Diet in UTI

Dietary factors protecting women from urinary tract infection
Am J Clin Nutr 2003;77:600–4. Printed in USA. 2003 American Society for Clinical Nutrition

More than half of all women experience at least one urinary tract infection (UTI) during their lifetime. urinary tract infections (UTIs) are caused by bacteria in the stool, dietary factors may affect the risk of contracting a UTI by altering the properties of the fecal bacterial flora..
We studied dietary factors for UTI in fertile women in a case-control setting.
Design: One hundred thirty-nine women from a health center for university students or from the staff of a university hospital (mean age: 30.5 y) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the past 5 y. Data on the women’s dietary and other lifestyle habits were collected by questionnaire. A risk profile for UTI expressed in the form of adjusted odds ratios (ORs) with 95% CIs was modeled in logistic regression analysis for 107 case-control pairs with all relevant information.
Results: Frequent consumption of fresh juices, especially berry juices, and fermented milk products containing probiotic bacteria was associated with a decreased risk of recurrence of UTI: the OR for UTI was 0.66 (95% CI: 0.48, 0.92) per 2 dL juice. A preference for berry juice over other juices gave an OR of 0.28 (95% CI: 0.14, 0.56). Consumption of fermented milk products ≥3 times/wk gave an OR of 0.21 (95% CI: 0.06, 0.66) relative to consumption < 1 time/wk. Intercourse frequency was associated with an increased risk of UTI (OR for ≥3 times/wk compared with < 1 time/wk: 2.7; 95% CI: 1.16, 6.2).
Conclusion: Dietary habits seem to be an important risk factor for UTI recurrence in fertile women, and dietary guidance could be a first step toward prevention.

REFERENCES
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000;10:509–15.
2. Raz R, Gennesin Y, Wasser J, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis 2000;30:152–6.
3. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000;182:1177–82.
4. Pascual-Teresa S, Santos-Buelga C, Rivas-Gonzalo JC. Quantitative analysis of flavan-3-ols in Spanish foodstuffs and beverages. J Agric Food Chem 2000;48:5331–7.
5. Foxman B, Somsel P, Tallman P, et al. Urinary tract infection among. women aged 40 to 65: behavioural and sexual risk factors. J Clin Epidemiol 2001;54:710–8.

Dyad 6 guomanman and chenya

There are a variety of natural remedies that can alleviate urinary tract disorders without the risk of harmful side effects. To begin with, the consumption of one 8-ounce glass of water per hour can aid in the treatment of an infection by diluting the bacteria in the urine, and is especially helpful in ameliorating severe pain.

Unsweetened cranberry juice or cranberry capsules contain natural antibacterial agents and increase the acidity or urine, creating an unpleasant environment for bacterial communities to develop.

Recent studies have demonstrated that 15 ounces of cranberry juice can hamper bacterial growth by up to 80% because the bacteria are no longer able to adhere to the urethal wall and, consequently, are excreted during urination. According to one study reported in Journal of the America Medical Association, within 2 hour of drinking cranberry juice, the bacteria-fighting ability was present in the urine and lasted for up to 10 hours. Other research has demonstrated that the consumption of vitamin C along with the cranberries can further heighten the acidity of urine. Some other beneficial drinks that tend to alter the pH level of urine are lemon juice mixed with water, buttermilk and a mixture of 2 teaspoons of apple cider vinegar and water. These concoctions should be consumed 3 to 4 times a day.

Severe UTI symptoms can also be alleviated by temporary changes in diet. Increased intake of acidic foods, such as certain grains, seeds, nuts, fish, dairy products and bread, and reduced consumption of fruits and vegetables is recommended during acute attacks, but it is important to remember that this dietary modification should be short-term only. Usually, foods that are low in acidity, such as whole grains, vegetables, flax oil, fish oils and beans, are recommended to prevent irritation.

After taking antibiotics for a UTI, plain yogurt should be consumed to help control the development of a yeast infection. In addition, the regular use of a probiotic supports good and healthy intestinal bacterial flora. Probiotics are good bacteria that naturally colonize in the colon and vagina. Probiotics allow you to maintain balanced bacterial flora in the intestine. Studies show that the presence of probiotics in the gut and vagina are connected with a reduced risk of UTIs. Seemingly, the presence of probiotics hinders the formation of the pathogenic bacteria.

Dyad 6 guomanman and chenya

Factors associated with variability in outcomes for children hospitalized with urinary tract infection.

Conway PH, Keren R

The purpose of this study is to describe the variability in outcomes and care processes for children hospitalized for urinary tract infection (UTI), and to identify patient and hospital factors that may account for variability.

STUDY DESIGN: Retrospective cohort of children 1 month to 12 years of age hospitalized for UTI at 25 children's hospitals from 1999 to 2004. We measured variability in length-of-stay (LOS), cost, readmission rate, intensive care unit admission, and performance of renal ultrasound and voiding cystourethrogram and identified patient and hospital factors associated with these outcomes.

RESULTS: The cohort included 20,892 children. There was significant variation in outcomes and processes of care across hospitals (eg, mean LOS, 2.1-5.0 days; patients with both imaging tests performed, 0.3%-72.9%). Older children had shorter LOS and were less likely to undergo imaging. Patients hospitalized at high volume hospitals were more likely to undergo imaging. Hospitals with high percentage of Medicaid patients had longer LOS and were less likely to perform imaging tests. Hospitals with a clinical practice guideline for UTI had shorter LOS and decreased costs per admission.

CONCLUSIONS: The variability across hospitals may represent opportunities for benchmarking, standardization, and quality improvement. Decreased LOS and costs associated with clinical practice guidelines support their implementation.

Published 18 May 2009 in J Pediatr, 154(6): 789-96.

RESPONSE: Diet- Urinary Tract Infection
By: D2- Gil Legarda and Joanalyn Balino


Title: Cranberry Juice and Urinary Tract Infection
R. Raz, B. Chazan, and M. Dan

This study made by Raz et al. was a quasi-experimental this study was to assess the effectiveness of cranberry juice and other cranberry products for preventing Urinary tract infections in susceptible populations. The number of participants of this study was 604 randomised in a control or treatment group. The researchers used a randomized control trial differentiating all the effectiveness of different forms of cranberry in preventing Urinary tract infection. The inclusion criteria of this research were participants with history of lower UTI with more than 2 episodes the previous 12 months, elderly men and women, those needed intermittent catheterisation, pregnant women, those with indwelling catheter, with abnormality of urinary tract. Exlcusion criteria were trials of treatment of asymptomatic or symptomatic UTI, trials of any UT condition not caused by bacterial infection. Internet and electronic data base were used to search using English and non English language terms, the companies involved in manufacturing any kind of cranberry for prevention of UTI. All the eligible studies were assessed independently by RJ and LM while JC with the studies with discrepancies. They allocated their studies by grading it as adequate, unclear and inadequate. Heterogeneity and sensitivity analysis were used to in grading investigation.

There were 7 trials met the inclusion criteria and all of the research studies showed that cranberry in any forms whether juice or tablet or capsule can cure urinary tract infection. There were 5 trials not included in the meta analysis because of methodological flaws but there was a report in the significant result for the outcome of symptomatic urinary tract infections.

Based on the result of two well conducted randomized controlled trials there is an evidence to recommend cranberry juice to prevent UTI. The big number of withdrawal from some of the trials however indicates that cranberry juice may be not acceptable in a long periods of time. Also there are no evidence concerning the dosage and span of use as a factor for efficacy of cranberry. Those other group trials should determine the effectiveness of the cranberries for the prevention of UTI. Also the study periods should be more than 6 months to take into account the natural course of the illness

Reference
Ras R. et al. (2004).Cranberry Juice and Urinary Tract Infection. The Cochrane Library, issue 1. Retrieved June 29, 2009 from http://www.juxx.com.br/prof_data/materias/2004%20Cranberries%20.pdf.

Interaction Between Warfarin and Cranberry Juice
Jonathan L. Aston, BS; Amy E. Lodolce, PharmD; and Nancy L. Shapiro, PharmD
Published: 11/06/2006

The use of warfarin as an anticoagulant is extensively used for clients who are at high risk of developing idiopathic cloth formations. If the blood levels of warfarin fluctuate, this may lead to failure in therapy or bleeding complications. On the other hand, the use of cranberry juice may aid clients in the prevention and management of UTI. One study conducted by the UK committee on safety of medicines caution the clinicians that there is a potential interaction between the uses of warfarin together with cranberry juice. The goal of this research study is to conduct follow-up studies regarding the effects of combined warfarin and cranberry juice intake.

According to some literatures conducted by Grant P. (2004) and Rindone JP (2006), some of the effects of combined warfarin and cranberry juice includes: lethal gastrointestinal and pericardial hemorrhage after 6 months of therapy. Long term intake of large volume of cranberry juice can disturb the chemical stability of warfarin. One author of a literature states that the amount of cranberry juice can be considered safe. Second author commented that the client’s dietary intake may affect the client’s outcome on the treatment. The third author agreed on that the client’s diet may affect the outcome and advised the client to avoid cranberry juice during warfarin therapy

Nurses should advice clients who are receiving anticoagulant therapy to reduce or eliminate the ingestion of cranberry juice until further research data is obtained. If the client is prone to develop UTI and the concomitant intake of cranberry juice cannot be prevented, they should be warned of the impending dangers of the interactions. Nurses should be aware of the signs and symptoms of bleeding through frequent and careful monitoring.

References:
Grant P. Warfarin and cranberry juice: an interaction? J Heart Valve Dis 2004;13:25-6.

Rindone JP, Murphy TW. Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding. Am J Ther 2006;13(3):283-4.

Authors and Disclosures
From the Department of Pharmacy Practice, College of Pharmacy (Drs. Aston and Lodolce); and the Antithrombosis Center (Dr. Shapiro), University of Illinois at Chicago, Chicago, Illinois.

DYAD THREE (3)
Byron Webb A. Romero
Von Deneb H. Vitto
Raymond C. Ursal

RESPONSE TO: DIET FOR URINARY TRACT INFECTION

Cranberry juice has long been used to prevent and treat uncomplicated UTIs. Although cranberry juice is not bacteriostatic nor does it acidify the urine, it does inhibit bacterial adhesion to uroepithelial cells by the action of epicatechin, a proanthocyanidin. The most recent randomized trial of ingesting 50 mL of cranberry juice concentrate daily for 6 months in a population of women with at least on previous UTI for prevention of recurrent UTI showed significant effect preventing UTI (Jepson, Mihaljevic, & Craig, 2003).

In an evidence-based research by Kiel and Nashelsky (2003), it revealed that an intake of 200mL to 250mL, three times a day of cranberry juice or at least 1:30 parts concentrated juice twice daily or cranberry tablets may reduce recurrent, symptomatic UTI in women by 12% to 20% or absolute risk reduction compared with placebo. However, there is no conclusive evidence that cranberry juice effectively treats urinary tract infection.

The result of study therefore would suggest cranberry as preventing UTI and its recurrence. It would also imply that further researches are needed to arrive at a conclusion that cranberry can cure UTIs as string evidences only pertain to the prevention or UTI and its recurrence but unclear on how cranberry cures or treats UTIs. We must therefore counsel or advice our patients to continually seek health care and avoid self-medication as UTI has high recurrence rates.

References:

Kiel, R.J. & Nashelsky, J. (2003). Does cranberry juice prevent or treat urinary tract infection?. Journal of Family Practice. FindArticles.com. Retrieved July 6, 2009, from http://findarticles.com/p/articles/mi_m0689/is_2_52/ai_97724151/

Jepson, R.G., Mihaljevich, L. & Craig, J. (2003). Cranberries for preventing urinary tract infections 9cochrane Review). In: The Cochrane Library. Issue 2. Oxford Update Software.

DYAD 4
BALAJADIA, BOND
ZANO, ALEXIS

D4 RESPONSE TO DIET OF UTI PATIENTS

Cranberry Juice
Cranberry juice can be an effective deterrent to the recurrence of simple UTIs (Schmidt et al. 1988). Cranberry juice has developed into a popular nondrug means to reduce or treat UTIs. Studies document that drinking eight 8-ounce glasses of cranberry juice twice a day (or a total of 16 glasses daily), may eradicate most simple UTIs. As long as cranberry juice consumption is continued the infections are not likely to return. One way that cranberry juice works is to prevent bacteria from adhering to the linings of the urinary tract. Studies suggest that bacterial infections (bacteriuria) and the associated influx of white blood cells into the urine (pyuria) can be reduced by nearly 50% in elderly women who drink 300 mL of cranberry juice cocktail each day (Fleet 1994).

In a study in JAMA, researchers at Rutgers University and the University of Michigan assessed whether the consumption of cranberry juice cocktail prevented adhesion of antibiotic-resistant pathogenic E. coli to the uroepithelium in 39 women aged 18-39 years with confirmed UTIs (Howell et al. 2002). According to the researchers, after cranberry juice cocktail consumption, the urine prevented adhesion of 31 (80%) of the 39 isolates and 19 (79%) of the 24 antibiotic-resistant isolates in all bioassays, while preconsumption urine failed to prevent adhesion in any of the samples.

According to the study, the anti-adhesion activity was evident in the urine within 2 hours and persisted for up to 10 hours following ingestion of cranberry juice cocktail. In addition, the extracted cranberry juice pro-anthocyanidins inhibited adhesion of all isolates at concentrations ranging from 6-375 mcg/mL, demonstrating potent in vitro anti-adhesion activity against antibiotic-resistant strains. According to the researchers, these data suggest that consumption of cranberry juice cocktail may offer protection against both sensitive and resistant strains of P-fimbriated E. coli (the initial step in development of UTIs) and support previous findings which have found cranberry juice to be an effective alternative option in the treatment of UTIs (Howell et al. 2002).

In urostomy patients (surgical diversion of urine away from a diseased or defective bladder and through the skin to the outside of the body), problem urinary wall skin conditions are common and may stem from alkaline urine. Cranberry juice appears to acidify urine and have bacteriostatic properties. Thus, cranberry juice is widely recommended for the reduction of UTIs. A study showed that drinking cranberry juice could help to prevent and improve skin complications for urostomy patients. The study also showed that in patients with severe urinary wall disease, cranberry juice resulted in improvements of skin conditions and a reduction in skin complications (Tsukada et al. 1994).

Most people will find it difficult to drink sixteen 8-ounce glasses of cranberry juice a day. Fortunately, there are dietary supplements that will provide the equivalent of eight to sixteen 8-ounce glasses of cranberry juice in just one capsule. A major advantage of using cranberry juice concentrate supplements is that cranberry juice is high in sugar. If a person were to consume 8-16 glasses of cranberry juice each day, the high fructose intake would induce weight gain and possibly create other serious health problems.

Reference: Bladder Health Council, 300 West Pratt Street, Suite 401, Baltimore, MD 21201
http://www.lef.org/protocols/prtcl-107.shtml#juice