Objectives This study aimed to evaluate the relationship between lung function and body composition in cystic fibrosis (CF) and examine the presence of normal weight obesity (NWO), a high body fat percentage with a normal body mass index (BMI), in this population. Research Methods & Procedures In a pilot, cross-sectional study, 32 subjects with CF and a reference group of 20 adults without CF underwent body composition analysis with air displacement plethysmography. NWO was defined as a BMI <25 kg/m2 and body fat >30% (women) or >23% (men). Lung function in subjects with CF was determined by the percentage of predicted forced expiratory volume in 1 second (FEV1% predicted). Results Despite lower BMI and fat-free mass index (P<0.01), fat mass index and percent body fat did not differ between CF subjects and the reference group. Among CF subjects, FEV1% predicted was positively associated with fat-free mass index (β=6.31 ± 2.93, P=0.04) and inversely associated with fat mass index (β= −6.44 ± 2.93, P=0.04), after adjusting for age, gender and BMI. Ten CF subjects (31%) had NWO, which corresponded with lower fat-free mass index and FEV1% predicted compared to overweight subjects (P=0.006 and 0.004, respectively). Conclusions Excess adiposity, particularly in the form of NWO, was inversely associated with lung function in CF. Larger prospective studies should confirm these findings and determine the long-term metabolic and clinical consequences of excess adiposity in CF. As the lifespan of individuals with CF increases, nutrition screening protocols, which primarily rely on BMI, may require re-assessment.

Chronic kidney disease (CKD) patients have exercise intolerance associated with increased cardiovascular mortality. Previous studies demonstrate that blood pressure (BP) and sympathetic nerve responses to handgrip exercise are exaggerated in CKD. These patients also have decreased nitric oxide (NO) bioavailability and endothelial dysfunction, which could potentially lead to an impaired ability to vasodilate during exercise. We hypothesized that CKD patients have exaggerated BP responses during maximal whole body exercise and that endothelial dysfunction correlates with greater exercise pressor responses in these patients. Brachial artery flow-mediated dilation (FMD) was assessed before maximal treadmill exercise in 56 participants: 38 CKD (56.7 ± 1.2 yr old, 38 men) and 21 controls (52.8 ± 1.8 yr old, 20 men). During maximal treadmill exercise, the slope-of-rise in systolic BP (+10.32 vs. +7.75 mmHg/stage, < 0.001), mean arterial pressure (+3.50 vs. +2.63 mmHg/stage, = 0.004), and heart rate (+11.87 vs. +10.69 beats·min·stage, = 0.031) was significantly greater in CKD compared with controls. Baseline FMD was significantly lower in CKD (2.76 ± 0.42% vs. 5.84 ± 0.97%, = 0.008). Lower FMD values were significantly associated with a higher slope-of-rise in systolic BP (+11.05 vs. 8.71 mmHg/stage, = 0.003) during exercise in CKD, as well as poorer exercise capacity measured as peak oxygen uptake (V̇o; 19.47 ± 1.47 vs. 24.57 ± 1.51 ml·min·kg, < 0.001). These findings demonstrate that low FMD in CKD correlates with augmented BP responses during exercise and lower V̇o, suggesting that endothelial dysfunction may contribute to exaggerated exercise pressor responses and poor exercise capacity in CKD patients.

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Chronic kidney disease (CKD) patients have an exaggerated increase in blood pressure (BP) during rhythmic handgrip exercise (RHG 20%) and static handgrip exercise (SHG 30%). Nitric oxide levels increase during exercise and help prevent excessive hypertension by both increasing vasodilation and reducing sympathetic nerve activity (SNA). Therefore, we hypothesized that tetrahydrobiopterin (BH4), an essential cofactor for nitric oxide synthase, would ameliorate the exaggerated exercise pressor response in CKD patients. In a randomized, double-blinded, placebo-controlled trial, we tested the effects of 12 wk of sapropterin dihydrochloride (6R-BH4; n = 18) versus placebo (n = 14) treatement on BP and muscle SNA (MSNA) responses during RHG 20% and SHG 30% in CKD patients. The 6R-BH4-treated group had a significantly lower systolic BP (+6 ± 1 vs. +13 ± 2 mmHg, P = 0.002) and mean arterial pressure response (+5 ± 1 vs. +10 ± 2 mmHg, P = 0.020) during RHG 20% and a significantly lower systolic BP response (+19 ± 3 vs. +28 ± 3 mmHg, P = 0.043) during SHG 30%. Under baseline conditions, there was no significant difference in MSNA responses between the groups; however, when the BP response during exercise was equalized between the groups using nitroprusside, the 6R-BH4-treated group had a significantly lower MSNA response during RHG 20% (6R-BH4 vs. placebo, +12 ± 1 vs. +21 ± 2 bursts/min, P = 0.004) but not during SHG 30%. These findings suggest that 6R-BH4 ameliorates the augmented BP response during RHG 20% and SHG 30% in CKD patients. A reduction in reflex activation of SNA may contribute to the decreased exercise pressor response during RHG 20% but not during SHG 30% in CKD patients.

The gut microbiome may be both helpful and harmful, and not only is it affected by diet, it has also been shown to affect mental health including personality, mood, anxiety and depression. In this clinical study we assessed dietary nutrient composition, mood, happiness, and the gut microbiome in order to understand the role of diet in the gut microbiome and how that affects mood and happiness. For this pilot study, we enrolled 20 adults to follow this protocol: recording a 2-day food log, sampling their gut microbiome, and completing five validated surveys of mental health, mood, happiness and well-being, followed by a minimum 1 week diet change and repeating the food log, microbiome sampling and the 5 surveys. The change from a predominantly Western diet to vegetarian, Mediterranean and ketogenic diets led to changes in calorie and fiber intake. After the diet change, we observed significant changes in measures of anxiety, well-being and happiness, and without changes in gut microbiome diversity. We found strong correlations between greater consumption of fat and protein to lower anxiety and depression, while consuming higher percentages of carbohydrates was associated with increased stress, anxiety, and depression. We also found strong negative correlations between total calories and total fiber intake with gut microbiome diversity without correlations to measures of mental health, mood or happiness. We have shown that changing diet affects mood and happiness, that greater fat and carbohydrate intake is directly associated with anxiety and depression and inversely correlated with gut microbiome diversity. This study is an important step towards understanding how our diet affects the gut microbiome and in turn our mood, happiness and mental health.

AimTo obtain information on habitual dietary intake of selected micronutrients in TB patients in Tbilisi, Georgia.MethodDietary intake was obtained from patients at TB diagnosis using a tool that captures specific foods common in Georgian culture. Foods consumed during the previous 3 days were determined by one‐on‐one interviews. Food intake data was entered into the NDS‐R software program and mean daily micronutrient intake determined. Descriptive statistics and intake of micronutrients compared to the United States Dietary Reference Intake (US DRI) guidelines for adults and food group frequency were evaluated.ResultsA total of 199 subjects were studied (mean age 34 y; 64% male). No subject consumed specific micronutrient supplements. Mean daily intake of vitamin D 186±173(SD) IU/day (31% of US RDA); retinol (vitamin A) 686±600 mcg/day (84% of US RDA), vitamin E 19±9 IU/day (85% of US RDA); manganese 4.56±1.74 mg/day (217% of US AI); copper 2.28±1.01 mg/day (253% of US RDA), selenium 147±65 mcg/day (267% of US RDA) and zinc 12.2±5.3 mg/day (125% of US RDA). Dietary intake of both thiamine (vitamin B1) and riboflavin (vitamin B2) was adequate at 2.4±0.9 mg/day (209% of US RDA) and 2.6±1.0 (216% of US RDA), respectively.ConclusionsDietary intake data from these Georgian TB patients revealed adequate intake of the B vitamins thiamine and riboflavin, and specific trace elements linked to human immune function (copper, selenium, and zinc). In contrast, dietary intake of several vitamins linked to immune function (vitamin D, retinol and vitamin E) was inadequate.Grant Funding Source: NIH D43 TW007124, D43 TW007124‐06S, K24 RR023356, UL1 RR025008, Emory Global Health Institute

ObjectiveTo determine serial dietary intake and serum concentrations of immune‐related micronutrients in patients with TB disease.Methods: Estimated mean daily intake of iron (Fe), zinc (Zn), and copper (Cu) was determined in 192 adults with pulmonary TB within 7 days of diagnosis and at 16 weeks using a validated instrument and NDS‐R. Serum levels of Fe, Zn and Cu were determined by inductively coupled argon plasma spectrometry at baseline and week 16.Results: Mean subject age was 34 y and 64% were male. Serum Fe levels were below normal in 25% at baseline (24±20 umol/L), and rose significantly by week 16 [to 26±15 umol/L (P< 0.01)]. Mean dietary Fe intake at baseline and week 16 was adequate. Serum Zn levels were below normal in 35% at baseline (11.6±2.8 umol/L) and 26% at week 16 (12.2±3.2 umol/L). Mean dietary Zn intake at baseline was 11.7±5.0 mg/day (121% of RDA)] and decreased at wk 16 (to 10±3.5 mg/day;P=0.03). Serum Cu levels were normal at baseline (26.5±0.6 umol/L) and fell significantly by week 16 to 20.5±0.5 umol/L (P<0.01). Mean dietary Cu intake at baseline and week 16 was adequate.ConclusionA significant proportion of adults with newly diagnosed TB exhibited low Fe and Zn levels, while Cu levels decreased over time. Changes during treatment may reflect diet intake, decreased inflammation and endogenous anti‐microbial processes.