Nutrición y dietética clínica
- La nueva edición de Nutrición y Dietética Clínica pretende ser una obra de referencia de habla hispana en cuanto al tratamiento dietético permanentemente actualizado de las enfermedades más estrechamente relacionadas con la alimentación y la nutrición.
- Nutrición y Dietética Clínica se ha convertido en un gran referente para todos los dietistas-nutricionistas pero también para todos aquellos interesados en la nutrición y la dietética como son: médicos, farmacéuticos, biólogos y otros profesionales dentro de las ciencias de la salud.
- Tal como en ediciones anteriores los autores pretenden describir minuciosamente las bases científicas en que reposan la dietética y la dietoterapia.
- Se ofrecen las recomendaciones nutricionales para definir códigos de dietas hospitalarias que combinen la viabilidad económica y de producción económica con la excelencia dietética. Igualmente, constituye una referencia imprescindible para el tratamiento de los pacientes en atención primaria.
- Sección 1 Principios generales
- Capítulo 1 Necesidades y recomendaciones nutricionales
- Capítulo 2 Alimentación saludable
- Capítulo 3 Preparación, confección y seguimiento de una prescripción dietética
- Capítulo 4 Desnutrición relacionada con la enfermedad y dietética hospitalaria
- Capítulo 5 La dieta en la prevención de la enfermedad
- Capítulo 6 Normas de higiene y seguridad alimentaria
- Capítulo 7 Métodos de valoración del consumo alimentario
- Capítulo 8 Tablas de composición de alimentos: aplicaciones en nutrición clínica
- Capítulo 9 Evaluación clínica del estado nutricional
- Sección 1 Caso clínico
- Sección 2 Dieta en las diferentes situaciones de la vida
- Capítulo 10 Dieta durante la infancia y la adolescencia
- Capítulo 11 Dieta durante el embarazo y la lactancia
- Capítulo 12 Dieta en las personas mayores
- Capítulo 13 Alimentación y deporte
- Sección 2 Caso clínico
- Sección 3 Dietas con modificación de la textura y la consistencia. Dietas progresivas
- Capítulo 14 Dietas de texturas líquida, semisólida y de fácil masticación
- Capítulo 15 Dietas progresivas
- Sección 3 Caso clínico
- Sección 4 Dietas controladas en energía
- Capítulo 16 Dietas hipocalóricas
- Capítulo 17 Dieta altamente hipocalórica
- Sección 4 Caso clínico
- Sección 5 Dietas controladas en hidratos de carbono
- Capítulo 18 Dieta en la diabetes
- Capítulo 19 Dieta controlada en lactosa
- Capítulo 20 Dieta controlada en fructosa y sorbitol
- Capítulo 21 Dieta controlada en sacarosa
- Capítulo 22 Dieta restringida en galactosa
- Sección 5 Caso clínico
- Sección 6 Dietas controladas en proteínas y/o aminoácidos
- Capítulo 23 Dieta alta en proteínas y energía
- Capítulo 24 Nutrición y alimentación en la enfermedad renal crónica
- Capítulo 25 Dieta controlada en proteínas en el síndrome nefrótico
- Capítulo 26 Dieta controlada en proteínas en la encefalopatía hepática
- Capítulo 27 Dieta controlada en gluten
- Capítulo 28 Dieta controlada en fenilalanina
- Capítulo 29 Homocistinuria y otros trastornos del metabolismo de la metionina
- Capítulo 30 Dieta en la leucinosis o enfermedad de la orina con olor a jarabe de arce
- Capítulo 31 Dieta en los trastornos del ciclo de la urea
- Sección 6 Caso clínico
- Sección 7 Dietas controladas en fibra
- Capítulo 32 Introducción a las dietas controladas en fibra
- Capítulo 33 Dieta pobre en fibra y dieta pobre en residuo
- Capítulo 34 Dieta rica en fibra
- Sección 7 Caso clínico
- Sección 8 Dietas controladas en grasas
- Capítulo 35 Dieta en las dislipemias
- Capítulo 36 Dieta controlada en triglicéridos de cadena larga y en triglicéridos de cadena media
- Capítulo 37 Dieta controlada en ácidos grasos en la adrenoleucodistrofia
- Sección 8 Caso clínico
- Sección 9 Dietas controladas en minerales
- Capítulo 38 Dieta controlada en sodio
- Capítulo 39 Dieta controlada en potasio
- Capítulo 40 Dietas controladas en calcio y fósforo
- Capítulo 41 Dieta controlada en hierro
- Capítulo 42 Dieta controlada en cobre
- Sección 9 Caso clínico
- Sección 10 Dieta en la alergia e intolerancias alimentarias
- Capítulo 43 Dieta y alergia alimentaria
- Capítulo 44 Dieta baja en histamina
- Capítulo 45 Dieta restrictiva en tiramina
- Capítulo 46 Dieta restrictiva en tartracina
- Capítulo 47 Dieta restrictiva en sulfitos
- Capítulo 48 Dieta restrictiva en glutamato
- Capítulo 49 Dieta restrictiva en benzoatos
- Sección 10 Caso clínico
- Sección 11 Otras dietas
- Capítulo 50 Dieta vegetariana
- Capítulo 51 Dieta de bajo contenido microbiano
- Capítulo 52 Dieta restringida en purinas
- Capítulo 53 Dieta controlada en oxalatos
- Sección 11 Caso clínico
- Sección 12 Recomendaciones en la sintomatología gastrointestinal
- Capítulo 54 Dieta y alteraciones del gusto y la salivación
- Capítulo 55 Mucositis
- Capítulo 56 Disfagia
- Capítulo 57 Modificaciones dietéticas ante la diarrea
- Sección 12 Caso clínico
- Sección 13 Dieta en la cirugía gastrointestinal
- Capítulo 58 Dieta en la resección intestinal
- Capítulo 59 Dieta en la cirugía gástrica y sus complicaciones
- Capítulo 60 Dieta poscirugía bariátrica
- Sección 13 Caso clínico
- Sección 14 Modificaciones dietéticas pretest diagnóstico
- Capítulo 61 Cuantificación de grasas en heces
- Capítulo 62 Dieta y excreción de catecolaminas
- Capítulo 63 Dieta para la prueba del ácido 5-hidroxiindolacético
- Capítulo 64 Dieta de preparación para la prueba de tolerancia oral a la glucosa
- Capítulo 65 Dieta pobre en yodo para el diagnóstico de enfermedades tiroideas
- Sección 14 Caso clínico
- Sección 15 Suplementación e interacción de fármacos-nutrientes
- Capítulo 66 Interacción de fármacos-nutrientes
- Capítulo 67 Principios básicos de la suplementación nutricional
- Sección 15 Caso clínico
- No. of pages:
- © Elsevier Masson 2014
- 23rd July 2014
- Elsevier Masson
- Paperback ISBN:
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Doctor en Medicina y Cirugía; Jefe Clínico, Unidad de Nutrición Humana, Servicio de Medicina Interna, Hospital Universitari Sant Joan de Reus; Profesor Titular de Nutrición y Bromatología, Facultat de Medicina i Ciències de la Salut, Universitat Rovi
Evaluation of the inhibitory effect of various drugs / active ingredients on the activity of human diamine oxidase in vitro
Evaluation of the inhibitory effect of various drugs / active ingredients on the activity of human diamine oxidase in vitro.
In this study the influence of active ingredients of certain drugs on the activity of human diamine oxidase (DAO; EC 126.96.36.199) was quantified. DAO is the main enzyme in catabolism of biogenic amines in the intestine. Ingestion of food containing high amounts of biogenic amines in case of reduced activity of DAO leads to an accumulation of histamine which causes symptoms of histamine intolerance. Many drugs are suspected to inhibit DAO-activity, nevertheless, only few scientific data are available to support this thesis.
Therefore, based on a selection of drugs / active ingredients by literature research, the interaction with purified human diamine oxidase is determined and quantified in vitro with an activity test. Various drugs at pharmacologic concentrations were incubated with human diamine oxidase. Inhibition of diamine oxidase activity was calculated as the percentage of inhibition versus control (no inhibitor). To exclude drug formulation specific influences active ingredients (AI) of drug products (D) in pure form were examined.
Chloroquine and clavulanic acid showed greatest inhibition potential on diamine oxidase (> 90%). Cimetidine and verapamil showed inhibition of about 50%. Moderate influence on DAO was caused by isoniazid and metamizole, acetyl cysteine and amitriptyline (>20%). Diclofenac, metoclopramide, suxamethonium and thiamine have very low inhibition potential (<20%). Interestingly cyclophosphamide and ibuprofen displayed no effect on DAO.
Since even levels of about 30% inhibition may be critical, most of the observed substances, can be designated as DAO inhibitors. Other drug components than active ingredients did not affect DAO activity or its interaction with a specific drug.
Diamine Oxidase Activity As a Serum Biomarker for Intestinal Mucosal Damage, Appearance of Diarrhea and Malnutrition Due to Anticancer Drugs
Diamine Oxidase Activity As a Serum Biomarker for Intestinal Mucosal Damage, Appearance of Diarrhea and Malnutrition Due to Anticancer Drugs.
- Miyoshi, H. Miyamoto, S. Matsumoto, Y. Fujino, K. Tanaka, F. Nakamura, M. Kagawa, T. Goji, S. Kitamura, N. Muguruma, T. Okahisa, T. Takayama.
2014 AGA Institute. Gastroenterology, Oficial Journal of the AGA Institute.321.
May 2014Volume 146, Issue 5, Supplement 1, Pages S-72–S-73
Intestinal mucosal damage due to anticancer drugs which induces QOL impairment and malnutrition is one of major problems for cancer treatment. However, there is no method to evaluate objectively intestinal mucosal damage and malnutrition due to anticancer drugs. Diamine oxidase(DAO) is an enzyme which exists specifically in villi tips of enterocytes of the small intestine. Since DAO activity decreases as intestinal mucosa is damaged, it is expected that DAO activity is a good indicator which reflects sharply damage of small intestinal mucosa. The aim of this study is to investigate whether DAO activity is useful as an indicative marker for intestinal mucosal damage, appearance of diarrhea and malnutrition in patients with chemotherapy. Method:The subjects are 20 patients with unresectable advanced gastric cancer who received docetaxel, CDDP and S-1(DCS) combination chemotherapy (Takayama et al, Br J Cancer, 2008) as a first line chemotherapy.
DCS therapy is a modified regimen of docetaxel, CDDP and 5-FU combination chemotherapy, in which 5-FU was replaced by S-1. DAO activity was measured according to the methods of Takagiet al. (Clin Chim Acta, 1994) before, during and after chemotherapy. Mucosal atrophy is characterized by diminished intestinal function as well as morphological changes including decreased villous height, surface area(Shaw et al, World J Gastroenterol, 2012) and reduction in the number of goblet cells(Chang et al, World J Gastroenterol, 2005). Therefore, damage of small intestinal mucosa was evaluated by villous height, villous surface area and the number of goblet cells by endoscopic duodenum biopsies before and during chemotherapy.
Degree of diarrhea was evaluated by NCI-CTC V4.0. Nutrition was evaluated by serum albumin and serum total protein before, during and after chemotherapy. Results:The mean DAO activities(± SD) in 20 patients were 4.88±2.06U/L before chemotherapy, 2.96±1.62U/ L during chemotherapy(day14) and 3.66±1.27U/L after drug holiday(day21).
The DAO activity decreased significantly during chemotherapy and recovered significantly after drug holiday. Diarrhea(Grade1-3) appeared in 19 patients in the 10 to 18 day after administration of anticancer drugs and followed decrease in DAO activity. Villous height, villous surface area, the number of goblet cells were all significantly reduced by anticancer drugs and followed decrease in DAO activity. Serum albumin and serum total protein were significantly reduced by anticancer drugs and significantly increased after drug holiday. The DAO activity reduction rate between day1 and day14 was significantly correlated with albumin and total protein reduction rate between day1 and day21. Conclusion:Our results suggested that the DAO activity was useful as an indicative marker for intestinal mucosal damage, appearance of diarrhea and malnutrition in patients with chemotherapy.
Chronic rhinitis and its association with headache frequency and disability in persons with migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study
Chronic rhinitis and its association with headache frequency and disability in persons with migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study.
- Department of Internal Medicine, University of Cincinnati, OH, USA.
Rhinitis is a comorbidity of migraine, but its relationship to migraine headache frequency and headache-related disability is unknown.
To determine if rhinitis and its subtypes are associated with an increased frequency and associated disability of migraine.
The AMPP Study is a longitudinal study of individuals with “severe” headache from the US population. Respondents meeting ICHD-2 criteria for migraine in 2008 were identified and the presence of rhinitis was determined using the European Community Respiratory Health Survey (ECRHS). Those with rhinitis were subtyped as allergic, non-allergic, mixed and unclassified based on a rhinitis questionnaire. The primary outcome measures were categories of headache-day frequency and headache-related disability as measured by the Migraine Disability Assessment Scale (MIDAS). Logistic regression for ordered categories was used for modeling each outcome separately, adjusted for sociodemographics profile, headache features, headache treatments and comorbidities.
The AMPP Study questionnaire was mailed to 17,892 persons and returned by 60.1% of respondents. Among the migraine sample ( N = 5849), 66.8% had rhinitis with mixed rhinitis as the most common form. The presence of rhinitis of any type was associated with headache frequency after adjusting for sociodemographic variables only (OR 1.33; 95% CI 1.16, 1.53) and in the fully adjusted model (OR 1.25; 95% CI 1.05-1.49). Headache-related disability (MIDAS category) was associated with rhinitis after adjusting for sociodemographic features (OR 1.30; 95% CI 1.17-1.46), but lost significance in the fully adjusted model (OR 1.10; 95% CI 0.96-1.26). Mixed rhinitis was associated with an increased headache frequency category in the model adjusted for sociodemographics (OR 1.45; 95% CI 1.24-1.70) and in that adjusted for all covariates (OR 1.28; 95% CI 1.05-1.57). The odds ratio for MIDAS categories were similarly increased in both models for the mixed rhinitis group.
The frequency and disability of migraine are higher in persons with rhinitis, particularly those with mixed rhinitis. These results, however, should be considered preliminary until confirmed in future studies because of the modest questionnaire response rate in this study.
Rhinitis; allodynia; comorbidities; depression; headache frequency; headache-related disability; migraine
Diamine oxidase activity levels in anorexia nervosa.
Int J Eat Disord. 2014 Mar;47(2):203-5. doi: 10.1002/eat.22202. Epub 2013 Oct 30.
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Anorexia nervosa (AN) patients often experience gastrointestinal complications caused by their malnutrition. We hypothesized that intestinal integrity is disturbed in AN. Therefore, the objective of the present study was to investigate serum diamine oxidase (DAO) activity, which is considered to be a clinical indicator of the integrity of the intestinal mucosa, in AN patients.
Thirty-six AN female patients including 21 AN restricting type (AN-R) and 15 AN binge-eating/purging type (AN-BP) were compared with twenty healthy women on serum DAO activity using immunoassay.
DAO levels in AN-R patients were significantly lower than in AN-BP patients and healthy controls.
DAO levels were decreased in AN-R patients. This finding suggests the presence of intestinal structural disturbance as one of the physical complications of malnutrition in AN-R patients.
Copyright © 2013 Wiley Periodicals, Inc.
PMID: 24488839 DOI: 10.1002/eat.22202
Histamine in migraine and brain.
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
Histamine has been studied in both health and disease since the initial description a century ago. With its vasodilative effect, it was suggested early on to be involved in the pathophysiology of migraine. Over the past 25 years, much has been learned about histamine as a neurotransmitter in the central nervous system. The role of this neurotransmitter system in migraine has not been previously reviewed.
Discuss a potential role of the brain histaminergic system in migraine.
Unstructured literature search with a no specific hypothesis-driven approach.
There is substantial evidence that systemically given histamine may elicit, maintain, and aggravate headache. The mechanisms for this are not known, and histamines do not penetrate the blood-brain barrier (BBB). However, circulating histamine may influence hypothalamic activity via the circumventricular organs that lack BBB. In the rat, prolonged activation of meningeal nociceptors induced by dural mast cell degranulation has been observed. Subcutaneous injections of N-alpha-methyl histamine, a catabolite of histamine with high affinity to the histamine H3 receptor, probably have some migraine preventive effect. A negative feedback on histamine release from mast cells in proximity to C-fiber endings has been a postulated mechanism. Most antihistamines have shown to be ineffective as acute medication for migraine. Two centrally acting potent H1 receptor antagonists (cinnarizine and cyproheptadine) have been reported to be efficacious in preventing migraine. However, the proof for this is limited, and their efficacy has been ascribed other actions than the antihistaminergic. In general, lack of specificity and side effects limit the potential use of centrally acting H1 and H2 antagonists. Brain histamine is synthesized by neurons that are restricted to the posterior basal hypothalamus, more specific to the tuberomamillary nucleus (TMN), and that project practically to the whole central nervous system. The posterior hypothalamus is a suspected locus in quo in several primary headaches. Recently, a positron emission tomography study performed in the prodromal phase of migraine attacks supported the idea of initial involvement of this area. In another recent study, the thalamic nuclei receiving trigeminal output was also shown to have direct connections with the ventral TMN. The central histaminergic system plays an important role in the complex sleep-wake cycle, promoting cortical excitability during wakening and attention, and it consolidates the wake state. The period of the day, in the evenings and during the night, when there is reduced susceptibility for migraine attacks corresponds with less central histaminergic firing. Activation of both the H3 and the H4 receptor promotes inhibitory actions on neurons. The H3 receptor causes autoinhibition of the histaminergic neurons themselves, and centrally acting H3 receptor agonist prodrugs have shown to both inhibit neurogenic inflammation in dura, to induce sleep, and to produce antinociception. There are no registered ongoing studies on H3 and H4 receptor ligands in migraine.
The role of the central histaminergic system in migraine is largely unexplored, but findings from preclinical research may be linked to several aspects of the disorder. The histaminergic system of the brain may play an important role, especially in the initial phase of an attack, and histamine H3 and H4 receptor ligands may potentially have migraine prophylactic properties. However, the basis for this is still circumstantial, and the evidence is lacking.
© 2014 American Headache Society.
antihistamine; chronobiology; histamine; hypothalamus; migraine; pathophysiology
A focus on mast cells and pain.
J Neuroimmunol. 2013 Nov 15;264(1-2):1-7. doi: 10.1016/j.jneuroim.2013.09.018. Epub 2013 Sep 27.
- Physiology Department, Faculty of Pharmaceutical and Biological Sciences, Paris Descartes University, 4 avenue de l’Observatoire, F-75270 Paris Cedex 06, France. Electronic address: email@example.com.
Mast cells (MCs) are immunocytes with secretory functions that act locally in peripheral tissues to modulate local hemodynamics, nociceptor activation and pain. They are also able to infiltrate the central nervous system (CNS), especially the spinal cord and the thalamus, but their cerebral function remains an enigma. A role in regulating the opening of the blood-brain barrier has been proposed. Paracrine-like action of MCs on synaptic transmission might also signal a modulation of the nervous system by the immune system. In this review, we examine the link between MCs and nociceptive process, at the periphery as well as in the CNS.
Brain; Immuno-neuromodulation; Mast cells; Nociception
A randomized doubled blinded trial of treatment with diamino-oxidase (DAO) in patients with migraine and deficit of enzyme’s activity
A randomized doubled blinded trial of treatment with diamino-oxidase (DAO) in patients with migraine and deficit of enzyme’s activity
J. Izquierdoa, D. Mona, M. Lorenteb, L. Soler Singlaa.
a Hospital General de Catalunya, Sant Cugat del Vallès, Spain;b Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
Abstract — WCN 2013
Topic: 8 — Headache
October 15, 2013Volume 333, Supplement 1, Pages e505–e506
Histamine has been considerate as a chemical mediator of migraine. The degradation is done in two different pathways. One
of the enzymes that allow this process is the diamino-oxidase (DAO).
The aim of this study is to identify the prevalence of the deficit in the activity of DAO in patients with migraine, and test the supplementation of this enzyme in a randomized controlled doubleblind trial.
Material and methods:
This was a randomized parallel-group controlled study. After a 1-month run-in, patients with migraine attacks/month between 4 and 14 were randomized 1:1 to placebo or DAO three times at day during one month. Primary outcome measures were diminution of hours of pain, and the use of antimigraine drugs.
We studied 137 patients with migraine, and find the deficit of DAO activity (b80 HDU/ml) in 119 (87%).One hundred patients were randomized and included in the intentionto-treat analysis. Between run-in and first month of treatment, the mean number of hours of pain decreases in both groups but with significant difference in the final control in the group treated with DAO compared with placebo (6,3 vs 5,1: p b 0.03). The use of the acute antimigraine drug was significantly reduced in the DAO but not in placebo group (p N 0.022). There were no adverse events in either group.
Deficit in the activity of DAO is very prevalent in population with migraine. The supplementation with the enzyme is effective and safe as a preventive therapy for migraine.
Histamine intolerance as a cause of chronic digestive complaints in pediatric patients.
Rev Esp Enferm Dig. 2013 Apr;105(4):201-6.
histamine intolerance (HI) is a poorly described disease in gastroenterology that may present with predominant digestive complaints. The goals of this study include a report of two cases diagnosed in a pediatric gastroenterology clinic.
MATERIAL AND METHODS:
observational, retrospective study of patients diagnosed with HI from September 2010 to December 2011 at the pediatric gastroenterology clinic of a tertiary hospital.They were deemed to have a diagnosis of HI in the presence of 2 or more characteristic digestive complaints, decreased diamino oxidase (DAO) levels and/or response to a low histamine diet with negative IgE-mediated food allergy tests.
sixteen patients were diagnosed. Males predominated versus females (11/5). Mean age at symptom onset was 4 years (6 months vs. 13 years and 6 months) and mean age at diagnosis was 6 years and 6 months (17 months vs. 13 years and 11 months), with an interval of 2 years and 1 month between symptom onset and diagnosis (5 months vs. 4 years). Predominant symptoms included diffuse abdominal pain (16/16), intermittent diarrhea (10/16), headache (5/16), intermittent vomiting (4/16), and skin rash (2/16). The diagnosis was established by measuring plasma diamino oxidase levels, which were below 10 kU/L (normal > 10 kU/L) in 14 cases, and symptom clearance on initiating a low histamine diet. In two patients DAO levels were above 10 kU/L but responded to diet. Treatment was based on a diet low in histamine-contaning food, and antihistamines H1 y H2 had to be added for two cases.
histamine intolerance is a little known disease with a potentially relevant incidence. Predominant complaints include diffuse abdominal pain, diarrhea, headache, and chronic intermittent vomiting. Its diagnosis is based on clinical suspicion, plasma DAO measurement, and response to a low histamine diet. Management with the latter provides immediate improvement.
DIETARY TREATMENT AND BLOOD DIAMINOOXIDASE (DAO) VALUES IN CYCLIC VOMITING SYNDROME (CVS) INTRODUCTION.
Tormo Carnicé R, Cárdenas Lagranja G, Segurola Gurrutxaga H.
Gastroenterology and Nutrition Unit Via Augusta. Barcelona. Spain.
ESPEN Congress on Clinical Nutrition & Metabolism, Leipzig (Germany), 31 August – 3 September 2013.
Certain authors consider CVS as a variant of the headache/migraine, due to a disorder of the brain gut axis. In DAO enzyme deficiency, histamine is not removed and accumulates, causing various disorders, being the most common and disabling migraine headaches. The consumption of certain histamine rich foods (proteins and fats) may be associated with these symptoms.
Determine values in blood of the DAO enzyme in
CVS patients. Assess its evolution after prescription
of a low fat and protein diet.
MATERIAL AND METHODS
Interventional prospective descriptive study in CVS patients. We determined the DAO value and dietary interview was realyzed. All of them recieved fractional and low fat and protein diet ( fat <30% TC and protein <12%TC) and dietary counseiling, as well as specific pharmacological treatment where necessary. Patients with low and intermediate DAO values, were supplemented with (DAOSIN®/MIGRASIN®: 1-3 capsules/day). Low DAO values<40 HDU/ml; Intermediate DAO values 40-80 HDU/ml; normal DAO values >80 HDU/ml.
- 11 patients presented vomiting and migraines .
- 8 of them, were diagnosed CVS.
- Mean of age: 28,3±6; 6 women.
- DAO values:
- we found intermediate/low activity in 100% of vomiting and migranies patients.
- In 3 patients not diagnosed of CVS presented intermediate activity values.
- After the nutritional support with low fat, a fractional diet and DAO supplementation, we found a drastic reduction of the crisis: reduction of 100% in patients with vomiting and migraines, and crisis reduction of 70% CVS patients. We observed correct adherence to dietary advice provided in all patients.
In CVS patients low fat and protein diet must be recommended. DAO supplementation may improve their