Correction Of Nutritional Deficiencies Research Articles

Osteoporotic Vertebral Compression Fractures: Medical, Social Aspects, Clinical Picture, Treatment and Medical Rehabilitation. A Review

INTRODUCTION. Osteoporosis is one of the most common metabolic skeletal diseases in the world, which is characterized by a decrease in bone tissue strength and an increased risk of fractures with minimal trauma, including pathological vertebral compression fractures (VCFs). VCFs are accompanied by a decrease in the quality of life of patients with osteoporosis due to a pronounced pain syndrome, sleep problems, decreased motor and social activity, a high risk of falls and fractures, the development of pathological spinal deformities, decreased lung capacity and increased number of comorbid diseases. In this regard, timely treatment and medical rehabilitation in patients with osteoporosis and VCFs are of particular importance to restore functionality, reduce the risk of developing new fractures, disability and death.
 MAIN CONTENT OF THE REVIEW. The literature review is the analysis of 7 domestic and 49 foreign literary sources, which was used to describe the prevalence, medical and social significance and clinical picture of osteoporotic VCFs. It provides data on modern methods of drug and non-drug treatment of patients with VCFs. The effectiveness and limitations of the use of physical therapy methods in the rehabilitation of patients with pathological spinal fractures are described in detail.
 CONCLUSION. It is concluded that VCFs pose a significant healthcare burden due to their high prevalence and negative impact on the quality of life of older patients with osteoporosis. Osteoporotic VCFs lead to the development of severe back pain, limited mobility, spinal deformities, loss of height and permanent disability. An effective strategy for the treatment and rehabilitation of patients with osteoporotic VCFs should include the use analgesics, orthotics, correction of nutritional deficiency, elimination of vitamin D and calcium deficiency, modern methods of physical therapy, fall prevention and timely prescription of effective drugs for pathogenetic therapy of osteoporosis to reduce the risk of pathological fractures in the future and ensure a high level of functioning and of the quality of life.

Bone health in children undergoing solid organ transplantation.

Pediatric solid organ transplant recipients are a unique and growing patient population who are at risk for metabolic bone disease both before and after transplantation. The odds of sustaining a fracture in adulthood are significantly higher if an individual has sustained at least one childhood fracture, therefore, close monitoring before and after transplant is essential. Emerging data in patients with chronic kidney disease mineral and bone disorder (CKD-MBD) and hepatic osteodystrophy highlights the role of fibroblast growth factor 23 in the pathogenesis of metabolic bone disease in these conditions. While dual X-ray absorptiometry (DXA) is the most widely used imaging modality for assessment of bone mass in children, quantitative computer tomography (QCT) is an emerging modality, especially for patients with glucocorticoid-induced osteoporosis. Solid organ transplantation improves organ function and quality of life; however, bone mineral density can decline following transplantation, particularly during the first three to six months. Immunosuppressive medications, including glucocorticoids, are a major contributing factor. Following transplant, treatment should be tailored to achieve mineral homeostasis, correct nutritional deficiencies, and improve physical conditioning. In summary, early identification and treatment of metabolic bone disease can improve the bone health status of pediatric transplant recipients as they enter adulthood. http://links.lww.com/MOP/A71.

Nutritional status in perianal Crohn's disease: are we underestimating the impact?

Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of involvement is associated with a poor prognosis and a disabling course. The treatment is challenging and involves both surgical and medical approaches. Despite combined therapy, a significant portion of patients may still require proctectomy to control the symptoms. Consequently, investigating factors that may influence the outcome of perianal disease remains a priority area of research in CD. Nutritional deficiencies are well documented among CD patients with luminal forms of involvement and are closely related to poor clinical outcomes, therapy response, and postoperative complications. As a result, leading guidelines recommend regular nutritional assessment and correction of nutritional deficiencies in patients requiring a surgical approach. Despite these recommendations and the high rate of surgeries among CD patients with perianal disease, there is a shortage of studies addressing the real impact of nutritional status on the course and outcomes of perianal disease. This knowledge gap underscores the importance of further research to understand better and improve the management of perianal CD. This narrative review aims to provide an overview of nutritional status assessment and the influence of nutritional status on the outcomes of patients with perianal CD.

The effect of nutritional insufficiency on clinical outcomes of patients with acute ischemic stroke

Acute cerebrovascular accident is one of the main causes of disability in patients and has a significant impact on the functions of daily activity and the ability to self-care. With the improvement of methods of medical care and the increase in patient survival, active rehabilitation of patients is becoming increasingly important. Malnutrition and loss of muscle mass are among the most frequent complications associated with a decrease in rehabilitation potential and an increased risk of adverse outcomes, and therefore the issues of timely assessment and correction of nutritional deficiency are relevant for all specialists of the interdisciplinary team that takes part in the rehabilitation treatment at all stages of rehabilitation

Transition of Care in Celiac Disease.

Celiac disease (CD) is a gluten related disorder which affects all age-groups and occurs in genetically susceptible population after introduction of gluten in diet. The worldwide prevalence of CD is ~1% and it is higher in certain "at-risk groups". The clinical features are variable, ranging from classical diarrhea to an asymptomatic state. Diagnosis requires serology and duodenal histology although a non-biopsy diagnosis is recommended by European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) for a select group of children. Treatment of CD is with a life-long strict gluten free diet (GFD) along with correction of nutritional deficiencies. Regular follow-up to assess compliance and efficacy of GFD is mandatory. Non-responsive CD needs evaluation by a specialist as it can be due to incorrect diagnosis, poor dietary compliance, coexisting conditions like small bowel bacterial overgrowth, pancreatic insufficiency etc. and lastly, refractory CD. Most patients diagnosed as CD in childhood receive no medical or dietary supervision after transition to adulthood and nearly a third are non-compliant to GFD. No requirement of medications, patient's perception of understanding GFD and absence of symptoms with intermittent non-compliance leads to neglect of care after transition. Poor dietary adherence leads to nutritional deficiencies, osteoporosis, fertility issues and risk of malignancy. It is mandatory that the patients know about CD, need of strict GFD, regular follow-up, disease complications, and are capable of communicating with the health-care personnel before transition. Formulating a phased transition care program with joint pediatric and adult clinics is required for a successful transition and improving the long-term outcome.

Assessing the frequency of anemia evaluations in patients who are transfusion-dependent in an academic hematology and oncology practice.

e24104 Background: There is a high rate of anemia present in cancer patients and anemia is also a common referral to a hematologist. Symptomatic anemia can significantly impair an individual’s functional status so identifying its cause is essential for improving quality of life. Correction of nutritional deficiencies, like iron, B12, and folate deficiency can improve hemoglobin counts, prevent recurrent PRBC transfusions, and can often resolve the anemia. In a busy academic hematology oncology practice, we hypothesize that it is easy to overlook performing a basic nutritional evaluation especially in the setting of other causes for anemia such as chemotherapy, hemolysis, blood loss, chronic kidney disease, and other disorders. We aim to evaluate the frequency of anemia workup in the hematology and oncology division at our academic institution. Methods: We conducted a retrospective study of all hematology oncology patients seen in our clinic who received a blood transfusion in 2021. All patients were 18 years old or order and received at least one-unit PRBC transfusion as an outpatient. One “transfusion event” was defined as any number of PRBC transfusions on a single day and any subsequent transfusions within a 90-day periods. A single patient, therefore, can have multiple distinct transfusion events. We analyzed whether patients received a “basic” anemia evaluation, defined as checking ferritin, iron saturation, B12, and folate levels within 3 months before or after the first transfusion, and whether a discrepancy in practice patterns exists between different hematology oncology subspecialties. Results: At the interim analysis, we identified 368 transfusion events for 275 patients. Those events were ordered by providers (physician, nurse practitioner, or physician assistant) in the following subspecialties: oncology (n = 20), malignant hematology (n = 18), classical hematology (n = 3), and fellow-in-training (n = 5). A basic anemia workup was missing in 58% (84 of 146), 27% (49 of 183), 23% (8 of 35), 40% (2 of 5) in the above groups respectively. For patients with macrocytic anemia defined as mean corpuscular volume (MCV) > 100 fL, 48% (38 of 79) did not have B12 or folate levels checked within 3 months before or after a transfusion event. For patients with MCV < 80 fL, 47% (14 of 30) did not have ferritin or iron saturation checked within 3 months before or after a transfusion event. Conclusions: We observed a high percentage of cancer and non-malignant hematology patients who did not receive a basic anemia evaluation within three months before or three months after a blood transfusion. A higher percentage of patients with solid tumors patients who required PRBC transfusions did not receive a basic anemia evaluation in a timely manner. Our study identified an area of quality improvement and need for intervention that can easily be overlooked in a busy academic hematology oncology practice.

A short update on new approaches to celiac disease.

Celiac disease is an autoimmune enteropathy of the small intestine, related to gluten intolerance occurring in genetically predisposed patients. Currently, the only available treatment is a lifelong gluten-free diet. However, the total avoidance of gluten is difficult and poses a challenge to patients, nutritionists and treating physicians. For this reason, scientists have developed in recent years new therapeutic approaches complementary to dietary treatment, such as modification of gluten to make gliadin non-toxic, reduction of the inflammatory response with elafin and Lactococcus Lactis, degradation of gluten by endoproteolytic enzymes, and correction of nutritional deficiencies by adding pseudo-cereals to the diet of celiac patients. This literature review focuses on the different treatment strategies for celiac disease previously studied and summarizes the latest advances in this field.

A precision-designed gastrostomy button securement device

BackgroundGastrostomy buttons (g-buttons) are commonly placed in children to facilitate weight gain, correct nutritional deficiencies, and provide hydration and/or medication delivery. At our institution, parents are taught to place a gauze sponge under their child's g-button and secure it with strips of tape; however, the g-button still moves in the tract, which delays wound healing and leads to a variety of tract-related complications. We viewed this universal problem as a challenge and a prime opportunity for innovation. MethodsIn 2016, a pediatric surgeon and a team of graduate engineering students outlined the problem, created a list of design requirements, and began to iterate on a variety of device designs. ResultsOver 400 design ideas were iterated upon to various degrees. The first prototype was studied in a small clinical trial, in which 80% of caregivers reported satisfaction with the design, but 90% noted difficulty connecting the extension feeding tube. A second-generation prototype was developed, which included a reusable lid and disposable base layer. Third- generation prototypes added “edge-grippers” to facilitate attaching the extension tubing, plus pre-cut absorbent, sterile gauze pads to fit around the stem of the g-button. Finally, in 2020, the design was finalized with the addition of a childproof hinge between the lid and base layer. ConclusionsAn intuitive g-button securement device was created to simplify daily gauze replacement, reduce tract-related complications, and lower the cost of care. A randomized controlled trial comparing the securement device to the “tic-tac-toe” dressing will begin in early 2022 with results available later this year.

Algorithm for the development of enriched bakery products using food additives

The problem of health saving of the Russian population is one of the key problems that cannot be solved without the development of functional foods, which include fortified foods, and their systematic use as part of diets of different age groups of the population. The development of fortified food products, and, above all, bakery products with food additives is the most promising direction in the field of creating functional food products. The algorithm for the development of enriched bakery products food additives has been proposed considering the importance of the problem of health saving of the Russian population of different age groups by enriching traditional bakery products with food additives, which are essential food and are in stable demand of the population, allowing for their systematic use to correct nutritional deficiencies in the diet, and therefore reduce the risk of socially significant diseases. The algorithm for the development of enriched bakery products with the use of food additives provides for the implementation of several stages, including the scientific justification of the choice of a food additive for enriching a traditional bakery product; the rationale for choosing the recipe of a traditional bakery product for its enrichment with a food additive; the scientific justification of the effective dosage of a food additive for its inclusion in the recipe of a traditional bakery product; development of the formulation and technological modes of the production processes of a bakery product enriched with a food additive; study of the consumer properties of the developed enriched bakery product and its effectiveness when consumed by the population of different age groups; assessment of the competitive potential of the developed enriched bakery product compared with traditional bakery product; development of technical documentation: technical specifications, RC and TI for the production of enriched bakery product. The implementation of the proposed algorithm will make it possible to create enriched bakery products with the use of food additives, the systematic use of which will ensure the normalization of the nutritional status of the Russian population, and therefore will contribute to health conservation.

Differentials in dietary intake of macro and micronutrients in patients with type 2 diabetes and foot ulcers: Observations from a pilot study.

The dietary profiles of patients with type 2 diabetes mellitus (T2DM) from Southern India have been infrequently studied. We aimed to study the differences in dietary intake of macro and micronutrients in elderly patients of Type 2 diabetes mellitus (T2DM), with and without foot ulcers. Elderly patients with T2DM and foot ulcers (n=79; mean age: 60.6 years) and those without foot ulcers (n=59; mean age: 55.0 years) were studied. Biochemical evaluation for measures of glycemia, lipids and albumin were done and staging of foot ulcers was done using Wagner's scale. A 24-hour dietary recall was administered to quantify the mean daily intake (MDI) of macro, micronutrients and trace elements from portion sizes of food items consumed and compared to the recommended dietary allowance (RDA) for Indians aged 55 years and above. In patients with T2DM and foot ulcers, the MDI of carbohydrates, fats and phosphorus were significantly higher whereas the MDI of proteins and micronutrients namely zinc, folic acid, iron and carotene were lower than the RDA. Elderly patients with nephropathy and longer duration of T2DM have higher odds of developing foot ulcers, when compared to patients without foot ulcers. Elderly patients with T2DM and foot ulcers were deficient in dietary intake of proteins and micronutrients inclusive of carotene, folic acid, zinc, and Iron. Clinical care, regular monitoring of dietary intake and appropriate correction of nutritional deficiencies will aid in the management of diabetic foot ulcers.

Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.

Obesity in children with acute lymphoblastic leukemia in remission: the evaluation of causes, hidden nutritional deficiency and the experience of its correction by using artificial enteral nutrition

Background. Antineoplastic treatment can have late toxic manifestations that can often appear after end of treatment. Children after treatment for acute lymphoblastic leukemia (ALL) have a risk of developing both obesity and undernutrition, which may be concealed by increased fat mass.Objective: to explore the incidence of obesity and hidden undernutrition in children with ALL and to describe the effect of enteral feeding using in these children.Materials and methods. In a retrospective study the data of 62 children with obesity that was revealed by standard examination was analyzed. The criterion of obesity was increased value of fat mass received by bioimpedance analysis. For this evaluation Russian bioimpedance analysis standards were used. Additionally, the included data were following: presence of endocrine pathology, weight change during latter 6 months before admission, physical activity and alimentary characteristics (usual regimen and structure of daily feed).Results. Only 54.8 % of patients with an actual excess of fat body mass index detected obesity (Z‑score higher than +2.00) and another 29 % body mass index was within the normal range (Z‑score from –1.00 to +1.00). This was the result of a tissue imbalance: reduce fat‑free mass. Some patients were diagnosed with insulin resistance and hyperinsulinemia. 83.7 % have a completely passive lifestyle. 49.0 % almost do not eat fruits and berries, 79.6 % – vegetables and 91.8 % – fish and seafood. Frequent intake of sweet dishes – 22.4 %, sausage products – 49.0 %, bakery products – 42.9 %, dishes from fast food restaurants – 42.9 %. 55.1 % of patients had more than 5 meals a day, while 18.4 % – less than 3. In or‑ der to correct hidden nutritional deficiencies, 22 patients received artificial nutritional formulas. They had a significant increase in fat‑free mass and a decrease in fat, in comparison with those who did not receive enteral feeding.Conclusion. Treatment‑associated factors, physical activity and alimentary causes play an important role in formation of not only obesity, but also hidden nutritional insufficiency in children with ALL after treatment. Enteral feeding using artificial polymeric formulas showed its effectiveness. An integrated and multidisciplinary approach to solving the problem is appropriate of prevention and treatment of obesity.

Natural Bioactive Compounds from Food Waste: Toxicity and Safety Concerns.

Although synthetic bioactive compounds are approved in many countries for food applications, they are becoming less and less welcome by consumers. Therefore, there has been an increasing interest in replacing these synthetic compounds by natural bioactive compounds. These natural compounds can be used as food additives to maintain the food quality, food safety and appeal, and as food supplements or nutraceuticals to correct nutritional deficiencies, maintain a suitable intake of nutrients, or to support physiological functions, respectively. Recent studies reveal that numerous food wastes, particularly fruit and vegetables byproducts, are a good source of bioactive compounds that can be extracted and reintroduced into the food chain as natural food additives or in food matrices for obtaining nutraceuticals and functional foods. This review addresses general questions concerning the use of fruit and vegetables byproducts as new sources of natural bioactive compounds that are being addressed to foods as natural additives and supplements. Those bioactive compounds must follow the legal requirements and evaluations to assess the risks for human health and their toxicity must be considered before being launched into the market. To overcome the potential health risk while increasing the biological activity, stability and biodistribution of the supplements’ technological alternatives have been studied such as encapsulation of bioactive compounds into micro or nanoparticles or nanoemulsions. This will allow enhancing the stability and release along the gastrointestinal tract in a controlled manner into the specific tissues. This review summarizes the valorization path that a bioactive compound recovered from an agro-food waste can face from the moment their potentialities are exhibited until it reaches the final consumer and the safety and toxicity challenges, they may overcome.

Перинатальные риски, гендерные особенности и возможные пути профилактики осложнений при COVID-19

В статье приведены современные данные об особенностях развития, течения и влияния на состояние здоровья беременной, роженицы, плода и новорожденного болезни, вызванной вирусом SARS-COV-2. Проанализированы некоторые из существующих на сегодня в мире протоколов профилактики инфицирования и лечения COVID-19 и предложена адаптированная для беременных модификация. Предложена методика профилактики одного из наиболее частых и опасных осложнений COVID-19 у беременных – невынашивания беременности – и коррекция нутритивных дефицитов.

Evaluating the Pharmacoeconomic Impact of Nutrient Supplementation Post-operatively on Patients Receiving Roux-Y Gastric Bypass vs. Biliopancreatic Diversion with Duodenal Switch

BackgroundWithout the needed medical support, bariatric surgery can be associated with post-operative malnutrition and associated nutrient deficiencies. We aimed to evaluate the cost difference of perioperative infusion requirements and TPN between GBP and BPD-DS.MethodsAll patients undergoing GBP or BPD-DS procedures between August 2015 and June 2018 were included. Information was collected to standardize the nutritional information into two categories: (1) oral supplementation and standard intravenous infusions, as predicted costs forming part of preoperative quote and (2) infusions prescribed for malnutrition, based on blood biochemistry, caterized as unexpected costs.ResultsA total of 573 patients over 3 years (GBP 60%, BPD-DS 40%) were included in the analysis. The average predicted costs from oral supplementation for both surgery groups and prophylactic infusions for BPD-DS were GBP (46.90USD) vs. BPD-DS (154.13 USD) (p-value = NS). Unexpected costs for infusions to correct nutritional deficiencies were GBP (199.14 USD) vs. BPD-DS (127.29 USD) (p-value = NS). TPN incidence rate was GBP (2.1%) and BPD-DS (12.7%) (p-value < 0.001) and admission rate per patient was GBP (0.9) and BPD-DS (0.63) (p-value < 0.05). Costs for acquiring TPN were GBP (153.58 USD) vs. BPD-DS (268.76 USD). Total unexpected costs were GBP (352.72 USD) vs. BPD-DS (396.05 USD) (p-value = NS).ConclusionNutrient deficiencies are known to occur within both GBP and BPD-DS surgeries, even up to 3 years. The admission rate/patient, requiring TPN, was higher in the GBP group, indicating that BPD-DS surgery can be efficient and cost-effective with holistic and multitherapeutic post-surgery care. BPD-DS procedures should be reserved for centers with a comprehensive and experienced multidisciplinary team enforcing stringent follow-up regimes.

Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated...

The link between nutrition and Alzheimer's disease: from prevention to treatment.

Alzheimer's disease (AD) is the most common cause of dementia. To date, there is no effective pharmacological strategy to slow or stop disease progression. In this context, multiple alternative therapeutic strategies have been investigated for AD. This review addresses the potential role of nutrition interventions in AD prevention and treatment. Nutritional strategies for AD have been based on four pillars: maintaining a healthy weight (i.e., prevention and/or treatment of obesity, especially in midlife and prevention of weight loss in the later stages of AD); correction of nutritional deficiencies; adequate consumption of micronutrients (vitamins and minerals), especially those implicated in the pathways of AD pathophysiology; andmicrobiota modulation.

Nutritional problems in smokers and passive smokers

Objective: active or passive tobacco use affects a high percentage of individuals and is associated with various health risks. The aim of this review was to look more closely at the nutritional problems that are specific of smokers, which may harm their health. Methods: a bibliographic search related to the topic. Results: smokers consume lower amounts of various foods, especially fruits, vegetables, cereals and dairy. As a result, their intake of vitamins, minerals, and phytochemicals is lower than that observed in non-smokers. Their consumption of meat, caffeine and alcohol is usually higher, and their activity lower than those of non-smokers, coexisting in smokers unhealthy behaviors that contribute to harming their health and quality of life. Oxidative stress and metabolic changes render the needs for some nutrients higher in smokers to achieve the same biochemical situation as in non-smokers. Recommended intakes of vitamin C have increased, but it will probably be necessary to also increase the intakes of other nutrients. In general, smokers suffer from deficiencies more frequently (vitamins C, E, β-carotene, B1, B2, B12, folic acid, calcium, magnesium, iron, iodine, etc.) than non-smokers. Passive smokers are also affected in their eating habits and nutritional status. Conclusions: the worse nutritional status of smokers can contribute to the appearance/worsening of various diseases associated with smoking (cardiovascular, cancer, cataracts, osteoporosis, etc.); therefore, nutritional surveillance and correction of nutritional deficiencies could represents health benefits for smokers and passive smokers, which should be considered in the future.

Maintaining a Balanced Diet While Gluten-Free: Treatment Options

The goal of this review is to address the different reasons individuals adopt a gluten-free diet (GFD), including, but not limited to, celiac disease (CD), gluten ataxia (GA), and dermatitis herpetiformis (DH) and non-celiac gluten sensitivity (NCGS). The perceived health benefits and confusion surrounding gluten and gluten-free (GF) options will be addressed. The benefits and challenges of the diet will be discussed. There will be a specific emphasis on how to avoid and correct potential nutritional deficiencies which are commonly seen in patients on a GFD. Several studies have addressed challenges with the GFD including availability, nutrient quality of GF foods, and cost. Data has shown that nutritional deficiencies are common in patients following a GFD. More patients are starting the GFD for symptoms and conditions. It is important to be aware of the nutritional inadequacies of the diet. Counseling by a registered dietitian for individuals following a GFD with or without a gluten-related diagnosis is essential to achieve best outcomes.

Indications for transfusion of blood components

Indications for transfusion of blood components