Accepted Manuscript Nutritional strategies to reduce inflammation in chronic kidney disease patients Denise Mafra, RD, PhD PII:
S0899-9007(14)00556-5
DOI:
10.1016/j.nut.2014.12.018
Reference:
NUT 9443
To appear in:
Nutrition
Received Date: 2 December 2014 Accepted Date: 16 December 2014
Please cite this article as: Mafra D, Nutritional strategies to reduce inflammation in chronic kidney disease patients, Nutrition (2015), doi: 10.1016/j.nut.2014.12.018. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Nutritional strategies to reduce inflammation in chronic kidney disease patients Denise Mafra, RD, PhD
RI PT
Fluminense Federal University (UFF), Graduate Program in Medical Sciences, Niterói-RJ, Brazil.
SC
To the Editor:
Inflammation is common feature in chronic kidney disease (CKD) patients that can lead
M AN U
to cardiovascular disease (1). A number of therapeutic strategies may be effective in reducing the cardiovascular risk in these patients, such as use of bioactive foods that have anti-oxidant and anti-inflammatory protective effects (2).
In fact, polyphenols, resveratrol, curcumin, catechins, sulforaphane, allicin, and
TE D
lycopene have potent biological activity with important role in a reduction of inflammation and may be beneficial to reduce cardiovascular risk (3). For example, there is convincing evidence of
EP
a beneficial effect of controlled wine polyphenols consumption in CKD patients (4) or Brazil nut supplementation to reduce inflammation in hemodialysis patients (2). However, controlled
AC C
clinical trials are needed to confirm that these bioactive compounds have an important antiinflammatory effect.
The randomized, double-blind, placebo-controlled study by Imani et al. (5) showed that
ginger intake during 10 weeks reduced the serum fasting glucose in CKD patients on peritoneal dialysis. The study was well designed and performed; however, the authors did not observed
ACCEPTED MANUSCRIPT
differences in oxidative stress, inflammatory and cardiovascular risk markers after supplementation, only the serum fasting glucose reduced up to 20%.
RI PT
The ginger (Zingiber officinale) is consumed as a spice and herbal medicine and contains phenolic substances known as gingerols, which the 6-Gingerol is the major pharmacologicallyactive component of ginger and exhibits several biological activities such as anti-inflammatory
SC
and antioxidant (6).
There are some limitations in the study by Imani et al. (5), such as the amount of
M AN U
phenolic in the ginger capsules given to the patients and moreover, the supplementation period may not be sufficient to show the effects of ginger on inflammation markers levels in CKD patients.
TE D
In a recent study, Yang et al. (7) observed that supplement with ginger extract attenuated chronic fructose consumption-induced kidney injury in rats by suppressing renal overexpression of proinflammatory cytokines. So, further investigations are needed to know
EP
the details about the therapeutic actions of ginger in CKD patients.
AC C
These nutritional compounds may promote the reduction of inflammation by activation of nuclear factor E2-related factor 2 (Nrf2), which has emerged as a factor that plays an important role in cellular protection against oxidative stress and inflammation (3). In fact, studies in vitro have shown that bioactive compounds isolated from ginger may activate Nrf2 (8, 9). However, we do not know if these bioactive compounds can be effective in humans.
ACCEPTED MANUSCRIPT
Food sources of bioactive compounds are preferable to supplementation practices, because they are sustainable, less expensive, and have advantage of relatively low toxicity. So,
RI PT
a "nutritional therapy" is an important strategy to reduce inflammation in CKD patients.
SC
Acknowledgement: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
References
M AN U
1. Pedruzzi LM, Stockler-Pinto MB, Leite M, Jr., Mafra D. Nrf2-keap1 system versus NFkappaB: the good and the evil in chronic kidney disease? Biochimie 2012; 94:2461-6. 2. Stockler-Pinto MB, Mafra D, Moraes C, Lobo J, Boaventura GT, Farage NE, Silva WS, Cozzolino SF, Malm O. Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients. Biol Trace Elem Res 2014;158:105-12.
TE D
3. Cardozo LF, Pedruzzi LM, Stenvinkel P, Stockler-Pinto MB, Daleprane JB, Leite M Jr, Mafra D. Nutritional strategies to modulate inflammation and oxidative stress pathways
via
activation
of
the
master
antioxidant
switch
Nrf2.
EP
Biochimie 2013;95:1525-33.
4. Presti RL, Carollo C, Caimi G. Wine consumption and renal diseases: new perspectives. Nutrition. 2007;23:598-602.
AC C
5. Imani H, Tabibi H, Najafi I, Atabak S, Hedayati M, Rahmani L. Effects of ginger on serum glucose, advanced glycation end products and inflammation in peritoneal dialysis patients. Nutrition 2015, in press.
6. Wang S, Zhang C, Yang G, Yang Y. Biological properties of 6-gingerol: a brief review. Nat Prod Commun. 2014;9:1027-30. 7. Yang M, Liu C, Jiang J, Zuo G, Lin X, Yamahara J, Wang J, Li Y. Ginger extract diminishes chronic fructose consumption-induced kidney injury through suppression
ACCEPTED MANUSCRIPT
of renal overexpression of proinflammatory cytokines in rats. BMC Complement Altern Med. 2014; 14:174. 8. Chen H, Fu J, Chen H, Hu Y, Soroka DN, Prigge JR, Schmidt EE, Yan F, Major MB, Chen
RI PT
X, Sang S. Ginger compound [6]-shogaol and its cysteine-conjugated metabolite (M2) activate Nrf2 in colon epithelial cells in vitro and in vivo. Toxicol 2014;27:1575-85.
Chem Res
9. Yao J, Ge C, Duan D, Zhang B, Cui X, Peng S, Liu Y, Fang J. Activation of the phase II
SC
enzymes for neuroprotection by ginger active constituent 6-dehydrogingerdione in
AC C
EP
TE D
M AN U
PC12 cells. J Agric Food Chem 2014;62:5507-18.
S0899-9007(14)00556-5
DOI:
10.1016/j.nut.2014.12.018
Reference:
NUT 9443
To appear in:
Nutrition
Received Date: 2 December 2014 Accepted Date: 16 December 2014
Please cite this article as: Mafra D, Nutritional strategies to reduce inflammation in chronic kidney disease patients, Nutrition (2015), doi: 10.1016/j.nut.2014.12.018. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Nutritional strategies to reduce inflammation in chronic kidney disease patients Denise Mafra, RD, PhD
RI PT
Fluminense Federal University (UFF), Graduate Program in Medical Sciences, Niterói-RJ, Brazil.
SC
To the Editor:
Inflammation is common feature in chronic kidney disease (CKD) patients that can lead
M AN U
to cardiovascular disease (1). A number of therapeutic strategies may be effective in reducing the cardiovascular risk in these patients, such as use of bioactive foods that have anti-oxidant and anti-inflammatory protective effects (2).
In fact, polyphenols, resveratrol, curcumin, catechins, sulforaphane, allicin, and
TE D
lycopene have potent biological activity with important role in a reduction of inflammation and may be beneficial to reduce cardiovascular risk (3). For example, there is convincing evidence of
EP
a beneficial effect of controlled wine polyphenols consumption in CKD patients (4) or Brazil nut supplementation to reduce inflammation in hemodialysis patients (2). However, controlled
AC C
clinical trials are needed to confirm that these bioactive compounds have an important antiinflammatory effect.
The randomized, double-blind, placebo-controlled study by Imani et al. (5) showed that
ginger intake during 10 weeks reduced the serum fasting glucose in CKD patients on peritoneal dialysis. The study was well designed and performed; however, the authors did not observed
ACCEPTED MANUSCRIPT
differences in oxidative stress, inflammatory and cardiovascular risk markers after supplementation, only the serum fasting glucose reduced up to 20%.
RI PT
The ginger (Zingiber officinale) is consumed as a spice and herbal medicine and contains phenolic substances known as gingerols, which the 6-Gingerol is the major pharmacologicallyactive component of ginger and exhibits several biological activities such as anti-inflammatory
SC
and antioxidant (6).
There are some limitations in the study by Imani et al. (5), such as the amount of
M AN U
phenolic in the ginger capsules given to the patients and moreover, the supplementation period may not be sufficient to show the effects of ginger on inflammation markers levels in CKD patients.
TE D
In a recent study, Yang et al. (7) observed that supplement with ginger extract attenuated chronic fructose consumption-induced kidney injury in rats by suppressing renal overexpression of proinflammatory cytokines. So, further investigations are needed to know
EP
the details about the therapeutic actions of ginger in CKD patients.
AC C
These nutritional compounds may promote the reduction of inflammation by activation of nuclear factor E2-related factor 2 (Nrf2), which has emerged as a factor that plays an important role in cellular protection against oxidative stress and inflammation (3). In fact, studies in vitro have shown that bioactive compounds isolated from ginger may activate Nrf2 (8, 9). However, we do not know if these bioactive compounds can be effective in humans.
ACCEPTED MANUSCRIPT
Food sources of bioactive compounds are preferable to supplementation practices, because they are sustainable, less expensive, and have advantage of relatively low toxicity. So,
RI PT
a "nutritional therapy" is an important strategy to reduce inflammation in CKD patients.
SC
Acknowledgement: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
References
M AN U
1. Pedruzzi LM, Stockler-Pinto MB, Leite M, Jr., Mafra D. Nrf2-keap1 system versus NFkappaB: the good and the evil in chronic kidney disease? Biochimie 2012; 94:2461-6. 2. Stockler-Pinto MB, Mafra D, Moraes C, Lobo J, Boaventura GT, Farage NE, Silva WS, Cozzolino SF, Malm O. Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients. Biol Trace Elem Res 2014;158:105-12.
TE D
3. Cardozo LF, Pedruzzi LM, Stenvinkel P, Stockler-Pinto MB, Daleprane JB, Leite M Jr, Mafra D. Nutritional strategies to modulate inflammation and oxidative stress pathways
via
activation
of
the
master
antioxidant
switch
Nrf2.
EP
Biochimie 2013;95:1525-33.
4. Presti RL, Carollo C, Caimi G. Wine consumption and renal diseases: new perspectives. Nutrition. 2007;23:598-602.
AC C
5. Imani H, Tabibi H, Najafi I, Atabak S, Hedayati M, Rahmani L. Effects of ginger on serum glucose, advanced glycation end products and inflammation in peritoneal dialysis patients. Nutrition 2015, in press.
6. Wang S, Zhang C, Yang G, Yang Y. Biological properties of 6-gingerol: a brief review. Nat Prod Commun. 2014;9:1027-30. 7. Yang M, Liu C, Jiang J, Zuo G, Lin X, Yamahara J, Wang J, Li Y. Ginger extract diminishes chronic fructose consumption-induced kidney injury through suppression
ACCEPTED MANUSCRIPT
of renal overexpression of proinflammatory cytokines in rats. BMC Complement Altern Med. 2014; 14:174. 8. Chen H, Fu J, Chen H, Hu Y, Soroka DN, Prigge JR, Schmidt EE, Yan F, Major MB, Chen
RI PT
X, Sang S. Ginger compound [6]-shogaol and its cysteine-conjugated metabolite (M2) activate Nrf2 in colon epithelial cells in vitro and in vivo. Toxicol 2014;27:1575-85.
Chem Res
9. Yao J, Ge C, Duan D, Zhang B, Cui X, Peng S, Liu Y, Fang J. Activation of the phase II
SC
enzymes for neuroprotection by ginger active constituent 6-dehydrogingerdione in
AC C
EP
TE D
M AN U
PC12 cells. J Agric Food Chem 2014;62:5507-18.
