Changes to patients’ lifestyle, especially a modified dietary approach, play a key role in the treatment of nonalcoholic fatty liver disease (NAFLD). A balanced, limiting and individually tailored nutritional scheme enables weight loss and an improvement in the clinical picture of NAFLD. According to nutritional recommendations for patients with NAFLD, carbohydrates should comprise 40–50% of total dietary energy. It is advisable to increase the amount of complex carbohydrates rich in dietary fibre. A major role in the aetiology of NAFLD is played by excessive intake of fructose, which is related to the rise in consumption of nonalcoholic beverages among subjects in developed countries. Fat intake should comprise < 30% of daily calories. It is essential to increase consumption of food products rich in mono- and polyunsaturated fatty acids. Ingestion of protein should constitute 15–20% of total energy.

Introduction and objective. A decreased concentration of iron, and consecutively haemoglobin, ferritin and decreased level of saturated transferrin, were observed in obese individuals more often than in healthy subjects. The purpose of this study was to determine whether iron, ferritin, transferrin saturation are significantly diminished in obese female patients compared to non-obese counterparts, and whether excess adiposity and inflammation were associated with depleted iron. Materials and methods. Female patients (n=48) diagnosed with obesity (BMI > 30 kg/m

Abnormal vitamin K status was documented in patients with chronic kidney diseases (CKD), especially those undergoing hemodialysis. The data related to patients undergoing peritoneal dialysis (PD) are contradictory. Therefore, in the present study we aimed to evaluate vitamin K status in patients with CKD who are treated with continuous ambulatory PD. Twenty-eight patients entered into the study. Dialysis vintage ranged from 3 to 89 months. Vitamin K status was assessed in all subjects using undercarboxylated prothrombin measurement (PIVKA-II). In addition, total protein and albumin levels, total cholesterol, LDL cholesterol, triglyceride, calcium, urea and creatinine concentrations were determined. PIVKA-II concentrations were abnormal in 13 (46.4 %) subjects. BMI values, both total and LDL cholesterol concentrations were significantly higher in patients with than those without vitamin K deficiency. Moreover, PIVKA II levels correlated with BMI values (r = 0.441, p < 0.019), LDL cholesterol (r = 0.434, p < 0.021) and creatinine (r = 0.406, p< 0.032) concentrations. However, through the use of logistic regression analysis and multiple regression analysis, no clinical factor was documented to be the independent risk factor of vitamin K deficiency. In conclusion, vitamin K deficiency is a frequent condition in peritoneally dialyzed patients. Assessment of vitamin K status should become a standard procedure in this group of patients.

In our previous study, we demonstrated that abstaining from meat, for 1 month, by healthy omnivores (lacto-ovovegetarian model) resulted in a statistical decrease in pancreatic secretion as measured by faecal elastase-1 output. However, no correlation between relative and non-relative changes of energy and nutrient consumption and pancreatic secretion was documented. Therefore, in the present study, we aimed to assess the changes of exocrine pancreatic secretion with a more restrictive dietetic modification, by applying a vegan diet. A total of twenty-one healthy omnivores (sixteen females and five males) participated in the prospective study lasting for 6 weeks. The nutrient intake and faecal output of pancreatic enzymes (elastase-1, chymotrypsin and lipase) were assessed twice during the study. Each assessment period lasted for 7 d: the first before the transition to the vegan diet (omnivore diet) and the second during the last week of the study (vegan diet). The dietary modification resulted in a significant decrease in faecal elastase-1 (P, 0·05) and chymotrypsin output (P, 0·04). The lipase excretion remained unchanged. The decrease in proteolytic enzymes was documented to be positively correlated with a decreased protein intake (P,0·05). In addition, elastase-1 and chymotrypsin outputs were also related to the changes of protein type, plant v. animal (P,0·04 and P, 0·03, respectively). It was concluded that significant reduction and modification of protein intake due to a short-term vegan diet resulted in an adaptation of pancreatic protease secretion in healthy volunteers.Key words: Exocrine pancreatic secretion: Elastase: Chymotrypsin: Vegan dietThe adaptation of pancreatic enzymes to the type of food available is one of the physiological advantages that allows animals to use nutrients and energy for metabolism as efficiently as possible. In today's era, numerous opportunities of genetic analysis exist, human genome mapping and even the sequencing of individual digestive enzyme DNA is possible, yet exocrine pancreatic adaptive mechanisms still remain unsolved. Direct research methodology for the collection of pancreatic juice is an invasive procedure and therefore, the challenge still remains to search for some non-invasive methods that would allow for the clarification of what exact exocrine pancreatic adaptive changes occur in humans.Walkowiak et al. assessed the changes of exocrine pancreatic secretion in a group of healthy omnivores who modified their diet by abstaining from meat (following a lacto-ovovegetarian model) for 1 month (1) . These dietary changes resulted in a statistically significant decrease in pancreatic secretion as measured by faecal elastase-1 (FE1) output. On the other hand, faecal chymotrypsin (FChT) and faecal lipase (FLp) excretions remained unchanged. Hypothetically, the major dietetic influence was related to the subject's exclusion of meat from their diet. The lack of elastin, the target molecule for elastase-1, might be responsible for the observed selective changes...

IntroductionTreatment of obesity with life style modifications often fails; therefore pharmacological treatment has become a very popular approach. Metformin is one of the examined possibilities. The aim of this study was to verify indications for metformin use in obese women based on metabolic and anthropometric parameters assessed by dual-X-ray absorptiometry (DXA), to establish the degree of insulin resistance and its correlations.Material and methodsAnthropometry, fat measurement by bioimpedance and metabolic profile, including lipids, and oral glucose tolerance test (OGTT) with insulin (0 and 120 min) were performed in 50 female patients diagnosed with simple obesity, aged 18-40 years. Homeostatic model assessment HOMA-R was calculated for insulin resistance, and area under the curve (AUC) for insulin response. Total, android and gynoid fat distribution, and their ratio (A/G), were measured by DXA.ResultsFrom 50 women who entered the study, 33 were classified as insulin resistant (IR subgroup) and 17 as non-insulin resistant (non-IR subgroup), according to their HOMA-R indices. IR women presented higher waist circumference and DXA A/G ratio. The IR subgroup demonstrated elevated fasting triglycerides and glucose (but in the normal range) and a higher insulin response in OGTT (4.1-fold vs 2.5-fold). From different insulin measurements HOMA index turned out to have the strongest correlations with the metabolic parameters triglycerides and glucose. We found significant positive correlations between android fat and insulin: waist circumference and HOMA-R, WHR and HOMA-R, android fat and HOMA-R, A/G ratio and insulin after OGTT, and A/G ratio and HOMA-R. We found a strong correlation between WHR and A/R ratio.Conclusions67% of premenopausal obese women were insulin resistant. Measures of DXA visceral fat determined by android fat percentage and android/gynoid ratio were the strongest determinants of insulin resistance. Waist-to-hip ratio might be a simple method for determining the indications for metformin treatment.