COVID-19 infection causes cognitive changes in the acute phase, but also after apparent recovery.... more COVID-19 infection causes cognitive changes in the acute phase, but also after apparent recovery. Over fifty post (long)-COVID symptoms are described, including cognitive dysfunction (“brain fog”) precluding return to pre-COVID level of function, with rates twice as high in females. Additionally, the predominant demographic affected by these symptoms is younger and still in the workforce. Lack of ability to work, even for six months, has significant socio-economic consequences. This cognitive dysfunction is associated with impaired cerebral glucose metabolism, assessed using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), showing brain regions that are abnormal compared to age and sex matched controls. In other cognitive conditions such as Alzheimer’s disease (AD), typical patterns of cerebral glucose hypometabolism, frontal hypometabolism and cerebellar hypermetabolism are common. Similar FDG-PET changes have also been observed in post-COVID-19, raising the possibili...
Myopenia (reduced skeletal muscle [SM]) is common in children with end-stage liver disease (ESLD)... more Myopenia (reduced skeletal muscle [SM]) is common in children with end-stage liver disease (ESLD) and suboptimal nutritional status pre- and post-liver transplantation (LTx). Myopenia may result in altered SM morphology (changes in muscle fibre size and types [type I vs. II proportions]) contributing to adverse outcomes and deficits in muscle strength/functionality. Understanding how SM morphology changes in healthy children with age and the potential impact of ESLD on SM morphology offers insight into the effectiveness of rehabilitation strategies for children with ESLD at risk for myopenia. Literature searches in PubMed, Scopus, and Web of Science identified studies examining SM morphology in healthy children and in ESLD. Muscle fibre size increases with age in healthy children. Type I fibres are more prevalent in childhood, whereas type II fibres increase post-puberty. Preliminary evidence indicates that adults with ESLD have reduced muscle fiber size with type II fibre atrophy. ...
International Journal of Molecular Sciences, Dec 1, 2022
Syndromic and non-syndromic obesity conditions in children, such as Prader-Willi syndrome (PWS) a... more Syndromic and non-syndromic obesity conditions in children, such as Prader-Willi syndrome (PWS) and non-alcoholic fatty liver disease (NAFLD), both lower quality of life and increase risk for chronic health complications, which further increase health service utilization and cost. In a pilot observational study, we compared body composition and muscle strength in children aged 7-18 years with either PWS (n = 9), NAFLD (n = 14), or healthy controls (n = 16). Anthropometric and body composition measures (e.g., body weight, circumferences, skinfolds, total/segmental composition, and somatotype), handgrip strength, six minute-walk-test (6MWT), physical activity, and markers of liver and cardiometabolic dysfunction (e.g., ALT, AST, blood pressure, glucose, insulin, and lipid profile) were measured using standard procedures and validated tools. Genotyping was determined for children with PWS. Children with PWS had reduced lean body mass (total/lower limb mass), lower handgrip strength, 6MWT and increased sedentary activity compared to healthy children or those with NAFLD (p < 0.05). Children with PWS, including those of normal body weight, had somatotypes consistent with relative increased adiposity (endomorphic) and reduced skeletal muscle robustness (mesomorphic) when compared to healthy children and those with NAFLD. Somatotype characterizations were independent of serum markers of cardiometabolic dysregulation but were associated with increased prevalence of abnormal systolic and diastolic blood pressure Z-scores (p < 0.05). Reduced lean body mass and endomorphic somatotypes were associated with lower muscle strength/functionality and sedentary lifestyles, particularly in children with PWS. These findings are relevant as early detection of deficits in muscle strength and functionality can ensure effective targeted treatments that optimize physical activity and prevent complications into adulthood.
Objectives, Design, Setting: The ketogenic effect of medium chain triglyceride (MCT) oil offers p... more Objectives, Design, Setting: The ketogenic effect of medium chain triglyceride (MCT) oil offers potential for Alzheimer’s disease prevention and treatment. Limited literature suggests a linear B-hyroxybutyrate (BHB) response to increasing MCT doses. This pharmacokinetic study evaluates factors affecting BHB response in three subject groups. Participants: Healthy subjects without cognitive deficits <65years, similarly healthy subjects >=65years, and those with Alzheimer’s Disease were assessed. Intervention: Different doses (0g,14g, 28g, 42g) of MCT oil (99.3% C8:0) were administered, followed by fasting during the study period. Measurements: BHB measured by finger prick sampling hourly for 5 hours after ingestion. Each subject attended four different days for each ascending dose. Data was also collected on body composition, BMI, waist/hip ratio, grip strength, gait speed, nutrient content of pre-study breakfast and side effects. Results: Twenty-five participants: eight healthy...
Canadian Journal of Dietetic Practice and Research
A gluten-free (GF) food guide for children and youth (4–18 years) living with celiac disease (CD)... more A gluten-free (GF) food guide for children and youth (4–18 years) living with celiac disease (CD) has been developed and extensively evaluated by stakeholders, including registered dietitians. A case study analysis was conducted on data from 16 households of youth with CD to examine how factors related to parental food literacy, the home food environment, and food purchasing patterns may influence food guide uptake by Canadian youth with CD and their families. Households were of higher socioeconomic status, parents had good food literacy, and the home food availability of fruits, vegetables and GF grains was diverse. However, households also had a diverse supply of convenience foods and snack options. Youth reported consuming a larger proportion of these foods (>35% dietary intake) and had suboptimal diet quality. Dietary intake of fruits and vegetables were below GF plate model recommendations by over 30%. Despite limited economical barriers, good parental food literacy, and div...
Canadian Journal of Dietetic Practice and Research
There is no specific diet quality tool recommended for adults living with chronic kidney disease ... more There is no specific diet quality tool recommended for adults living with chronic kidney disease (CKD). Identifying how diet quality tools assess nutritional adequacy and correlate with potassium and phosphorus (nutrients of interest in CKD) is warranted. Our aim was to compare Mediterranean Diet Scores (MDS), Healthy Eating Index (HEI), and Healthy Food Diversity (HFD) to determine their correlation with nutrient intake in adults living with diabetes and CKD. Using data from a longitudinal study of 50 participants with diabetes and CKD, diet quality was assessed at baseline and 1 or more times at annual visits up to 5 years (complete diet records n = 178). Diet quality was investigated for correlation with nutrient intake. Compared with HEI and HFD, MDS was poorly correlated with nutrient intake (all r values <0.40). HFD and HEI were moderately correlated with potassium (r = 0.66, P < 0.01 and r = 0.57, P < 0.01, respectively). HEI was weakly correlated with phosphorus (r ...
BACKGROUND: Celiac disease (CD) is a digestive disease that is caused by an immune reaction to th... more BACKGROUND: Celiac disease (CD) is a digestive disease that is caused by an immune reaction to the protein gluten. The gluten free diet (GFD) is the only treatment for CD. In 2012, the sale of GF processed foods reached up to $460million in Canada; an increase in 25% since 2008. Despite being the fastest growing food intolerance category in Canada, GFD consumers face challenges from various voluntary GF-labelling schemes and limited retail and food-service product options. OBJECTIVES: To estimate GF-food expenditure patterns for affected families with children or adolescents with CD to identify the cost burden of following a GFD and compared against non-GFD Canadian families. DESIGN/METHODS: A pilot study was conducted in families with a child with biopsy proven CD following the GFD (n=15; 10±3 years) and attending a GI/CD clinic. Family Socio-demographics (age of parents, number of children/number of members following GFD in households) and the receipts of food purchases over a one...
OBJECTIVE The 2020 KDOQI guidelines recommend adjusting phosphorus intake achieve and maintain no... more OBJECTIVE The 2020 KDOQI guidelines recommend adjusting phosphorus intake achieve and maintain normal serum phosphorus levels for adults living with chronic kidney disease (CKD). These guidelines also recommend considering the dietary source of phosphorus as different sources have different bioavailability, however phosphorus food lists are not provided. Therefore, the aim of this study was to investigate the current teaching materials in Canada regarding low phosphorus diet. DESIGN AND METHODS Using a geographical approach, each province and territories government, health and renal program (where applicable) websites were reviewed for resources on dietary phosphorus restriction in CKD. All publicly available handouts/booklets/printable webpages were obtained and reviewed for recommendations on how to implement a low phosphorus diet. RESULTS 61 resources in total met inclusion criteria (52 handouts from health agencies in six provinces and 9 handouts from the Kidney Foundation of Canada). Items with minimal nutrition value, such as cola, beer and cocoa, chocolate and baking powder, were the most commonly restricted with 51 of 61 resources (84%) making this recommendation. Plant proteins and minimally processed dairy were restricted in 80% (49/61) of resources. Processed animal meat was recommended to be restricted in 70% (43/61) of resources and whole grains in 65% (40/61). 63% of the handouts (39/61) discuss avoiding phosphorus additives. CONCLUSION Many resources restrict items with minimal nutrition value to lower phosphorus intake, however plant foods, including plant proteins and whole grains continue to be restricted in the majority of resources, despite having lower bioavailability. The 2020 KDOQI guidelines recommend considering bioavailability of phosphorus source when implementing low phosphorus diets; current handouts in Canada would likely benefit from review.
Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022
IntroductionCerebral glucose and insulin metabolism is impaired in Alzheimer's disease (AD). ... more IntroductionCerebral glucose and insulin metabolism is impaired in Alzheimer's disease (AD). Ketones provide alternative energy. Will medium chain triglyceride (MCT) oil, a nutritional source of ketones, impact cognition in AD?MethodsThis was a 6‐month randomized, double‐blind, placebo‐controlled, crossover study, with 6‐month open‐label extension in probable AD subjects, on stable medications. MCT dose was 42 g/day, or maximum tolerated. Cognition was assessed with Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Cognigram®.ResultsTwenty subjects, average age 72.6 years, 45% women, 70% university educated had baseline MMSE 22.6/30 (10–29); MoCA 15.6/30 (4–27); baseline Cognigram® Part 1: 65–106, Part 2: 48–107. Average MCT oil consumption was 1.8 tablespoons/day (25.2 g, 234 kcal). Eighty percent remained stable or improved. Longer MCT exposure and age > 73, resulted in higher final MMSE (P < .001) and Cognigram® 1 scores.DiscussionThis is t...
OBJECTIVE Several recent publications, including an expert summary on hyperkalemia management, ha... more OBJECTIVE Several recent publications, including an expert summary on hyperkalemia management, have encouraged plant-based foods for patients with chronic kidney disease (CKD) and highlighted the impact of potassium additives on total potassium intake. The aim of this research brief was to investigate if and/or how current recommendations for low-potassium diet may incorporate these new recommendations. DESIGN AND METHODS Using a geographical approach, each province's and territory's government health and renal program (where applicable) website was reviewed for resources on dietary potassium restriction. All handouts/booklets/printable webpages were obtained and reviewed. RESULTS Eighteen resources from 6 provincial health agencies in Canada were included. Six additional resources from national agencies were also included, 4 from Canada and 2 from the United States. The 5 most commonly restricted foods were bananas, potatoes, oranges, cantaloupe, and avocados. All resources recommended restriction of fruits and vegetables, 67% recommended restriction of dairy products, 57% recommended restriction of whole grain products, 62% recommended restrictions of plant-based proteins, and 67% mentioned restriction of other foods (such as coffee, tea, and chocolate), 28% mentioned restriction of potassium additives in ultraprocessed foods. CONCLUSION Low-potassium diets primarily restrict fruits and vegetables while the least common restriction is ultraprocessed food. Several recent publics have recommended a greater focus on ultraprocessed versus unprocessed food for hyperkalemia management. These new recommendations differ from current teaching materials that predominately restrict plant-based foods to manage hyperkalemia in CKD. Updates will likely be needed to current resources to reflect new recommendations.
COVID-19 infection causes cognitive changes in the acute phase, but also after apparent recovery.... more COVID-19 infection causes cognitive changes in the acute phase, but also after apparent recovery. Over fifty post (long)-COVID symptoms are described, including cognitive dysfunction (“brain fog”) precluding return to pre-COVID level of function, with rates twice as high in females. Additionally, the predominant demographic affected by these symptoms is younger and still in the workforce. Lack of ability to work, even for six months, has significant socio-economic consequences. This cognitive dysfunction is associated with impaired cerebral glucose metabolism, assessed using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), showing brain regions that are abnormal compared to age and sex matched controls. In other cognitive conditions such as Alzheimer’s disease (AD), typical patterns of cerebral glucose hypometabolism, frontal hypometabolism and cerebellar hypermetabolism are common. Similar FDG-PET changes have also been observed in post-COVID-19, raising the possibili...
Myopenia (reduced skeletal muscle [SM]) is common in children with end-stage liver disease (ESLD)... more Myopenia (reduced skeletal muscle [SM]) is common in children with end-stage liver disease (ESLD) and suboptimal nutritional status pre- and post-liver transplantation (LTx). Myopenia may result in altered SM morphology (changes in muscle fibre size and types [type I vs. II proportions]) contributing to adverse outcomes and deficits in muscle strength/functionality. Understanding how SM morphology changes in healthy children with age and the potential impact of ESLD on SM morphology offers insight into the effectiveness of rehabilitation strategies for children with ESLD at risk for myopenia. Literature searches in PubMed, Scopus, and Web of Science identified studies examining SM morphology in healthy children and in ESLD. Muscle fibre size increases with age in healthy children. Type I fibres are more prevalent in childhood, whereas type II fibres increase post-puberty. Preliminary evidence indicates that adults with ESLD have reduced muscle fiber size with type II fibre atrophy. ...
International Journal of Molecular Sciences, Dec 1, 2022
Syndromic and non-syndromic obesity conditions in children, such as Prader-Willi syndrome (PWS) a... more Syndromic and non-syndromic obesity conditions in children, such as Prader-Willi syndrome (PWS) and non-alcoholic fatty liver disease (NAFLD), both lower quality of life and increase risk for chronic health complications, which further increase health service utilization and cost. In a pilot observational study, we compared body composition and muscle strength in children aged 7-18 years with either PWS (n = 9), NAFLD (n = 14), or healthy controls (n = 16). Anthropometric and body composition measures (e.g., body weight, circumferences, skinfolds, total/segmental composition, and somatotype), handgrip strength, six minute-walk-test (6MWT), physical activity, and markers of liver and cardiometabolic dysfunction (e.g., ALT, AST, blood pressure, glucose, insulin, and lipid profile) were measured using standard procedures and validated tools. Genotyping was determined for children with PWS. Children with PWS had reduced lean body mass (total/lower limb mass), lower handgrip strength, 6MWT and increased sedentary activity compared to healthy children or those with NAFLD (p < 0.05). Children with PWS, including those of normal body weight, had somatotypes consistent with relative increased adiposity (endomorphic) and reduced skeletal muscle robustness (mesomorphic) when compared to healthy children and those with NAFLD. Somatotype characterizations were independent of serum markers of cardiometabolic dysregulation but were associated with increased prevalence of abnormal systolic and diastolic blood pressure Z-scores (p < 0.05). Reduced lean body mass and endomorphic somatotypes were associated with lower muscle strength/functionality and sedentary lifestyles, particularly in children with PWS. These findings are relevant as early detection of deficits in muscle strength and functionality can ensure effective targeted treatments that optimize physical activity and prevent complications into adulthood.
Objectives, Design, Setting: The ketogenic effect of medium chain triglyceride (MCT) oil offers p... more Objectives, Design, Setting: The ketogenic effect of medium chain triglyceride (MCT) oil offers potential for Alzheimer’s disease prevention and treatment. Limited literature suggests a linear B-hyroxybutyrate (BHB) response to increasing MCT doses. This pharmacokinetic study evaluates factors affecting BHB response in three subject groups. Participants: Healthy subjects without cognitive deficits <65years, similarly healthy subjects >=65years, and those with Alzheimer’s Disease were assessed. Intervention: Different doses (0g,14g, 28g, 42g) of MCT oil (99.3% C8:0) were administered, followed by fasting during the study period. Measurements: BHB measured by finger prick sampling hourly for 5 hours after ingestion. Each subject attended four different days for each ascending dose. Data was also collected on body composition, BMI, waist/hip ratio, grip strength, gait speed, nutrient content of pre-study breakfast and side effects. Results: Twenty-five participants: eight healthy...
Canadian Journal of Dietetic Practice and Research
A gluten-free (GF) food guide for children and youth (4–18 years) living with celiac disease (CD)... more A gluten-free (GF) food guide for children and youth (4–18 years) living with celiac disease (CD) has been developed and extensively evaluated by stakeholders, including registered dietitians. A case study analysis was conducted on data from 16 households of youth with CD to examine how factors related to parental food literacy, the home food environment, and food purchasing patterns may influence food guide uptake by Canadian youth with CD and their families. Households were of higher socioeconomic status, parents had good food literacy, and the home food availability of fruits, vegetables and GF grains was diverse. However, households also had a diverse supply of convenience foods and snack options. Youth reported consuming a larger proportion of these foods (>35% dietary intake) and had suboptimal diet quality. Dietary intake of fruits and vegetables were below GF plate model recommendations by over 30%. Despite limited economical barriers, good parental food literacy, and div...
Canadian Journal of Dietetic Practice and Research
There is no specific diet quality tool recommended for adults living with chronic kidney disease ... more There is no specific diet quality tool recommended for adults living with chronic kidney disease (CKD). Identifying how diet quality tools assess nutritional adequacy and correlate with potassium and phosphorus (nutrients of interest in CKD) is warranted. Our aim was to compare Mediterranean Diet Scores (MDS), Healthy Eating Index (HEI), and Healthy Food Diversity (HFD) to determine their correlation with nutrient intake in adults living with diabetes and CKD. Using data from a longitudinal study of 50 participants with diabetes and CKD, diet quality was assessed at baseline and 1 or more times at annual visits up to 5 years (complete diet records n = 178). Diet quality was investigated for correlation with nutrient intake. Compared with HEI and HFD, MDS was poorly correlated with nutrient intake (all r values <0.40). HFD and HEI were moderately correlated with potassium (r = 0.66, P < 0.01 and r = 0.57, P < 0.01, respectively). HEI was weakly correlated with phosphorus (r ...
BACKGROUND: Celiac disease (CD) is a digestive disease that is caused by an immune reaction to th... more BACKGROUND: Celiac disease (CD) is a digestive disease that is caused by an immune reaction to the protein gluten. The gluten free diet (GFD) is the only treatment for CD. In 2012, the sale of GF processed foods reached up to $460million in Canada; an increase in 25% since 2008. Despite being the fastest growing food intolerance category in Canada, GFD consumers face challenges from various voluntary GF-labelling schemes and limited retail and food-service product options. OBJECTIVES: To estimate GF-food expenditure patterns for affected families with children or adolescents with CD to identify the cost burden of following a GFD and compared against non-GFD Canadian families. DESIGN/METHODS: A pilot study was conducted in families with a child with biopsy proven CD following the GFD (n=15; 10±3 years) and attending a GI/CD clinic. Family Socio-demographics (age of parents, number of children/number of members following GFD in households) and the receipts of food purchases over a one...
OBJECTIVE The 2020 KDOQI guidelines recommend adjusting phosphorus intake achieve and maintain no... more OBJECTIVE The 2020 KDOQI guidelines recommend adjusting phosphorus intake achieve and maintain normal serum phosphorus levels for adults living with chronic kidney disease (CKD). These guidelines also recommend considering the dietary source of phosphorus as different sources have different bioavailability, however phosphorus food lists are not provided. Therefore, the aim of this study was to investigate the current teaching materials in Canada regarding low phosphorus diet. DESIGN AND METHODS Using a geographical approach, each province and territories government, health and renal program (where applicable) websites were reviewed for resources on dietary phosphorus restriction in CKD. All publicly available handouts/booklets/printable webpages were obtained and reviewed for recommendations on how to implement a low phosphorus diet. RESULTS 61 resources in total met inclusion criteria (52 handouts from health agencies in six provinces and 9 handouts from the Kidney Foundation of Canada). Items with minimal nutrition value, such as cola, beer and cocoa, chocolate and baking powder, were the most commonly restricted with 51 of 61 resources (84%) making this recommendation. Plant proteins and minimally processed dairy were restricted in 80% (49/61) of resources. Processed animal meat was recommended to be restricted in 70% (43/61) of resources and whole grains in 65% (40/61). 63% of the handouts (39/61) discuss avoiding phosphorus additives. CONCLUSION Many resources restrict items with minimal nutrition value to lower phosphorus intake, however plant foods, including plant proteins and whole grains continue to be restricted in the majority of resources, despite having lower bioavailability. The 2020 KDOQI guidelines recommend considering bioavailability of phosphorus source when implementing low phosphorus diets; current handouts in Canada would likely benefit from review.
Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022
IntroductionCerebral glucose and insulin metabolism is impaired in Alzheimer's disease (AD). ... more IntroductionCerebral glucose and insulin metabolism is impaired in Alzheimer's disease (AD). Ketones provide alternative energy. Will medium chain triglyceride (MCT) oil, a nutritional source of ketones, impact cognition in AD?MethodsThis was a 6‐month randomized, double‐blind, placebo‐controlled, crossover study, with 6‐month open‐label extension in probable AD subjects, on stable medications. MCT dose was 42 g/day, or maximum tolerated. Cognition was assessed with Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Cognigram®.ResultsTwenty subjects, average age 72.6 years, 45% women, 70% university educated had baseline MMSE 22.6/30 (10–29); MoCA 15.6/30 (4–27); baseline Cognigram® Part 1: 65–106, Part 2: 48–107. Average MCT oil consumption was 1.8 tablespoons/day (25.2 g, 234 kcal). Eighty percent remained stable or improved. Longer MCT exposure and age > 73, resulted in higher final MMSE (P < .001) and Cognigram® 1 scores.DiscussionThis is t...
OBJECTIVE Several recent publications, including an expert summary on hyperkalemia management, ha... more OBJECTIVE Several recent publications, including an expert summary on hyperkalemia management, have encouraged plant-based foods for patients with chronic kidney disease (CKD) and highlighted the impact of potassium additives on total potassium intake. The aim of this research brief was to investigate if and/or how current recommendations for low-potassium diet may incorporate these new recommendations. DESIGN AND METHODS Using a geographical approach, each province's and territory's government health and renal program (where applicable) website was reviewed for resources on dietary potassium restriction. All handouts/booklets/printable webpages were obtained and reviewed. RESULTS Eighteen resources from 6 provincial health agencies in Canada were included. Six additional resources from national agencies were also included, 4 from Canada and 2 from the United States. The 5 most commonly restricted foods were bananas, potatoes, oranges, cantaloupe, and avocados. All resources recommended restriction of fruits and vegetables, 67% recommended restriction of dairy products, 57% recommended restriction of whole grain products, 62% recommended restrictions of plant-based proteins, and 67% mentioned restriction of other foods (such as coffee, tea, and chocolate), 28% mentioned restriction of potassium additives in ultraprocessed foods. CONCLUSION Low-potassium diets primarily restrict fruits and vegetables while the least common restriction is ultraprocessed food. Several recent publics have recommended a greater focus on ultraprocessed versus unprocessed food for hyperkalemia management. These new recommendations differ from current teaching materials that predominately restrict plant-based foods to manage hyperkalemia in CKD. Updates will likely be needed to current resources to reflect new recommendations.
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