence of diabetes, use of diabetes specific nutrition supplements (DSNS) is common for better management of the disease. To study effect of 12-week DSNS supplementation on glycemic markers, anthropometry, lipid profile, SCFAs, and gut microbiome in individuals with diabetes. Markers studied were glycemic [Fasting Blood Glucose (FBG), Post Prandial Glucose (PPG), HbA1c, Incremental Area under curve (iAUC), Mean Amplitude of Glycemic Excursions (MAGE), Time in/above Range (TIR/TAR)], anthropometry [weight, Body Mass Index (BMI), waist circumference (WC)], lipid profile, diet and gut health [plasma short chain fatty acids (SCFAs)]. N = 210 adults were randomized to receive either DSNS with standard care (DSNS + SC;n = 105) or standard care alone (SC alone;n = 105). After 12 weeks, significant differences between DSNS + SC versus SC alone was observed in FBG [−3 ± 6 vs 14 ± 6 mg/dl;p = 0.03], PPG [−35 ± 9 vs −3 ± 9 mg/dl;p = 0.01], weight [−0.6 ± 0.1 vs 0.2 ± 0.1 kg;p = 0.0001], BMI [−0.3 ± 0.1 vs 0.1 ± 0.1 kg/m2;p = 0.0001] and WC [−0.3 ± 0.2 vs 0.2 ± 0.2 cm;p = 0.01]. HbA1C and low-density lipoprotein (LDL) were significantly reduced in DSNS + SC [−0.2 ± 0.9;p = 0.04 and −5 mg/dl;p = 0.03] respectively with no change in control. Continuous Glucose Monitoring (CGM) reported significant differences between DSNS + SC versus SC alone for mean glucose [−12 ± 65 vs 28 ± 93 mg/dl;p < 0.01], TAR 180 [−9 ± 42 vs 7 ± 45 mg/dl;p = 0.04], TAR 250 [−3 ± 27 vs 9 ± 38 mg/dl;p = 0.05], iAUC [−192 (1.1) vs −48 (1.1) mg/dl;p = 0.03]. MAGE was significantly reduced for both DSNS + SC (−19 ± 67;p < 0.001) and SC alone (−8 ± 70;p = 0.04), with reduction being more pronounced for DSNS + SC. DSNS + SC reported a decrease in carbohydrate energy % [−9.4 (−11.3, −7.6) %;p < 0.0001] and amount [−47.4 (−67.1, −27.7) g;p < 0.0001], increased dietary fiber [9.5 (7.2, 11.8) g;p < 0.0001] and protein energy % [0.9 (0.5, 1.3) %;p < 0.0001] versus SC alone. DSNS + SC reported significant increases versus SC alone in total (0.3 ng/ml;p = 0.03) and individual plasma SCFAs. The consumption of DSNS significantly improves the glycemic, anthropometric, dietary, and gut health markers in diabetes.