Chronic kidney disease (CKD) is associated with various nutritional disorders, including both malnutrition and obesity, which have a detrimental effect on patient health, disease progression, and outcomes. Central obesity, in particular, is known to be harmful to health, contributing to increased risk of cardiovascular disease and other comorbidities. This study aimed to assess the prevalence of malnutrition and obesity in outpatient CKD patients, specifically examining the proportion of patients with central obesity. Additionally, we evaluated their nutritional status, dietary habits, and physical performance. The study included CKD stage 1–5 patients monitored at the nephrology outpatient clinic of the University Clinical Centre Ljubljana, Slovenia. Participants completed a food frequency questionnaire and provided information on physical activity, body weight, height, and waist circumference. Obesity was defined as a body mass index (BMI) > 29.9 kg/m², while central obesity was defined as an increased waist circumference (> 80 cm in women and > 94 cm in men). Body composition was measured using a 4-frequency bioelectrical impedance analysis (BIA), and muscle strength was assessed using handgrip strength. Malnutrition was determined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. A total of 199 CKD patients (stages 1–2: 95 patients; stages 3–5: 104 patients) participated, of whom 50.8% (n = 101) were male, and 41.2% (n = 82) were older than 64 years. Normal body weight and waist circumference were observed in 16.1% of patients (n = 32). Obesity based on BMI was found in 26% (n = 53) of patients, while 80.3% (n = 159) had an increased waist circumference. All obese patients also had an increased waist circumference. BIA revealed an elevated fat mass in 58.3% (n = 116) of patients, 96.6% (n = 112) of whom also had an increased waist circumference (P = 0.001), and 92.5% were classified as obese by BMI (P = 0.001). Based on GLIM criteria, 22 patients (11 %) were classified as moderately malnourished. Sarcopenia was diagnosed in 2 patients (1.0%) (CKD stages 3 and 4), with 1 patient (0.5%) (CKD stage 4) having sarcopenic obesity. Reduced muscle mass (myopenia) was present in 10.6% (n = 21) of patients, more frequently in women (15.3%) than in men (5.9%) (P = 0.06). Simultaneous myopenia and elevated fat mass were identified in 6% (n = 12) of patients. No significant differences were observed in dietary habits between obese patients with central obesity (26%, n = 52) and those with normal body weight and waist circumference (16%, n = 32). Both groups reported similar and excessive intake of sugar, sweets, and refined flour products, alongside insufficient consumption of legumes and leafy green vegetables. The only notable difference was in physical activity: obese patients with central obesity were less likely to engage in ≥150 minutes of weekly physical activity than other patients (P = 0.003). Central obesity is the most prevalent nutritional disorder in outpatient CKD stage 1–5 patients, affecting 80% of them. Malnutrition, as determined by the GLIM criteria, is present in a moderate proportion of patients, further highlighting the need for early intervention. Myopenia is present in one-tenth of patients, more frequently in women, while sarcopenia and sarcopenic obesity are less common. Elevated fat mass, as measured by BIA, can be reliably identified using waist circumference rather than BMI, making waist circumference an essential part of clinical assessments. Most patients exhibit suboptimal dietary patterns; however, those who are more physically active tend to have better body composition. The scope of intervention required to address the identified nutritional disorders, including malnutrition, is extensive. Early identification of nutritional issues calls for intensified multidisciplinary management by nephrology educators, clinical dietitians, and kinesiologists.

Abstract Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal disease. Gastrointestinal symptoms in such patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The reason for presence of some gastrointestinal symptoms is also chronic inflammatory state. Inflammation can have many negative effects, including decreased appetite, accelerated protein skeletal muscle breakdown and hypercatabolism. Method 14 peritoneal dialysis patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessment was conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to classify patient's stool. The dietary intake of peritoneal dialysis patients was assessed using 7-day food diaries and analyzed with Prodi program (PRODI® 6.4 Expert program, Stuttgart, Deutschland). Body composition has been measured with bio impedance spectroscopy. Routine blood analysis was performed. Results Among 14 patients undergoing peritoneal dialysis, most of them were male (71.4%) with average age of 53.07 ± 12.32 years. Average energy intake of 14 patients was 21.05 ± 5.72 kcal/kg body weight per day, average protein intake was 0.87 ± 0.39 g/ kg body weight per day and average fiber intake was 13.75 ± 7.25 g per day. They were inadequate according to the dietary guidelines for peritoneal dialysis patients. Average dietary protein-fiber index was 6.86 ± 3.81 per day. Average PRAL value was 15.84 ± 13.44 for women and 6.52 ± 17.99 for men. Average dietary potassium intake was 1917.80 ± 790.08 mg per day which corresponds to the guidelines for peritoneal dialysis patients and average potassium serum value 4.45 ± 0.42 mmol/L. GSRS questionnaire showed peritoneal patients had minor to mild discomfort in abdominal pain, constipation and indigestion GI symptom cluster. Patients’ self-analysis of stool showed BSFS Types 3.23 ± 1.64 if BSFS Types 3–5 are defined as normal stools. Dietary protein intake strongly correlated with dietary energy intake (r = 0.76, p = 0.003), dietary protein-fiber index strongly correlated with PRAL value (r = 0.70, p = 0.007) and dietary potassium intake moderately to strongly correlated with dietary fiber intake (r = 0.62, p = 0.025). Serum value of IL-6 strongly correlated with dietary potassium intake (r = 0.72, p = 0.006) and moderately to strongly correlated with dietary fiber intake (r = 0.6, p = 0.034). The correlation between dietary potassium intake and serum hsCRP was significant (p = 0.042). The correlation between Bristol stool consistency value and serum hsCRP was significant (p = 0.0255). The correlation between total GSRS score and serum value of albumin was significant (p = 0.0010). The correlation between total GSRS score and dietary potassium intake was significant (p = 0.0015). The correlation between total GSRS score and dietary protein-fiber index was significant (p = 0.0403). Conclusion Gastrointestinal diseases in peritoneal dialysis patients are comparatively understudied in the literature, despite having a significant impact on dialysis efficacy and the quality of life. Analysis of GSRS questionnaire showed that abdominal pain, constipation and indigestion caused minor to mild discomfort in PD patients. The analysis also showed that fiber intake, potassium intake and gastrointestinal symptoms are significantly associated with inflammation markers and are important contributing factors to chronic inflammatory state in these patients. Patients still lack the basic knowledge of nutrition, thus in the future nutritional consultations, innovative teaching techniques and help will be crucial to prevent the decline in nutritional status.

Background: End-stage renal disease (ESRD) and renal replacement therapy options are associated with malnutrition, which occurs in 30-50% of patients. Suboptimal nutritional status and physical inactivity are common in peritoneal dialysis patients also and are consequences of the restrictive diet, appetite loss, and poor physical fitness. Materials and methods: This single-center observational study aimed to analyze the dietary intake, body composition, and physical activity of 19 peritoneal dialysis (PD) patients. Dietary assessment was performed with a three-day 24-hour dietary recall, while nutritional status was assessed with body composition measurements. Patients’ physical performance was assessed with a handgrip test and a sit-stand test. Each value was expressed as a percentage or mean ± SD. Continuous variables between normal values and of study values were compared using paired t-tests and Wilcoxon signed ranks test. A two-tailed P value <0.05 was considered statistically significant. Results: The mean caloric intake of the 19 patients was 1545 ± 295 kcal/day (21.4 kcal/kg BW/day), and the mean protein intake was 0.8 g/kg BW/ day. The mean value of body mass index was 24.4 ± 2.9 kg/m2 , phase angle was 5.2 ± 0.9, lean tissue index was 14.5 ± 2.8 kg/m2 and adipose tissue index was 9.3 ± 3.6 kg/m2 . The results of the handgrip test and the sit-to-stand test showed muscular weakness associated with low caloric intake. Conclusion: In our PD patients, average energy and protein intakes were inadequate according to dietary recommendations, which are related to reduce muscle strength among observed patients and a poor physical activity profile. The overall approach of nutritional counseling is necessary to improve the nutritional status of patients.

This is the first study to examine the nutritional status of professional Slovenian football players. This study aimed to analyze the dietary intake of elite football players during their preparation phase of the season and to investigate whether there is a relationship between energy and macronutrient intake with body composition and physical performance. Twenty-three footballers completed a three-day dietary and physical activity diary and underwent body composition measurements via bioelectrical impedance vector analysis (BIVA). Fifteen participants also took part in the Cooper treadmill test to assess their physical performance in correlation with their nutritional intake. Football players had an energy intake that was significantly too low for their needs, reflecting low energy availability. The average carbohydrate (CHO) intake was below the Union of European Football Associations (UEFA) recommendations, i.e., <4 g CHO/kg body weight (BW). Additionally, players had adequate intakes of protein and fat, and inadequate intakes of saturated fat, fiber, calcium and vitamin D. There was a positive correlation between protein intake and lean body mass. Additionally, a negative correlation was observed between body fat mass and carbohydrate intake as well as between performance with the percentage of energy intake from fat. Results of this study highlight what aspects of nutrition might be improved upon in professional football players to maximize performance, longevity and body composition of athletes, as well as the necessity of a nutritionist role in this process.

Nitrates are an effective ergogenic supplement; however, the effects of nitrate supplements based on habitual dietary nitrate intake through diet alone are not well understood. We aimed to assess this in a group of 15 highly trained football players from Slovenian football's First Division. Participants underwent two separate Cooper performance tests either with nitrate supplementation (400 mg nitrates) or placebo while having their nutrition assessed for nitrate intake, as well as energy and macronutrient intake. Nitrate supplementation had a statistically significant positive effect on performance if baseline dietary nitrate intake was below 300 mg (p = 0.0104) in both the placebo and intervention groups. No effects of nitrate supplementation when baseline dietary nitrate intake was higher than 300 mg in the placebo group could be concluded due to the small sample size. Nitrate supplementation did not have a significant effect on perceived exertion. The daily nitrate intake of the participants was measured at 165 mg, with the majority of nitrates coming from nitrate-rich vegetables.

Izobraževalna pot študentov medicine je dolgotrajna in zahtevna. Usklajevanje študijskih obveznosti, obštudijskih dejavnosti in skrbi za zdravje je lahko za mlade velik izziv, za katerega so posamezniki različno dobro opremljeni. Naš narativni pregledni članek povzema doslej znane raziskave o vplivu študija medicine na dejavnike življenjskega sloga in determinante zdravja ter s tem na telesno in duševno zdravje posameznika. Raziskave glede vpliva teh dejavnikov smo pridobili prek iskalnih nizov s ključnimi besedami. Ugotovili smo, da nekakovostna, nezadostna in neredna prehrana v kombinaciji s pomanjkanjem telesne dejavnosti in sedečim slogom življenja vpliva na neželene spremembe telesne sestave ter poveča tveganje za razvoj presnovnih motenj ter akutnih in kroničnih zdravstvenih težav. Zdravstvene težave dodatno poglablja tudi pomanjkanje spanja in kronični stres zaradi zahtev študija, kar lahko vodi tudi v razvoj duševnih motenj. Vse to ne prispeva le k zmanjšanju študijskega uspeha študentov, temveč tudi do zdravstvenih težav številnih mladih, ki se že na začetku svoje zahtevne kariere soočajo z njimi. V Sloveniji zaenkrat nimamo sistematičnih raziskav, ki bi omogočale oceno vpliva dejavnikov življenjskega sloga in kroničnega stresa na zdravje slovenskih študentov medicine.

Rationale: Introduction: Evaluation of dietary intake of patients on peritoneal dialysis is necessary for understanding the elevated phosphate levels, as well as protein intake monitoring, which struggles to meet current dietary guidelines.

The importance of water homeostasis is extremely important. Maintaining hydration, the state of preserving body water within its optimal homeostatic range, is essential to sustain life. Water is an essential nutrient and contributes 50-70% of total body mass. An assessment of hydration during physical activity can prevent dehydration, which impairs physical and cognitive performance. A 2% body mass loss is a recognized threshold beyond which exercise dehydration impairs exercise performance. Liquid needs for recreational sports and physical activity are individual and are rarely higher than 500ml of hypotonic fluid per hour. If fluid requirements are low, concentrated sports drinks (providing energy intake) can help sustain exercise performance. Overhydration could be dangerous and can result in hyponatremia. Individual evaluation of water needs is important. In warm environmental conditions, an individual nutrition and hydration plan is crucial for the health and optimal performance and using existing recommendations in clinical sports nutrition to prevent over - and dehydration.

Nitrates have become increasingly popular for their potential role as an ergogenic aid. The purpose of this article was to review the current scientific evidence of nitrate supplementation on human performance. The current recommendation of nitrate supplementation is discussed, as well as possible health complications associated with nitrate intake for athletes, and dietary strategies of covering nitrate needs through sufficient intake of nitrate-rich foods alone are presented. Pubmed, Scopus, and Web of Science were searched for articles on the effects of nitrate supplementation in humans. Nitrates are an effective ergogenic aid when taken acutely or chronically in the range of ~5–16.8 mmol (~300–1041 mg) 2–3 h before exercise and primarily in the case of exercise duration of ~10–17 min in less trained individuals (VO2max < 65 mL/kg/min). Nitrate needs are most likely meet by ingesting approximately 250–500 g of leafy and root vegetables per day; however, dietary supplements might represent a more convenient and accurate way of covering an athlete’s nitrate needs. Athletes should refrain from mouthwash usage when nitrate supplementation benefits are desired. Future research should focus on the potential beneficial effects of nitrate supplementation on brain function, possible negative impacts of chronic nitrate supplementation through different nitrate sources, and the effectiveness of nitrate supplementation on strength and high-intensity intermittent exercise.

BACKGROUND Arterial stiffness represents an independent risk factor for cardiovascular mortality in dialysis patients and is strongly connected to hypervolemia. The aim of the study was to evaluate different methods for fluid status assessment and their association with arterial stiffness parameters in peritoneal dialysis patients. MATERIALS AND METHODS In 16 peritoneal dialysis patients (53 ± 18 years, 9/16 men) fluid status was determined by clinical examination, lung ultrasound (number of B-lines, normal up to 4), overhydration degree by bioimpedance monitor device, estimation of central venous pressure by ultrasound measurement of vena cava inferior, measurement of serum N-terminal pro b-type natriuretic peptide (NT-proBNP), and albumin level. Pulse wave velocity and augmentation index were measured non-invasively with an oscillometric device to indirectly assess arterial stiffness, blood pressure (BP) was obtained by the same device. RESULTS Clinical evaluation (BP 136 ± 15/93 ± 15 mmHg, edema in 2/16 patients) and lung ultrasound (on average 3 ± 6 B-lines) showed mostly normal fluid status of patients. Patients had slightly lower albumin values (37 ± 4 g/L), slightly elevated central venous pressure (10 ± 4 mmHg), and elevated NT-proBNP (11,596 ± 13,635 ng/L). Body composition evaluation showed mild overhydration (1.5 ± 2 L), which significantly correlated with central venous pressure (p = 0.046) and NT-proBNP (p = 0.004). Lung ultrasound significantly negatively correlated with albumin (r = -0.82, p < 0.001) and positively with NT-proBNP (r = 0.62, p = 0.011). Augmentation index (22 ± 11%) and augmentation pressure correlated with lung ultrasound (r = 0.54, p = 0.032 and r = 0.67, p = 0.004, respectively), although pulse wave velocity (8.4 ± 2.5 m/s) showed no significant correlation with fluid status parameters. The multivariate model showed that lung ultrasound B-lines were an independent determinant of augmentation pressure (β = 0.58, p = 0.043). CONCLUSION Fluid status evaluated with lung ultrasound showed good correlation with augmentation index and augmentation pressure, which are markers of arterial stiffness. The lung ultrasound B-lines were found to be an independent determinant of augmentation pressure. Overall arterial stiffness evaluated with pulse wave velocity and augmentation index was not markedly elevated in our patients, which could be due to a good euvolemic status. We conclude that different methods for fluid status evaluation are complementary, with lung ultrasound as a beneficial tool in routine clinical practice in peritoneal dialysis patients.

The aim of presented study is to compare parameters of oxidative stress in untrained volunteers, patients with chronic, non-motor related disease (dialysis patients) and professional athletes before and after exhaustive exercise. 40 subjects participated in the study: 14 healthy, untrained subjects, 12 hemodialysis patients and 14 professional rowers. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and non-transferrin bound iron (NTBI) were determined before and after exercise. Dialysis patients have increased oxidative stress at rest with highest NTBI, and show adaptation with increased values of GPx and decreased SOD. Professional athletes have low level of oxidative stress at basic circumstances with lowest NTBI, SOD, CAT and GPx as compared to untrained volunteers and dialysis patients. After strenuous exercise elevation of antioxidative enzymes is observed only in athletes, but not in untrained and dialysis patients. Due to limited antioxidative capacity, extreme physical effort is probably not recommended to dialysis patients and untrained people.

Rationale: Body mass composition using bio-impedance spectroscopy is extremely important for evaluation nutrition status in peritoneal dialysis patients. Protein malnutrition and comorbidity are very common in this group of patients. The aim of our observational study was to look for correlation between body mass composition as phase angle and lean tissue index and residual renal function in PD patients.

data of body composition showed higher levels of ECW (p ¼ 0048) or extracellular water and lean mass values LTI kg / m2 strongly reduced (p ¼ 0.005).Our malnourished patients were taking significantly low amounts of proteins (p ¼ 0.036) and Kilo Calories (kcal) (p ¼ 0.061).Concomitantly, BIA analysis showed in these patients lower levels of LTI (p ¼ 0.020) and FTI (p ¼ 0.033), as well as BMI (p ¼ 0.033 5).Besides analyzing blood tests, subjects with a lower MIS-score showed significantly lower levels of CRP (p ¼ 0.01) and higher serum albumin.CONCLUSIONS: Our results demonstrated that the percentage of our malnourished patients was rather high, about 72% showed signs of malnutrition and 58% of our patients showed signs and symptoms of "MIA" syndrome.Therefore in hemodialysis patients the early nutritional counseling and nutritional monitoring in time, could enables rapid diagnosis of MIA syndrome and it could prevent the complications related to protein-energy malnutrition and it could reduce the risk of hospitalization.

Abstract Background/Aims: Regular assessment of nutritional status of dialysis patients is vital for preventing malnutrition and protein energy wasting. The aim of this clinical study was to analyze dietary intake of dialysis patients and to determine if it meets their nutritional needs. Methods: Clinical study was conducted on 30 randomly selected dialysis patients in the dialysis department of the University Medical Centre Ljubljana. Nutritional interview was conducted unannounced five times over a period of three months with the 24-hour recall method. Results were analyzed with Prodi 6.6 Expert software. Body composition was measured with bioimpedance spectroscopy. Results: Average caloric intake of 30 patients is 14.1 ± 4.7 kcal/kg body weight per day, average protein intake is 0.61 ± 0.19 g/kg body weight per day. The average BMI (body mass index) is 27.9 ± 4.4 kg/m2, the average LTI (lean tissue index) is 12.5 ± 3.1 kg/m2, the average FTI (fat tissue index) is 14.2 ± 5.7 kg/m2 and the average phase angle is 4.2 ± 1.0. Average calorie intake and protein intake are inadequate according to the dietary recommendations for dialysis patients. Anthropometric measurements indicate sarcopenic obesity. Conclusion: According to the aim of the study, we confirmed that caloric and protein intake of dialysis patients were inadequate according to their needs. Depending on the results of nutritional analysis and bioimpedance measurements, we have confirmed the presence of protein energy wasting among observed patients.

INTRODUCTION AND AIMS: Secondary hyperparathyroidism (SHPT) is an important complication of end-stage renal disease.Cinacalcet is widely used in the management of SHPT in patients undergoing hemodialysis (HD).Despite of the beneficial clinical properties of cinacalcet, its use has been limited because of the gastrointestinal adverse event.Furthermore, most SHPT patients need to take other oral medications to treat HD-associated complications, thereby causing poor adherence.Etelcalcetide is a novel, peptide calcimimetic given intravenously.An intravenously administered could improve adherence and reduce an adverse gastrointestinal effect.However, the precise effective conversion ratio between cinacalcet and etelcalcetide is not known.Therefore we first investigated this issue in this ESCORT trial.Further, we examined how the switching from cinacalcet to etelcalcetide could induce adverse events in HD patients. .METHODS: This study was a multicenter open-label study.A total of 76 patients receiving thrice weekly maintenance HD on stable dose of cinacalcet (25mg-100mg) were screened and 57 patients with serum intact parathyroid hormone (iPTH) 60 pg/ mL and serum albumin-corrected Ca 8.4 mg/dL were enrolled.The patients were divided into 3 groups (cinacalcet 25mg, 50mg, and 75mg).After switching from cinacalcet, etelcalcetide was administered intravenously just after HD session thrice weekly for 24 weeks with an initial dose of 5 mg, and was flexibility adjusted at a dose between 2.5 and 15 mg.The primary endpoint was the dose distribution of etelcalcetide in patients achieved target serum iPTH levels (60-240 pg/mL) after 24 weeks in all groups.Further, we explored the safety and adverse events of switching from cinacalcet to etelcalcetide such as hypocalcemia, gastrointestinal symptom, and so on.RESULTS: At present, 12 weeks have passed in the 44 of the 57 patients after switching from cinacalcet to etelcalcetide.After 12 weeks, the 29 of the 35 patients (82.9%) with target serum iPTH levels maintained the target range (pre; 133.5645.6!post; 148.2646.9pg/ml).Six patients did not meet the target range at 12 weeks.Seven of the 9 patients (77.8%) with iPTH >240 pg/mL achieved the target range (pre; 354.66143.3!post; 150.3637.0pg/ml).No adverse events, such as hypocalcemia and gastrointestinal symptoms, led to study discontinuation in this trial.CONCLUSIONS: Switching from cinacalcet to etelcalcetide effectively achieved target serum iPTH levels for 12 weeks in particular in patients with high serum iPTH levels.There was no side effects.We will report the precise effective conversion ratio between cinacalcet and etelcalcetide at 24weeks with literature considerations.

Management of secondary hyperparathyroidism (SHPT) in dialysis population includes the use of active vitamin D forms, among which paricalcitol was shown to be more effective at reducing parathyroid hormone (PTH) concentrations. A prospective randomized study comparing the effectiveness and safety of peroral paricalcitol and calcitriol in suppressing PTH concentrations in 20 hemodialysis patients was performed comparing the influence of agents on PTH suppression, calcium (Ca) and phosphate (P) level and calcium-phosphorus product (CxP). The study was performed in an intent to treat manner with primary end point in reduction of PTH level in the target area of 150>PTH<300 ng/L after 3 months. At the time point 3 months after therapy induction paricalcitol and calcitriol were equally efficient at correcting PTH levels, with paricalcitol showing significantly less calcemic effect than calcitriol.