The relationship between behavioral disorders and the quality of life in patients with liver cirrhosis

The relationship between behavioral disorders and the quality of life in patients with liver cirrhosis

by | آبان 17, 1402 | Articles

The Relationship Between Behavioral Disorders and Quality of Life in Patients with Liver Cirrhosis

Although long-term alcohol consumption is the most common cause of cirrhosis, other causes include diseases such as hepatitis B and C, cystic fibrosis, galactosemia, and glycogen storage disease. The prevalence of this liver disease is particularly high in many Asian countries, where hepatitis B and C are widespread.

Symptoms of Cirrhosis

The symptoms of cirrhosis include increased portal hypertension, ascites (abdominal fluid retention), hepatic encephalopathy, esophageal bleeding, slowed drug metabolism leading to increased sensitivity to side effects, toxin accumulation in the bloodstream, and ultimately, death.

The buildup of toxins in the patient’s body can lead to mental impairment, personality changes, drowsiness and coma, memory loss, and lack of concentration. Like many other chronic diseases, patients with liver cirrhosis experience a significant decline in quality of life, which subsequently leads to psychological issues, especially depression, anxiety, and emotional deficits.

What Is Emotional Deficiency?

Emotional deficiency refers to an inability to express feelings due to a lack of emotional awareness. Individuals with emotional deficiency are generally unable to identify, understand, or describe emotions. These characteristics contribute to cognitive dysfunction, impaired emotion regulation, and are linked to the onset and persistence of certain psychiatric and medical disorders. Such individuals often misinterpret normal physiological arousal and physical signs of emotional activation as symptoms of illness.

Symptoms of Emotional Deficiency

Emotional deficiency is often accompanied by increased physiological arousal, heightened attention to physical symptoms, frequent complaints about these symptoms, and compulsive illness-related behaviors. Its role in the mechanisms of psychological distress is increasingly being recognized, particularly as a major risk factor for psychosomatic disorders. Since these individuals struggle to regulate their emotions, studies indicate a strong link between emotional deficiency and conditions such as anxiety and depression, particularly the latter.

The Link Between Liver Cirrhosis and Depression

According to available statistics, over 27% of cirrhosis patients in certain countries suffer from depression. Additionally, there is a direct correlation between the severity of depressive symptoms and the progression of the disease. A study conducted by Bianchi et al. on 56 Italian cirrhosis patients revealed a significant decline in psychological well-being compared to healthy individuals. Other studies suggest that increased compassion from family members can sometimes contribute to greater anxiety and depression in cirrhosis patients.

Why Is Depression So Common in Cirrhosis Patients?

Today, depressive disorders are considered a major health concern among cirrhosis patients due to their impact on disease severity, functional impairment, treatment adherence, and overall quality of life.

Quality of life is a dynamic and subjective concept that involves comparing past life circumstances with recent events, both positive and negative. Patients with similar conditions may have differing perceptions of their quality of life. Some researchers even argue that improving quality of life should be the primary goal of medical interventions, especially for patients with chronic illnesses for which no definitive cure exists. The varying research results, the clinical significance of behavioral disorders, and the limited studies conducted in Iran highlight the necessity of further investigation in this field.

Study Objective

The aim of this study is to evaluate the relationship between behavioral disorders and quality of life in cirrhosis patients and to compare their characteristics with healthy individuals. This research seeks to provide a foundation for enhancing public awareness in managing this disease.

Research Methodology

The study population consisted of patients with liver cirrhosis who visited a specialized clinic. A total of 100 patients were randomly selected based on a diagnosis by a gastroenterology specialist. Additionally, 100 healthy individuals were chosen as a control group from among hospital staff and the healthy companions of cirrhosis patients attending the clinic.

Efforts were made to ensure that the control group was matched with the patient group in terms of variables such as age, gender, education, economic status, and marital status. After selecting the participants, the study’s objectives were explained to them. The inclusion criteria were:

  • Age range of 18–60 years
  • Minimum education level of middle school
  • Absence of chronic physical or mental illness
  • Voluntary consent to participate in the study

Study Findings

The study’s findings indicate a direct relationship between behavioral disorders and reduced quality of life in cirrhosis patients. Many previous studies have highlighted the negative impact of depression on treatment outcomes, psychological well-being, and mortality rates among patients. Fortunately, advancements in psychological techniques and the improved validity and accuracy of psychological assessment tools have significantly enhanced the measurement of mental health factors. However, the successful management of this disease still requires the identification and treatment of behavioral disorders both before and during the medical treatment process.

Conclusion

It is hoped that the results of this research will pave the way for practical support in the multidisciplinary treatment of cirrhosis patients. This approach should integrate both clinical treatment and concurrent management of behavioral disorders. The findings may also contribute to policy-making, planning, and implementing programs aimed at improving the quality of life for patients with liver cirrhosis.

Reference:
Sheikhian, M., Meisami Bonab, S., Ahadi, M., Talebi, M., & Masoumi, E. (2014). The Relationship Between Behavioral Disorders and Quality of Life in Patients with Liver Cirrhosis. Govaresh, 19(1), 20-25. SID. https://sid.ir/paper/86106/fa

The relationship between body iron stores and atherosclerosis

The relationship between body iron stores and atherosclerosis

by | آبان 7, 1402 | Articles

The Relationship Between Body Iron Stores and Atherosclerosis

Ischemic myocardial diseases are now considered the leading cause of mortality in various industrial and developing societies.

The most important and common etiology is the phenomenon of atherosclerosis, which occurs naturally to varying degrees in all individuals. In certain groups, atherosclerosis progresses more rapidly and extensively, leading to serious pathogenesis. This can result in myocardial ischemia and related events, even at young ages.

Factors That Aggravate Myocardial Ischemia

Several factors contribute to the progression of ischemic heart disease, including:

  • Hypertension
  • Diabetes
  • Smoking
  • Hyperlipidemia

These factors are well-established and are considered significant risk factors for cardiovascular diseases.

Preventive Factors

To study preventive measures, we examined:

  • Serum homocysteine levels
  • Serum fibrinogen levels
  • Body iron stores

Preliminary investigations suggest that increased iron stores may contribute to the development of atherosclerosis. One theory proposes that the lower incidence of atherosclerosis in women during their reproductive years may be due to iron loss from menstrual bleeding. Consequently, postmenopausal iron accumulation may elevate atherosclerosis risk.

Research Methodology

This study included 80 randomly selected patients admitted to the cardiology unit due to acute coronary syndrome (myocardial infarction or unstable angina).

A questionnaire was prepared to collect patient data, including:

  • Age and gender
  • History of ischemic heart disease and blood disorders
  • Hypertension and diabetes history
  • Previous blood transfusions
  • Smoking habits
  • Iron supplement usage

All participants underwent laboratory tests for:

  • Blood glucose
  • Triglycerides and cholesterol
  • Hematocrit and hemoglobin
  • Serum ferritin and iron levels
  • Transferrin saturation percentage (analyzed separately for males and females)

What Are Risk Factors?

Cardiovascular diseases remain the leading cause of death worldwide. Risk factors—epidemiological findings that increase disease probability—are categorized as:

  • Behavioral (e.g., smoking)
  • Genetic (e.g., family history)
  • Laboratory findings (e.g., high cholesterol)
  • Pre-existing conditions (e.g., diabetes or hypertension)

Despite recent medical advancements, coronary artery disease remains a significant health concern in the 21st century. Therefore, identifying and controlling risk factors is crucial.

Factors That Accelerate Atherosclerosis

Well-established contributors to atherosclerosis progression include:

  • Hyperlipidemia
  • Smoking
  • Hypertension
  • Insulin resistance and diabetes
  • Obesity and physical inactivity
  • Psychological stress
  • Menopause in women

Recent research has also explored the role of homocysteine, fibrinogen, lipoprotein(a), inflammatory factors, and infections in atherosclerosis development.

The Link Between Serum Iron Levels and Coronary Atherosclerotic Events

Scattered studies suggest a potential association between serum iron levels and coronary atherosclerotic incidents. Individuals with excessively high or low iron levels may experience negative cardiovascular effects.

Iron-deficiency anemia is one of the oldest known human diseases. However, the adverse effects of iron overload have gained increasing attention in recent years, primarily due to greater blood transfusion usage and increased life expectancy.

Iron Overload (Overload Iron and Cardiovascular Risk)

Iron overload (Overload Iron) can lead to various complications, with heart failure being the most fatal consequence. The toxic effects of excess iron appear in different heart cell components, starting with iron deposition in cardiac muscle cells, which is the first step of iron-induced cardiac damage.

Another harmful effect of iron overload is the production of hydroxyl radicals, which damage heart cells. Iron overload significantly increases hydroxyl radical levels, exacerbating oxidative stress and cellular damage.

Diseases Caused by Iron Overload

Severe iron accumulation can result in clinical conditions such as:

  • Restrictive cardiomyopathy
  • Pericarditis
  • Angina, even with normal coronary arteries
  • Conduction disorders and various arrhythmias

In recent years, hematocrit levels have been recognized as a coronary artery disease risk factor. Laboratory studies suggest that hemoglobin can limit nitric oxide activity in the blood, impacting vascular function.

Conclusion

This study, along with previous similar research, suggests that minor fluctuations in iron levels within the normal range do not significantly impact atherosclerosis progression. However, long-term and substantial iron imbalances may play a role in accelerating atherosclerosis.

Reference

Khosravi, A., Hassanzadeh Delouei, M., & Habibi Mod, F. (2005). The relationship between body iron stores and atherosclerosis. Ofogh-e-Danesh, 11(3), 27-31. SID.

The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly

The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly

by | مهر 27, 1402 | Articles

The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly

This article examines the effect of magnesium supplementation on primary insomnia in the elderly. Insomnia is defined as dissatisfaction with the amount or quality of sleep, which persists for a long period. Its symptoms include difficulty falling asleep, staying asleep, and waking up too early. This issue is not an inevitable part of aging; however, due to various reasons, its prevalence increases with age. Most elderly individuals who do not have optimal aging conditions suffer from major sleep disorders. In other words, aging itself does not automatically lead to sleep disorders; rather, it often occurs due to other factors related to aging. The most significant sleep-related changes associated with aging include:

  • Decreased sleep duration
  • Reduced sleep efficiency
  • Less deep sleep

The prevalence of insomnia symptoms across all population groups ranges from 10% to 48%. Studies on its prevalence among the elderly indicate that 42% of them experience difficulty in falling asleep or staying asleep. A follow-up of the mentioned study over three years showed that 15% of participants who initially did not report insomnia later developed it, indicating an average annual incidence rate of 5%. Other estimates suggest that over 40% to 50% of adults over 60 years old suffer from insomnia.

Problems Associated with Insomnia

At all ages, individuals suffering from insomnia experience memory impairment, increased response time, short-term memory problems, and decreased efficiency. However, insomnia is particularly problematic in the elderly, as it increases their risk of falls, cognitive impairment, poor physical function, and mortality. Sleep disorders are also linked to reduced quality of life, general health issues, increased healthcare costs, and symptoms of anxiety and depression.

Treatment

Currently, treatment includes both pharmacological and non-pharmacological approaches. There is low to moderate-quality evidence regarding the effectiveness of non-pharmacological treatments for insomnia, and clinically significant results are often lacking. Generally, there is insufficient accurate data on the impact of these methods compared to control groups. Pharmacological treatment for insomnia involves a wide range of medications. However, the American National Institute of Health’s Sleep Disorders Conference has stated that the risks of commonly used sleep disorder medications outweigh their benefits, making them unsuitable for the elderly. This concern is particularly relevant for older adults, as 81% of sleep medications are used by them, often daily and for prolonged periods.

Magnesium

Magnesium is the fourth most abundant cation in the body and the second most prevalent intracellular cation, participating in over 300 vital biochemical reactions. It acts as an essential cofactor for numerous enzymatic reactions, particularly those involved in energy metabolism and neurotransmitter synthesis. Aging is a major risk factor for magnesium deficiency.

Its Effects in the Elderly

During aging, the body’s magnesium status undergoes several changes. With increasing age, total body magnesium decreases due to a reduction in bone mass, which serves as the primary reservoir of magnesium in the body.

Epidemiological studies indicate that despite magnesium’s significant physiological role, dietary magnesium intake is insufficient in various populations. Certain demographic groups, especially the elderly, have low magnesium intake due to:

  • Inability to consume magnesium-rich foods
  • Preference for processed foods
  • Lower consumption of whole grains and leafy green vegetables

However, studies show that the need for magnesium does not change with age. Other age-related changes in magnesium metabolism include:

  • Decreased magnesium intake
  • Reduced intestinal absorption
  • Increased urinary and fecal excretion due to medication use

Among these factors, reduced magnesium intake appears to play a key role in age-related magnesium deficiency.

Its Role in the Body

Although the exact impact of magnesium on neural function and sleep behavior is not fully understood, magnesium plays a role in regulating the conductivity of various ion channels, such as NMDA (N-Methyl-D-Aspartate) receptors and unidirectional potassium channels. It is also essential for the binding of most monoamines to their receptors.

Therefore, this cation plays a crucial role in neurotransmission at both the presynaptic and postsynaptic membrane levels. Several studies have confirmed its role in regulating excitability in the central nervous system. As a natural NMDA antagonist and a GABA agonist, magnesium may play a key role in sleep regulation.

Magnesium Supplementation

Given the points mentioned above, if magnesium supplementation can improve insomnia and prevent complications related to this disorder, such as:

  • Reduced daytime efficiency
  • Increased healthcare costs
  • Chronic stress
  • Depression
  • Shortened lifespan in the elderly

It may serve as an alternative or complementary treatment to conventional medications, helping to reduce their multiple side effects, including:

  • Long-term sedative effects
  • Memory impairment
  • Increased risk of falls due to daytime drowsiness
  • Rebound insomnia
  • Respiratory suppression
  • Tolerance development requiring higher doses
  • Dependence and withdrawal issues
  • Drug misuse
  • Potentially increased mortality risk

For this reason, the present study was designed to investigate the effect of magnesium supplementation on insomnia in the elderly.

Conclusion

Overall, the results of this study suggest that taking 500 mg of magnesium daily for eight weeks can improve biochemical and questionnaire-based sleep indices, including increased sleep duration, sleep efficiency, and serum levels of renin and melatonin. Additionally, magnesium supplementation can improve insomnia severity scores while reducing serum cortisol levels and sleep onset latency in elderly individuals with insomnia. The observed effects of magnesium supplementation on insomnia, at the administered dose, were free of any side effects, including gastrointestinal irritation symptoms.

Reference:

Abbasi, Behnoud, Kimiagar, Masoud, Sadeghniat, Khosro, Mohammad-Shirazi, Minoo, Hedayati, Mehdi, Rashidkhani, Bahram, Shahidi, Shahriar, Payab, Moloud, & Karimi, Nastaran. (2012). The Effect of Magnesium Supplementation on Primary Insomnia in the Elderly. Scientific Journal of Birjand University of Medical Sciences, 19(3 (Issue 52)), 0-0. SID. https://sid.ir/paper/384571/fa

The Effect of L-Carnitine on Women with Knee Osteoarthritis

The Effect of L-Carnitine on Women with Knee Osteoarthritis

by | مهر 15, 1402 | Articles

The Effect of L-Carnitine and Weight Loss Diet on Anthropometric Indices in Women with Knee Osteoarthritis

Introduction

Osteoarthritis is one of the most common chronic joint diseases, and its prevalence is increasing. Women are more prone to this condition due to higher fat tissue levels and inflammatory factors.

Factors Contributing to Osteoarthritis

Genetic and environmental factors (diet, obesity, physical activity, and joint injuries) play a role in the development of osteoarthritis. An improper diet leads to weight gain, which increases mechanical pressure on the knee joints. Studies show that individuals with a body mass index (BMI) over 30 are four times more likely to develop osteoarthritis.

The Impact of Weight Loss on Osteoarthritis Improvement

In women with osteoarthritis, losing 2 kg of weight reduces joint pressure by 7%. This reduction in mechanical stress prevents further cartilage damage and contributes to osteoarthritis improvement.

The Role of L-Carnitine in Treating and Improving Osteoarthritis

L-Carnitine supplementation has gained attention in osteoarthritis treatment from a nutritional perspective. It plays a role in glucose metabolism by reducing acetyl-CoA levels, increasing energy metabolism. Additionally, by facilitating fatty acid transport into the mitochondria, it enhances fatty acid oxidation and reduces body fat levels. These effects of L-Carnitine on blood sugar and fat levels may contribute to faster osteoarthritis improvement.

Prevention and Treatment of Osteoarthritis

Animal and in vitro studies have shown that L-Carnitine increases cartilage cell proliferation, ATP production, and the repair of damaged cells, helping to prevent and treat osteoarthritis. A study on 120 patients found that L-Carnitine supplementation reduced pain levels and clinical symptoms in osteoarthritis patients.

So far, no study has examined the simultaneous effect of a weight loss diet and L-Carnitine supplementation in this disease. Given the high prevalence of osteoarthritis, particularly in women, and its associated disabilities, along with the limited human studies on the effects of L-Carnitine in improving osteoarthritis, this study aims to evaluate the impact of L-Carnitine supplementation on anthropometric indices in obese women with knee osteoarthritis following a weight loss diet.

Study Methodology

Inclusion criteria included:

  • BMI over 25
  • Age between 45 to 70 years
  • No supplement consumption in the past three months
  • No weight loss diet in the past three months
  • No participation in other intervention programs
  • Willingness to lose weight
  • No history of heart, liver, kidney disease, diabetes, hypothyroidism, rheumatoid arthritis, or surgery

After signing the informed consent form, participants were randomly assigned to an intervention group (21 individuals) and a control group (22 individuals).

Participants in the intervention group received one 1000 mg L-Carnitine tablet daily along with a weight loss diet, while the control group received a placebo identical in color, shape, and weight, along with a weight loss diet for 12 weeks. Patients were advised to take the tablets after breakfast or lunch. The weight loss diet was determined based on individual daily energy needs using the Harris-Benedict formula, incorporating activity level and food energy consumption.

Over the 12-week period, each participant was required to consume 90 capsules. To ensure compliance, the capsules were packaged in bottles containing 30 tablets, and participants were asked to return the empty bottles at their next monthly visit before receiving a new bottle.

Study Findings

Although waist circumference, hip circumference, BMI, and weight significantly decreased in both groups, the only significant difference between the two groups was in waist circumference reduction.

The Impact of Weight Gain

Weight gain contributes to osteoarthritis progression by increasing inflammatory factors. Additionally, in the knee area, the mechanical pressure caused by excess weight leads to more pain. L-Carnitine facilitates fatty acid transport across the mitochondrial membrane, enhancing beta-oxidation and reducing blood fatty acid levels. Thus, weight loss not only reduces mechanical pressure but also decreases inflammatory factors.

In this study, due to the weight loss diet, significant changes in anthropometric indices were observed in both groups, except for the waist-to-hip ratio. However, in the intervention group, 1000 mg of L-Carnitine resulted in a significant reduction in waist circumference. A higher dose or longer intervention period may lead to more substantial changes in study results. This study demonstrated that 1000 mg of oral L-Carnitine could significantly reduce waist circumference.

The effect of soy nut consumption on hot flashes in postmenopausal women

The effect of soy nut consumption on hot flashes in postmenopausal women

by | مهر 1, 1402 | Articles

The Effect of Soy Nut Consumption on Hot Flashes in Postmenopausal Women

Half of the world’s population consists of women, and according to published statistics, nearly 90% of them reach the age of 65, meaning they spend about one-third of their lives in menopause. Menopause refers to the permanent cessation of menstruation, during which FSH levels increase (above 40 units per liter), while estrogen and progesterone hormone secretion decreases. This leads to various changes, including hot flashes, genital atrophy, osteoporosis, and cardiovascular problems in postmenopausal women.

In this article, we aim to examine the effect of soy nut consumption on hot flashes in postmenopausal women. The classic symptom caused by estrogen deficiency is hot flashes, which occur as recurrent and temporary episodes. Symptoms include:

  • Flushing
  • Sweating and a sensation of heat
  • Heart palpitations
  • Feelings of anxiety
  • Sometimes accompanied by chills

This common and distressing symptom in postmenopausal women, especially at night, can cause sleep disturbances, leading to chronic fatigue, irritability, poor concentration, and memory problems. Hormone replacement therapy (HRT) has been shown to improve hot flashes in most women within a few days. However, evidence suggests that long-term HRT increases the risk of uterine and breast cancer. Additionally, acceptance of this treatment among Iranian women is low, and only a small percentage use hormone replacement therapy.

Prevalence of Hot Flash Symptoms

The prevalence of hot flashes varies across different countries. Studies report a 70–80% prevalence in postmenopausal women in Europe and North America, while in Chinese and Japanese women, it is 18% and 14%, respectively. This difference seems to be related to dietary habits, particularly the consumption of phytoestrogen-rich foods in these populations.

Research Methodology

This was a clinical trial conducted on postmenopausal women who attended healthcare centers in Yazd, Iran. Participants were selected through convenience sampling until the required sample size was achieved. Based on similar studies, the total sample size was calculated to be 30 participants, but considering possible dropouts, 35 women were initially enrolled. During the study, four participants were excluded for reasons such as gastrointestinal issues, irregular consumption, and lack of cooperation, leaving 31 women who completed the intervention.

Eligible women completed an initial questionnaire and provided blood samples for hormone measurement. They were then given soy nuts for 10 days, along with a measuring cup containing 60 grams of soy nuts (daily dose: 60 grams). Participants were instructed on how to consume them.

Inclusion and Exclusion Criteria

Inclusion criteria:

  • At least 12 months since their last menstrual period
  • Experiencing at least 5 hot flashes per day
  • Willingness to participate in the study
  • No history of soy allergy
  • No hormone replacement therapy
  • No unexplained vaginal bleeding
  • No active liver or kidney disease
  • No history of cancer or thromboembolism

Exclusion criteria:

  • Vaginal bleeding
  • Soy allergy development
  • Unwillingness to continue the study
  • Need for medication use

Measurements

Demographic variables, such as age, number of pregnancies, number of births, and age of menopause, were recorded at the beginning of the study. Participants’ weight, height, and systolic and diastolic blood pressure were measured before and after the three-month intervention.

A 5cc blood sample was taken from each participant at the beginning and end of the three months to measure estradiol, FSH, and LH hormone levels. Participants were given a form to record each hot flash episode, allowing researchers to calculate the average frequency of hot flashes per month.

Characteristics of the Soy Nuts Used

The soy nuts used in this study were prepared by Toos Soy Company, with each 100 grams containing 123 mg of isoflavones. Participants consumed 60 grams of soy nuts daily, divided into morning and afternoon snacks.

The results showed that soy nut consumption reduced the frequency of hot flashes, although the exact mechanism remains unknown.

Reasons for Estrogen Reduction

Researchers believe that estrogen reduction is related to changes in metabolism due to soy consumption rather than interactions with FSH and LH hormones. Soy intake did not affect levels of Steroid Hormone Binding Globulin, FSH, or LH.

Another hypothesis is that the isoflavones in soy affect estrogen receptors. Phytoestrogens in soy may compete with endogenous estrogen for binding to sex hormone-binding globulins. Additionally, isoflavones have antioxidant properties, and genistein, a type of isoflavone, is known to inhibit tyrosine protein kinase, which influences endothelial function and may help reduce hot flashes.

Benefits of Soy Nut Consumption

Researchers suggest that soy acts selectively on estrogen receptors and can have agonistic, antagonistic, or neutral effects. Once ingested, phytoestrogens may be excreted, absorbed, or broken down into stronger phytoestrogens. Unlike synthetic estrogens, phytoestrogens are easily metabolized, do not accumulate in tissues, and have a short duration in the body, making them a safe and beneficial dietary option when consumed as part of a normal diet.

One limitation of this study was the lack of a control group, as finding a placebo alternative for natural soy was not feasible. However, consuming natural soy nuts has advantages such as accessibility, psychological acceptance, and nutritional value.

To further clarify the effects of soy nuts, future studies should examine different doses of soy nuts to determine the minimum effective amount for hot flash control and assess its long-term safety.

Conclusion

Since hot flashes are the most common complaint during menopause and hormone replacement therapy is neither widely accepted nor risk-free, a low-cost, low-risk, and beneficial dietary intervention is desirable.

Consuming 60 grams of soy nuts daily as a nutritious and accessible snack is recommended for postmenopausal women to help manage hot flashes effectively.

The Effect of Carnitine on Hemodialysis Patients

The Effect of Carnitine on Hemodialysis Patients

by | شهریور 7, 1402 | Articles

Cardiovascular diseases are considered the leading cause of mortality among hemodialysis patients. Hypertension, advanced age, diabetes, and other systemic diseases that affect cardiac function are commonly seen in these patients. This article will examine the effects of carnitine on hemodialysis patients.

Additionally, hemodialysis patients often suffer from deficiencies in some essential substances required for the metabolic functions of myocardial cells.

Introduction to Carnitine

Carnitine is a natural substance with its primary physiological role in the body:

It facilitates the transport of long-chain fatty acids from the cytoplasm into mitochondria for their beta-oxidation.
Therefore, sufficient carnitine within cells is essential for the normal metabolism of fatty acids in the human body. This is especially important in tissues like the heart and skeletal muscles, which depend on fatty acid metabolism to produce energy.

Key Features and Roles of Carnitine

  1. Fat Metabolism: Carnitine plays a role in transporting fatty acids into mitochondria for beta-oxidation (the process of producing energy from fatty acids). This process is essential for energy production in daily activities.
  2. Support for the Cardiovascular System: The heart, as the main blood pump in the human body, requires a constant supply of energy. Carnitine helps by transporting fatty acids into the mitochondria of the myocardium (heart muscle), improving energy supply and potentially improving cardiovascular function.
  3. Regulation of Glucose Metabolism: The breakdown of fats by carnitine can help reduce glucose utilization as an energy source, which may be beneficial in improving blood sugar control.
  4. Oxidative Balance: Carnitine acts as a natural antioxidant, helping to maintain oxidative balance within cells and preventing oxidative damage.
  5. Body Composition Support: Carnitine supplementation can help reduce abdominal fat and improve overall body composition.

Biological Function in Humans

In the human biological system, carnitine exists in two forms:

  1. Free form
  2. Esterified form

In hemodialysis patients, unlike healthy individuals, the esterified form of carnitine is more prevalent than the free form. This is due to the loss of free carnitine through the dialysis membrane. As a result, despite normal plasma levels of total carnitine, the accumulation of the esterified form and the reduction in free carnitine leads to lower carnitine levels in tissues (including the heart and skeletal muscles).

Effects of Carnitine Administration

Various studies have investigated the effects of carnitine administration (either intravenously or orally) in hemodialysis patients or those with heart failure. One such study found that carnitine had a significant effect on improving anemia in hemodialysis patients.

Effects of Low Dose Oral Carnitine Administration

A study conducted by researchers showed that administering a low dose of oral L-carnitine (500 mg per day) for six months resulted in improvement in:

  • Patient symptoms
  • Increased LVEF (Left Ventricular Ejection Fraction)
  • Decreased left ventricular mass

Given the mixed results regarding the effects of carnitine on cardiac function, further studies are necessary to evaluate its impact on heart function.

Results on the Cardiac Systolic Function in Hemodialysis Patients with Heart Failure

This study, conducted on hemodialysis patients, examined the effect of oral carnitine administration on the systolic function of the heart in these patients with heart failure.

In addition, the impact of carnitine administration on:

  • Cardiac symptoms
  • Anemia
  • Hyperlipidemia

was also assessed simultaneously in these patients. A total of 20 patients participated in the study, divided into control and intervention groups. They were studied for six months.

Inclusion criteria for the patients were having an LVEF (Left Ventricular Ejection Fraction) of less than 50%. Patients with heart failure due to other specific causes, such as congenital heart diseases or valvular heart disorders, were excluded from the study. After adjusting for variables such as:

  • Age
  • Gender
  • Cause of kidney failure
  • Hypertension
  • Diabetes, etc.

patients were randomly assigned to the intervention and control groups.

Drug Administration to Patients

After selecting patients and dividing them into two groups (intervention and control), the intervention group was given 250 mg carnitine tablets with a dose of 1 gram per day.

The control group received a placebo in the same form as the carnitine but without carnitine.

Other medications commonly used by these patients, including:

  • Rokatrol tablets
  • Ferrous sulfate tablets
  • Calcium carbonate tablets
  • Folic acid tablets
  • Eprex injections
  • Antihypertensive medications

were continued, and no changes were made to the doses. Efforts were made to ensure the medication types were similar between the two groups.

Results Regarding Ejection Fraction

The results obtained regarding:

  • Ejection fraction
  • Left ventricular end-diastolic diameter
  • The ratio of cardiac diameter to chest diameter on chest X-ray
  • Hemoglobin levels
  • Triglycerides
  • Plasma cholesterol

were compared using repeated-measures analysis of variance and Bonferroni post-hoc tests. To compare between the two groups, Student’s t-test was used.

According to the studies, low-dose oral carnitine (500 mg/day for six months) significantly improved cardiac symptoms and function in hemodialysis patients.

Conclusion

The difference in the results of this study compared to previous research might be due to:

  • The ejection fraction level, which in our study was set to less than 50%, whereas in the Matsumoto study it was set to less than 60%. This means the cardiac function of patients in our study was lower initially.
  • The carnitine dose in their study was almost half of the dose used in our study.

Another study examined the effect of intravenous carnitine on serum triglyceride levels and showed that carnitine is effective only in patients with hypertriglyceridemia.

Research Results

According to the studies, only oral carnitine has a significant and beneficial effect on improving anemia. Researchers found that carnitine helps:

  • Reduce fatigue
  • Increase exercise tolerance

Given the importance of cardiovascular problems in hemodialysis patients, which is the leading cause of mortality in these patients, further studies are necessary to evaluate the effect of carnitine in improving the cardiac condition of these patients.