Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000–40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m², mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m²), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60–90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.

The period of Ramadan (R) is associated with dramatic changes in eating habits involving extended periods of fasting on a daily basis. The current study assessed whether lipids and lipoproteins were impacted during R in chronic hemodialysis (HD) patients. Forty-five subjects in an outpatient dialysis clinic in Saudi Arabia were evaluated for anthropometric and lipid changes on a monthly basis before, during as well as one and two months after R. In addition to routine biochemical measures, anthropometric assessments including hand-grip strength (HGS), mid-arm muscle circumference (MAMC), plasma lipids and lipoproteins were evaluated. Dietary assessment was carried out using 24 h recalls. Over the course of the study, changes in renal-related parameters (creatinine, albumin, Kt/V) were minor, as were changes in plasma lipids. Large high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs) accounted for the majority of their respective lipoproteins and their proportions did not change over the study period. Mean LDL particle diameters were higher during the R period, but the changes over the study period were small. Calorie intake during R (2139 ± 709 kcal/d) was significantly higher than the value noted two month post-R (1755 ± 424 kcal/d) and this was associated with significant increases in protein (69 ± 24 vs. 60 ± 24 g/d) and fat (97 ± 38, vs. 73 ± 35 g/d), respectively. No changes were noted with respect to HGS and MAMC. These data show that for HD patients, the period of R results in temporal or non-significant effects on plasma lipids, despite changes in nutrient intake.

Background: Refeeding syndrome (RFS) is a lethal condition of metabolic disturbances that arise from the sudden switch of metabolism from a state of starvation to one of nourishment. Quick recognition would reduce health complications. Physicians who are unaware of the syndrome will not identify and treat it. As nutritional risk is associated with the risk of RFS, physicians should be aware of it. Aim: To determine whether the physicians of King Abdullah Medical City (KAMC) in Makkah know of RFS and, if so, have skills in diagnosis and managing the syndrome. Methods: One hundred and fifty-nine physicians of KAMC were recruited in a cross-sectional study. They were asked to complete a questionnaire by face-to-face interview. The questionnaire was designed to capture physicians’ knowledge and ability to manage RFS based on the awarding of certain scoring points. Results: The level of knowledge among physicians had a significant association between knowledge and age (p = 0.021) and medical specialty (p = 0.010). Additionally, the most knowledgeable physicians were those who work in critical care (21.4%). Around 18% of physicians were not able to manage RFS. Conclusions: Lacking knowledge of RFS and how to manage it leads to critical life-threatening complications. Physicians need nutritional education to help them diagnose RFS and consult dietitians to avoid its complications.

Black seed, or Nigella sativa , is famous for its therapeutic properties, antidiabetic, antioxidant, and anti-inflammatory effects. The study aimed to evaluate the preventive and therapeutic benefits of N. sativa seeds, oil, and its active component, thymoquinone, on diabetic rats that have been streptozotocin-induced. Vehicle (healthy control), STZ (diabetic rats induced by streptozotocin at 55 mg/kg), STZ + NSS (5 % aqueous extract of N. sativa seeds was administered to diabetic rats), STZ + NSO (0.2 mL/kg of N. sativa oil was administered to diabetic rats), and STZ + TQ (50 mg/kg of thymoquinone was administered to diabetic rats) were the five groups ( N = 10) of the experimental design. All treatments were given daily via gavage for 28 days. The STZ group weighed the least after 28 days (177.27 g), while the STZ + NSO (260.16 g) and STZ + TQ (264.21 g) groups significantly improved and remained close to the vehicle group (288.81 g). In contrast to the increased readings in the diabetic group, the STZ + TQ group showed the biggest improvements in insulin levels (9.10 ng/mL) and glucose regulation (BGL 152.21 mg/dL, FBG 161.10 mg/dL, OGTT 152.47 mg/dL). In terms of HDL (36.95, 43.01 mg/dL), LDL (55.12, 67.19 mg/dL), triglycerides (55.06, 75.44 mg/dL), and cholesterol (112.65, 133.58 mg/dL), the STZ + TQ group was similar to the vehicle group. STZ + NSS had the highest levels of TNF-α (25.87 pg/mL), IL-6 (33.23 pg/mL), and CRP (6.66 mg/L) among N. sativa treatments. The diabetic group had the lowest SOD (14.12 U/mg), CAT (28.02 U/mg), and TAC (0.47 mmol/L) activity and the highest urea (45.36 mg/dL), creatinine (1.01 mg/dL), and MDA (9.12 nmol/mg) levels. In contrast, the STZ + TQ and STZ + NSO groups had similar values for the majority of the parameters, suggesting that thymoquinone and N. sativa oil have strong protective effects. The findings of N. sativa especially oil and thymoquinone showed an opportunity as natural diabetes treatments by effectively preventing diabetes in rats by enhancing metabolic, antioxidant, and inflammatory indicators.

Aim: To assess the prevalence of constipation, dietary fiber intake, and their association with QoL among HD patients. Methods: A cross-sectional study was conducted among 35 adults undergoing maintenance HD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Constipation was assessed using the Rome IV criteria and Bristol Stool Form Scale (BSFS). QoL was evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-36), and dietary fiber intake was estimated from three 24-h dietary recalls and a validated Dietary Fiber Intake Short Food Frequency Questionnaire (DFI-FFQ). Data were analyzed using Fisher’s exact test, the Mann–Whitney U test, and correlation coefficients (p < 0.05). Results: Constipation prevalence was 32%. Stool frequency was 0.05). Conclusions: Constipation is common among Saudi HD patients, yet not significantly linked to fiber intake or QoL in this small cohort. Larger multicenter studies are needed to identify determinants and guide evidence-based interventions.

I am grateful for the opportunity to review your work! I appreciate the effort you put into extracting data from the existing database. However, it appears information about dietary intake, supplements (such as omega-3), physical activity, and smokin...