Osteoporosis is a systemic skeletal disease manifesting as weak and fragile bones. Dietary patterns have been described as an affecting constituent of bone metabolism. There is no consensus on the advantages or harms of vegetarian diets on bone health. This study aimed to design a lacto-vegetarian dietary score (LVDS) to evaluate the similarity of an individual\'s dietary pattern to the lacto-vegetarian dietary pattern and assess its association with postmenopausal osteoporosis (PMO). We hypothesized that individuals with greater LVDS will have a lower risk for PMO. In this hospital-based, case-control study, 220 cases (definitively diagnosed with osteoporosis) and 220 age-matched controls were registered. Usual dietary intakes were evaluated by a validated 147-item semiquantitative food frequency questionnaire. To design the LVDS, the energy-adjusted intakes of 12 food groups were categorized into quintiles, and positive or reverse points were assigned. To determine the association between the LVDS and PMO, binary logistic regression was used. Those in the top tertile of the LVDS had a lower chance of PMO compared with those in the bottom tertile (odds ratio, 0.11; 95% confidence interval, 0.06-0.22). An inverse relation was obtained between vegetables, fruits, legumes, nuts, dairy, soy protein, and egg consumption and PMO. Higher consumption of vegetable and animal oils significantly increased the risk of PMO. A dietary pattern similar to the lacto-vegetarian dietary pattern and concentrated on greater consumption of legumes, nuts, dairy, fruits, vegetables, and soy protein can be suggested as a protective method against PMO. Further, longitudinal studies are required to confirm these findings.

The obesity pandemic is associated with an increasing number of bariatric surgeries which allow improvement in obesity-related comorbidities and life expectancy but potentially induce nutritional deficiencies. Vegetarianism becomes more and more popular and exposes as well to vitamin and micronutrient deficiencies. Only one study has explored the impact of vegetarianism on the preoperative nutritional status of eligible patients for bariatric surgery, but none in postoperative care.
We conducted a retrospective case-control study in our cohort of bariatric patients, matching 5 omnivores for each vegetarian. We compared their biological profile regarding vitamin and micronutrient blood levels before and 3, 6, 12, and 30 months after surgery.
We included 7 vegetarians including 4 lacto-ovo-vegetarians (57%), 2 lacto-vegetarians (29%), and one lacto-ovo-pesco-vegetarian (14%). Three years after surgery with equivalent daily standard vitamin supplementation, the two groups showed a similar biological profile including blood levels of ferritin (p = 0.6), vitamin B1 (p = 0.1), and B12 (p = 0.7), while the total median weight loss at 3 years was comparable (39.1% [27.0-46.6] in vegetarians vs 35.7% [10.5-46.5] in omnivores, p = 0.8). We observed no significant difference between vegetarians and omnivores before surgery regarding comorbidities and nutritional status.
It seems that, after bariatric surgery, vegetarian patients taking a standard vitamin supplementation do not show an increased risk of nutritional deficiencies compared to omnivores. However, a larger study with a longer follow-up is needed to confirm these data, including an evaluation of different types of vegetarianism such as veganism.

We aimed to evaluate the association between three previously defined pro-vegetarian (PVG) food patterns and the cancers of the oesophagus, stomach, and pancreas in a multi case-control study. We analyzed data from a multi-case hospital-based study carried out in two Mediterranean provinces in Spain. A total of 1233 participants were included in the analyses: 778 incident cancer cases, histologically confirmed (199 oesophagus, 414 stomach, and 165 pancreas) and 455 controls. A dietary assessment was performed using a validated food frequency questionnaire (FFQ). Three PVG food patterns (general, healthful, and unhealthful) were estimated using 12 food groups for the general PVG (gPVG), scoring positive plant-based foods and negative animal-based foods, and 18 food groups, for the healthful (hPVG) and unhealthful (uPVG) food patterns. Multinomial logistic regression was used to estimate relative risk ratios (RRR) and confidence intervals (95% CI) for quintiles of adherence to PVG patterns and as a continuous variable. The RRR (95% CI) for the highest vs. the lowest quintile of gPVG were, RRR = 0.37 (0.32, 0.42) for the oesophagus, RRR = 0.34 (0.27, 0.43) for the stomach, and RRR = 0.43 (0.35, 0.52) for pancreas cancer. For the hPVG, the RRR were RRR = 0.72 (0.58, 0.90) for the oesophagus, RRR = 0.42 (0.34, 0.52) for the stomach, and RRR = 0.74 (0.59, 0.92) for pancreas cancer. The uPVG was associated with a higher risk of stomach cancer RRR = 1.76 (1.42, 2.18). Higher adherence to gPVG and hPVG food patterns is associated with a lower risk of oesophageal, stomach, and pancreas cancers, while a higher adherence to a uPVG food pattern is associated with a higher risk of stomach cancer.

Meat eaters have a more hierarchical, less egalitarian view at the world than vegetarians. This can be manifested in social dominance orientation, at the intergroup level, but also at the interspecies level, yielding more empathy with nonhuman animals, and at the interpersonal level. We examined if interpersonal motives in human-human relationships and empathy with people are associated with frequency of meat eating, using a cross-sectional survey (N = 580). For the motives power and affiliation, no significant relationships emerged, but the self-enhancement motive was positively related to the number of days that participants ate meat. This predicted additional variance over and above variables at the intergroup and interspecies level, such as social dominance orientation and human-animal continuity. Empathy with people was negatively related to meat consumption, but this was explained by its correlation with empathy with animals. Discussion focuses on the importance of the self-enhancement motive in attachment to meat, the symbol of human superiority, as well as resistance to meat refusers.

Creatine is a major component of energy metabolism that is abundant in human skeletal muscle, brain, and heart. Either synthesized internally or provided via an omnivorous diet, creatine is required for normal growth, development, and health. Recent advances in creatine nutrition and physiology suggest that the quantity of creatine the body naturally synthesizes is not sufficient to meet human needs. As a result, humans have to obtain enough creatine from the diet, which nominates creatine as an essential nutrient in certain circumstances. In this article, we summarize arguments that creatine should be considered a conditionally essential nutrient for humans and propose several questions that should be addressed in future research.

The association of dietary pattern with the risk of basal cell carcinoma (BCC) is little understood and has scarcely been investigated.
We assessed the association of several complete dietary patterns [Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Pro-vegetarian dietary pattern] with the risk of BCC, conducting a nested case-control study (4 controls for each case).
Cases and controls were selected from the SUN (Seguimiento Universidad de Navarra) cohort using risk set sampling. Cases were identified among subjects free of skin cancer at baseline but who later reported a physician-made BCC diagnosis during the follow-up period. In the cohort we identified 101 incident cases of BCC.
In multivariable-adjusted conditional logistic regression analyses, better adherence to the Mediterranean diet (highest compared with lowest quintile) was associated with a 72% relative reduction in the odds of BCC (OR: 0.28; 95% CI: 0.10, 0.77; Ptrend = 0.014); the DASH diet was associated with a 68% RR reduction (OR: 0.32; 95% CI: 0.14, 0.76; Ptrend = 0.013) for the comparison between extreme quintiles. No association was found between a Pro-vegetarian dietary pattern and BCC. Higher fruit consumption (highest compared with lowest quintile, OR: 0.27; 95% CI: 0.11, 0.64; Ptrend < 0.001) and low-fat dairy products (OR: 0.39; 95% CI: 0.16, 0.92; Ptrend = 0.014) were associated with a lower BCC risk.
Our results suggest that Mediterranean and DASH dietary patterns may be associated with a lower risk of BCC, but confirmatory studies are required.

Limited studies investigating the relationships between dietary patterns and congenital heart defects (CHDs) are available. This study aimed to explore the associations between dietary patterns and CHDs risk in Shaanxi, China. We conducted a hospital-based case-control study and included a total of 474 cases and 948 controls. Pregnant women waiting for delivery in the hospital were interviewed to report their diets during pregnancy using a validated food frequency questionnaire. Dietary patterns were derived using principal component factor analysis. Mixed logistic regression models were used to assess the associations between dietary patterns and CHDs. Pregnant women in the highest tertile of the prudent pattern had a lower risk of CHDs compared to those in the lowest tertile (OR = 0.65, 95%CI: 0.48-0.89). Pregnant women with high scores on the vegetarian pattern were at an increased risk of CHDs (medium vs. lowest tertile: OR = 1.50, 95%CI = 1.03-2.17; highest vs. lowest tertile: OR = 1.56, 95%CI = 1.13-2.15; ptrend = 0.015). Pregnant women with high scores on the dairy and egg pattern were at a reduced risk of CHDs (medium vs. lowest tertile: OR = 0.66, 95%CI = 0.49-0.90; highest vs. lowest tertile: OR = 0.60, 95%CI = 0.43-0.82; ptrend = 0.001). Maternal diet during pregnancy is an important target for intervention, and it may influence the likelihood of developing CHDs.

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent.
First we review the nature and scale of the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress\' four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress\' four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to.

The aim of this case study was to report on the performance outcomes and subjective assessments of long-term low-carbohydrate, high-fat (LCHF) diet in a world-class long-distance triathlete who had been suffering from gastrointestinal distress in Ironman competition. The lacto-ovo vegetarian athlete (age = 39 years; height = 179 cm; usual racing body mass = 75 kg; sum of seven skinfolds = 36 mm) changed his usual high carbohydrate (CHO) availability diet to an LCHF diet for 32 weeks (∼95% compliance). He participated in three professional races while on the LCHF diet, but acutely restored CHO availability by consuming CHO in the preevent meals and during the race as advised. The athlete had his worst-ever half-Ironman performance after 21 weeks on the LCHF diet (18th). After 24 weeks on LCHF, he had his second worst-ever Ironman performance (14th) and suffered his usual gastrointestinal symptoms. He did not finish his third race after 32 weeks on LCHF. He regained his usual performance level within 5 weeks back on a high CHO diet, finishing second and fourth in two Ironman events separated by just 3 weeks. Subjective psychological well-being was very negative while on the LCHF diet, with feelings of depression, irritability, and bad mood. In conclusion, this long-term (32 weeks) LCHF intervention did not solve the gastrointestinal problems that the athlete had been experiencing, it was associated with negative performance outcomes in both the half-Ironman and Ironman competitions, and it had a negative impact on the athlete\'s subjective well-being.

BACKGROUND: Sjogren\'s syndrome, involving sicca symptoms with xerostomia, stomatitis, and considerable pain is a difficult-to-treat autoimmune disease where the treatment options are limited and, as in the case of methotrexate, have a low therapeutic index.
METHODS: This case report concerns a male patient, aged 75 years and vegetarian, with Sjogren\'s syndrome subsequently confirmed by salivary gland biopsy. Serum antinuclear antibodies (ANA) were elevated (1 : 320). Low serum vitamin B12 and iron levels could be improved after 20 days using vitamin B12 and iron oral supplements. Despite symptomatic treatment, xerostomia, glossitis, and glossodynia were still present, at times marked, after 12 months when the ANA titer was unchanged. Following treatment with an anti-inflammatory polyvalent immunoglobulin formulation (Lactobin®N, 7 g daily), a bovine colostrum concentrate given orally in combination with oral vitamin D3 (2,000 IU daily), sicca symptoms and xerostomia progressively decreased and at day 750 were confined to occasional and minor glossitis of the upper lip.
CONCLUSIONS: This case report demonstrates the satisfactory control of Sjogren\'s syndrome using oral polyvalent immunoglobulins with vitamin D3. In contrast to treatment options involving antimalarial drugs and methotrexate, there are no safety issues in patients tolerant to milk products.
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